Relationship between forward head posture with neck pain and disability

Background Poor posture is traditionally associated with various musculoskeletal disorders. Consequently, educators in the musculoskeletal field have been teaching postural observation as part of the physical assessment. Forward head posture (FHP) is hypothesized to be associated with neck pain; however, evidence in this topic remains inconclusive. Purpose To investigate the association between FHP and neck pain intensity, disability, and cervical kinematics in individuals with neck pain compared to asymptomatic individuals. A secondary aim of this study was to explore the possible effect of a head-mounted display (HMD) used in a virtual reality (VR) assessment on FHP. Methods The study was conducted with 43 volunteers (20 asymptomatic individuals, 23 individuals with neck pain) aged 19 to 62. FHP was assessed by measuring craniovertebral angle on profile photographs. Secondary outcome measures included pain intensity, the neck disability index (NDI) questionnaire, and neck kinematics using specialized VR software. Results There were no significant differences between individuals with neck pain and asymptomatic individuals in FHP (craniovertebral angle = 48.24°±7.29; 48.90°±5.89, respectively, p > .05). The neck pain group demonstrated a restricted range of motion and slower neck movements (p < .05). We found no significant correlation between FHP and visual analog scale, NDI, and most neck kinematic measures. Conclusions Our findings cannot support a clinically applicable association between FHP and neck pain. Additionally, individuals with neck pain had a lower range of motion and slower neck movements.

BackgroundNeck pain is a common musculoskeletal disorder, often linked to forward head posture (FHP). Studies have shown that exercise interventions can improve pain, craniovertebral angle (CVA), range of motion, and function in individuals with FHP. While telerehabilitation exercise has proven effective for other musculoskeletal conditions, its effectiveness in addressing neck pain and FHP is still being investigated.ObjectiveThis study aimed to evaluate and compare the effectiveness of an internet-based telerehabilitation therapeutic exercise program with an in-person supervised program in improving clinical outcomes among young adult females with chronic nonspecific neck pain and FHP. The study hypothesized that there would be no significant differences in outcomes between the 2 groups.MethodsA randomized controlled trial was conducted with 50 participants experiencing chronic neck pain and FHP, recruited through public announcement and voluntary sign-up. Participants were randomly assigned to either a telerehabilitation group or an in-person supervision group. Both groups completed the same 6-week, physiotherapist-supervised therapeutic exercise program, delivered via Zoom (Zoom Video Communications) or in the physiotherapy department laboratory, respectively. Outcome assessments were conducted face-to-face by blinded assessors at baseline, after 4 and 6 weeks of intervention, and at a 2-week follow-up. Outcome measures included pain intensity (assessed using the Visual Analog Scale [VAS]), CVA, neck disability (assessed using the Neck Disability Index [NDI]), and cervical range of motion (CROM). Adherence was monitored using attendance logs.ResultsOf the 50 participants, 48 completed the intervention with 1 dropout from each group. Adherence among completers was 100 percent in both groups. All 50 participants were included in the analysis using the intention-to-treat principle. No differences in effectiveness were found between the telerehabilitation and in-person groups, as no significant interaction effect between group and time was observed across all outcome measures including VAS, CVA, NDI, and CROM (P values ranged .07-.61). However, improvements were observed in all outcomes across time, including a 2.2‐ to 4.1-cm reduction in VAS, 5°-8.8° increase in CVA, 3.3‐ to 7.1-point reduction in NDI (P<.001 for all), and 3.5°-22.7° increase in CROM (P<.001 to P=.04).ConclusionsBoth telerehabilitation and in-person supervision were similarly effective in improving pain, posture, neck disability, and CROM in young adult females with chronic neck pain and FHP. These findings suggest that telerehabilitation may be a feasible and accessible alternative to conventional in-person therapeutic exercise programs for managing chronic neck pain with FHP.

BackgroundNeck pain is a common condition across various populations, with a substantial impact on daily life and quality of life. Forward head posture is frequently observed in individuals with neck pain and is closely associated with lifestyle factors. This study aimed to examine the relationship between lifestyle factors and forward head posture in young adults with neck pain and determine the optimal cutoff value for assessing the risk of forward head posture.MethodsIn total, 200 men and women aged 35–44 years with persistent or recurrent neck pain with a numeric rating scale score of ≥ 3 in the previous week were included in the study. The participants’ sex, age, medical history, anthropometric parameters, posture- and activity-related lifestyle, pain, radiographs, and the craniovertebral angle were obtained. The associations between lifestyle factors and forward head posture were analyzed using logistic regression. The cutoff values for risk prediction were analyzed using receiver operating characteristic curves. The impact of lifestyle factors on changes in craniovertebral angle at the 6-month follow-up was analyzed using multiple linear regression and analysis of covariance.ResultsAfter adjusting for covariates, there were significant differences in lying time (odds ratio = 3.342, 95% confidence interval = 1.607–6.952) and physical activity level index (odds ratio = 0.404, 95% confidence interval = 0.210–0.775) between the forward and non-forward head posture groups. The cutoff values for detecting forward head posture were 6.50 h of lying time and a physical activity level score of 2.88. At the 6-month follow-up, the craniovertebral angle was closer to the diagnosis of forward head posture, with increasing lying time and lower physical activity level score; however, the association was not statistically significant.ConclusionsThe findings indicate that lying time and physical activity level scores are important lifestyle-related predictors of forward head posture. Thus, lying time and physical activity level should be addressed to predict and prevent forward head posture.

The study aimed to determine the effect of the proprioceptive neuromuscular facilitation (PNF) cervical stabilization exercise on pain, cranio vertebral angle (CVA), and neck disability index (NDI) in chronic neck pain patients with forward head posture. Following baseline measurements, 26 subjects (n=26) with chronic neck pain were randomized into two groups: the experimental group (n=13), which received PNF cervical stabilization exercise, and the control group (n=13), which received traditional physical therapy. Each group participated in the intervention for three times per week, for six weeks. The visual analogue scales (VAS) for pain, CVA, and NDI Korean version (KNDI) of both groups were recorded at both pre- and post-intervention. Paired t-tests were used to determine significant changes in the post-intervention period compared with pre-intervention, and independent t-tests were used to analyze differences in the dependent variables between the two groups. After the six-week intervention, both groups experienced significantly decreased VAS and KNDI (p<.05) and significantly increased CVA (p<.05). The experimental group that received the PNF cervical stabilization exercise showed greater improvements in pain, CVA, and KNDI than those of the control group (p<.05). These results suggest that the PNF cervical stabilization exercise reduces neck pain and functional disability and enhances CVA in chronic neck pain patients with forward head posture.

Background: Forward head posture (FHP) is a common postural deviation associated with neck pain, functional disability, and musculoskeletal imbalances. ELDOA and upper thoracic mobilization are therapeutic interventions aimed at correcting FHP and improving associated symptoms.Objective: To compare the effectiveness of Elongation Longitudinaux Avec Decoaptation Osteo Articulaire (ELDOA) versus upper thoracic mobilization and mobility exercises (UTMME) in treating forward head posture.Methods: A randomized clinical trial was conducted involving 36 participants with FHP, aged 20-40 years, divided into two groups (n=18 each). Group A received ELDOA, and Group B received UTMME, both for three sessions per week over four weeks. Outcomes measured included Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Craniovertebral Angle (CVA), and cervical range of motion (ROMs). Data were analyzed using the Friedman and Mann-Whitney U tests.Results: Both groups showed significant improvements; however, ELDOA demonstrated greater reductions in NPRS (4.00 vs. 5.00), NDI (9.00 vs. 12.50), and greater improvements in CVA (54.22 vs. 50.05) at week 4 (p&lt;0.05).Conclusion: ELDOA was more effective than UTMME in reducing pain, disability, and improving postural alignment in patients with FHP.

Assessment of forward head posture in individuals with and without chronic neck pain: A cross-sectional study.

Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: complications of cervical spine surgery: 157. Risk factors associated with failure to reach minimum clinically important difference in patient-reported outcomes after anterior cervical discectomy and fusion

BackgroundForward head posture (FHP) is a common disorder worsened by prolonged use of electronic devices, causing increased neck load and musculoskeletal issues. While McKenzie neck exercises (MNE) are widely used to address FHP, the potential benefits of hip extensor exercises (HEE) remain underexplored.ObjectiveThis study aims to compare the effects of MNE and HEE on neck disability index (NDI), craniovertebral angle (CVA), cranial rotation angle (CRA), and the thickness of the LC muscle and carotid artery (CA) in individuals with FHP.MethodsTwenty participants with FHP were randomly assigned to either the MNE or HEE group, undergoing their respective exercises for 20 min per session, three times a week for two weeks. Pre- and post-intervention assessments included NDI questionnaire, CVA, CRA measurements, and ultrasonographic evaluation of LC muscle and CA thickness.ResultsBoth MNE and HEE groups showed significant improvements in NDI, CVA, CRA, and LC muscle thickness post-intervention (P < 0.05), with no significant group differences (P > 0.05). CA thickness increased in both groups, though not significantly.ConclusionsBoth MNE and HEE effectively improved symptoms and alignment associated with forward head posture. These findings suggest that hip extensor exercises may be a beneficial approach to mitigating FHP, similar to MNE.

This study aims to investigate the relationship between forward head posture (FHP) and respiratory dysfunctions in patients with chronic neck pain. Between June 2014 and November 2016 , a total of 99 patients (11 males, 88 females; mean age 54.1±9 years; range, 38 to 75 years) with chronic neck pain were evaluated for head posture by cervical lateral radiograph measuring the anterior head translation distance (FHPmm) and C7 vertebrae position (C7°). We examined the chest expansion by subtracting chest circumference from the level of xiphoid during maximal inspiration and expiration. Pain severity and neck disability were assessed using the Visual Analog Scale (VAS) and modified Neck Disability Index (MNDI), respectively. The respiratory functions were evaluated using spirometry tests, lung volumes, and maximal inspiratory and expiratory pressures (Pimax and Pemax, respectively). There was a negative correlation between the FHPmm with Pemax% (rho: -0.314; p=0.005). A negative correlation was also observed between C7° and Pemax, Pemax%, forced expiratory volume in one sec (FEV1)/forced vital capacity (FVC)%, forced expiratory flow (FEF)25-75%, and FEF75% (rho:-0.245, -0.349, -0.218, -0.214, and -0.259 respectively; p=0.028, 0.002, 0.035, 0.040, and 0.012, respectively). There was a positive correlation between neck disability and VAS scores (rho: 0.424; p<0.001), while there was a negative correlation between neck disability and chest expansion, maximum voluntary ventilation (rho: -0.201 and -0.217, respectively; p=0.049 and 0.046, respectively). Based on our study results, FHP is associated with expiratory muscle weakness in chronic neck pain patients. To evaluate respiratory dysfunction, chest expansion tests may be useful, although these tests are not specific to muscle weakness. Interventions about FHP and neck pain should focus on the effects of respiratory muscle training.

Introduction: Forward head posture is the most common misalignment of the neck. It can lead to headaches, unusual neck pain, and stiffness in muscles. Posture corrective exercises were used to correct this misalignment hence improving the quality of life of the patient. Aim: To identify the effect of postural corrective exercises in forward head posture. Materials and Methods: The articles included were randomised controlled trials and systematic reviews. The databases included were Google Scholar and PubMed. The systematic reviews were taken from 2015-2023. Researchers have used the English language. The studies included were about posture corrective exercises that were used to correct forward head posture. Data were extracted from the proportion of clients in various systematic reviews and randomised controlled trials. Results: Several studies show that postural corrective exercises were effective in correcting forward head posture and improving the craniovertebral angle. These exercises help to improve posture, muscle strength and fl exibility. Conclusion: Forward head posture can be due to poor sitting posture, low height sitting or long hours of use of a laptop. Posture corrective exercises were benefi cial for improving forward head posture and decreasing the craniovertebral angle, which decreases neck pain and enhances the quality of life of patients.Keywords: Forward head posture, exercises, posture, cranio vertebral angle (CVA).

The correlation between pain and flexor and extensor muscles endurance and size with craniovertebral angle changes during prolong sitting task.

BackgroundForward head posture (FHP) is a common postural deviation that has been linked to neck pain and dysfunction. The impact of FHP on neck muscle endurance and thickness in individuals with chronic neck pain remains unclear. This study aimed to compare neck muscle endurance and thickness between women with chronic neck pain and FHP versus those with chronic neck pain but normal head/neck posture.MethodsForty women with chronic non-specific neck pain were divided into two groups based on craniovertebral angle assessment, 20 with FHP and 20 with normal posture in each group. Neck pain, disability, neck flexor and extensor muscle endurance, and neck muscle normalized thickness (sternocleidomastoid, upper trapezius (Utrap), longus coli and total neck extensors) measured via ultrasound were compared between the groups.ResultsWomen with FHP demonstrated significantly lower endurance of the extensor muscles, normalized thickness of the Utrap muscle, and significantly higher Neck Pain and Disability Scale (NPDS) and Neck Disability Index (NDI) scores compared to the Non-FHP group (p < 0.05). Craniovertebral angle (CVA) was positively correlated with extensor muscle endurance (p = 0.002, r = 0.481).ConclusionsOur findings indicate that the endurance of neck extensor muscles decreases, and neck pain and disability increase in women with chronic neck pain and FHP. This emphasizes the importance of addressing FHP in patients with chronic neck pain and considering the improvement of neck extensor muscle endurance as part of their treatment. These findings may also serve as indicators of the severity of neck pain and assist in patient monitoring.

Background: Forward head posture is considered a deviation because the position of the head varies from that reference line. Frequent use of computers and mobile phones promote rounded shoulders and humped upper back and therefore resulting in forward head posture and neck pain. Objective: To assess the association between forward head posture and neck pain in office workers. Methods: This is a cross-sectional study in which about 88 office workers with age between 20 to 50 years, having neck pain and those who were actively working in their offices in front of personal computers and laptops were included in this study. Participants who has any neurological conditions and those who had neck pain or faulty posture due to any recent accident, trauma or injury were excluded from this study. A mixture of standardized and self-modified structured questionnaires was given to office workers with neck pain. They were inquired about the intensity of their neck pain, and their work concentration levels and were assessed whether they adopted a forward head posture to do their daily visual tasks at work. The posture was evaluated using the postural assessment checklist form and REEDCO postural assessment form. For qualitative variables percentages and frequency were calculated whereas for descriptive analysis, means and standard deviations were calculated for quantitative variables. Results: Out of 88 office workers with neck pain 46(52.27%) office workers had a severely forward head posture, 35(39.77%) had a moderately forward head posture and only 7 (7.95%) had a normal forward head posture. The results of this study suggest that neck pain might be a cause and risk factor of abnormal forward head posture among office workers or faulty forward head posture might be a cause or risk factor for the pain in the neck. Conclusion: It concludes that neck pain among office workers and forward head posture is associated with each other. Neck pain among office workers might be a cause and risk factor of forward head posture in office workers or adopting forward head posture might be a risk factor leading to neck pain.

ABSTRACTBackground and AimsUsing ultrasonography to systematically review all published studies that investigated the association between craniovertebral angle (CVA) and neck muscle size.MethodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Searches were performed in PubMed, Science Direct, OVID, MEDLINE, and Google Scholar databases from January 2000 to October 2024. The keywords used were: “Forward head posture,” “Cranial vertebral angle,” “size,” “thickness,” “weakness,” “enlargement,” “hypertrophy,” “ultrasonography*,” “Diagnostic ultrasound,” “ultrasonic imaging,” “imaging,” “medical sonography,” and “ultrasonic diagnostic”.ResultsOf the 329 articles retrieved from the databases, 10 studies fulfilled the inclusion criteria. Four studies investigated the size of neck flexor muscles, four articles investigated the size of neck extensor muscles, and two articles focused on the size of both neck flexor and extensor muscles. Six studies compared participants with and without forward head posture (FHP). Two studies were conducted among asymptomatic subjects, while the other two studies were conducted among participants with and without neck pain. Consistent evidence supported that a significant correlation between the CVA and the thickness of deep neck flexor muscles (n = 1), a significant correlation between FHP and the thickness of the splenius capitis muscle (n = 1), an increase in sternocleidomastoid (SCM) muscle thickness (n = 2) and a decrease in semispinalis capitis (SSC) muscle thickness (n = 1) in subjects with FHP compared to those without, and a decrease in semispinalis capitis muscle thickness in individuals with FHP accompanied by neck pain compared to those with FHP without neck pain (n = 1).ConclusionThe reviewed studies demonstrated that changes in the CVA are associated with alterations in neck muscle size, particularly affecting the SCM and SSC muscles. Additional research is necessary to investigate the functional implications of alterations in muscle characteristics.

The aim of this study was to conduct the cross-cultural adaptation of Neck Disability Index (NDI) and investigate the validity and reliability of Turkish version in patients with neck pain. The NDI is a reliable evaluation instrument for disability but there are no published Turkish version. Eighty-eight patients with neck pain for at least 3 months were included in the study. NDI, The Neck Pain and Disability Scale and Visual Analogue Scale (VAS) were completed by all subjects. Test-retest reliability was determined by using intraclass correlation coefficient and Pearson's correlation analysis. For the determination of concurrent validity, the relation between NDI and VAS was examined by Pearson's correlation analysis and for the determination of construct validity, the relation between NDI and Neck Pain and Disability Scale was investigated. Intraclass correlation coefficient score for test-retest reliability was 0.979 (95%, confidence interval = 0.968-0.986). For concurrent validity, the relation between NDI and VAS was investigated, the r value for test and retest was 0.508 and 0.620, respectively (P < 0.0001). For construct validity, the relation between NDI and the Turkish version of NPDA was investigated, the r value for test and retest was 0.659 (P < 0.0001) and 0.728 (P < 0.0001), respectively. The Turkish version of NDI was found to be a valid and reliable method of measurement for evaluating disability, caused by problems of the neck region as it is easy to comprehend by the patients and the time needed to apply is short in clinics.