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The Relationship Between Forward Head Posture and Neck Pain: A Systematic Review & Meta-Analysis

See related article: https://pubmed.ncbi.nlm.nih.gov/31773477
By: Nesreen Fawzy MahmoudKarima A HassanSalwa F AbdelmajeedIbraheem M MoustafaAnabela G Silva

Current Reviews in Musculoskeletal Medicine – December 2019; Vol. 12; No. 4; pp. 562-577


The purpose of this study was to determine if forward head posture (FHP) is associated with neck pain. It is a systematic review and meta-analysis that used 15 cross-sectional studies that included 2,339 subjects.

This is the first systematic review estimating the relationship between neck pain measures and FHP.

The craniovertebral angle is the measured angle between the horizon and a line from the tragus of the ear to the spinous process of C7. A decrease in this angle indicates a greater FHP, and it is considered an accurate measure to discriminate FHP severity. “The craniovertegral angle was a significant predictor for lifetime prevalence and doctor visits due to neck pain.”

Neck alignment diagram

KEY POINTS FROM THIS ARTICLE

1) Forward head posture (FHP) is the most common cervical postural fault in the sagittal plane and is found with “different severity levels in almost all populations.”

2) “Neck pain is a common complaint in the population, with a considerable impact on individuals and their families, communities, health~care systems, and businesses.”

  • The estimated 1~year incidence of neck pain is 10.4% to 21.3%.
  • The overall prevalence of neck pain in the population can be as high as 86.8%.

3) Neck pain “is considered the most persistent musculoskeletal pain syndrome.”

4) The increase in time spent texting messages on mobile phones or using computers “might have a long-term impact on neck pain, potentially due to prolonged periods of neck flexion.”

  • Neck flexion facilitates forward head posture (FHP). “This is the most common cervical postural fault in the sagittal plane that is found with different severity levels in almost all populations.”
  • “Greater FHP has been associated with greater deficits in cervical range of motion.”

5) “Maintaining a high flexion angle of the neck during work leads to an increase in the weight of the head which puts extra load on the spine and leads to changes in ligaments, tendons, and muscles which may progressively cause permanent changes of posture in the form of FHP.”

  • “There appears to be long-term effects in terms of decreased neck muscle flexibility and endurance in adolescents predisposing to neck pain in adults.”

6) “There was a statistically significant difference in FHP between adults with neck pain and asymptomatic adults; i.e., adults with neck pain showed a greater FHP than asymptomatic adults.”

7) “The results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults.”

8) “Neck pain was significantly associated with holding the neck in a forward bent posture for a prolonged time.”

9) “The results showed that adults with neck pain have significantly more FHP than asymptomatic adults.”

10) “A significant correlation between FHP and neck pain intensity/disability in adults and older adults was also found.”

  • “The meta-analysis showed adults with neck pain to have increased FHP.”

11) “Adults with neck pain have significantly decreased ROM for all cervical movements when compared with asymptomatic participants.”

12) Despite the high prevalence of neck pain in adolescents, “our data suggested that most of neck pain measures in adolescent are not associated with static posture.”

13) “In adults and older adults, we found a significant correlation between FHP and neck pain intensity as well as disability, indicating that increased neck pain is associated with increased FHP.”

  • “Age affects the strength of the correlation between FHP and neck pain.”
  • “FHP is significantly correlated with neck pain measures in adults and older adults.”

 

 

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