Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability

The effect of indirect vision skills on head and shoulder posture amongst Korean dental hygienists

OBJECTIVES

This study aimed to investigate the effects of indirect vision skills on head and shoulder posture in dental hygienists.

MATERIALS AND METHODS

This cross-sectional study included a total of 100 female clinical dental hygienists. It evaluated musculoskeletal symptoms of the neck, shoulders and back, head and shoulder posture (craniovertebral angle [CVA] and sagittal shoulder posture angle [SSPA]). Indirect vision skills were assessed using the O'Connor tweezer test under indirect vision with a mirror. To analyse factors associated with the CVA and SSPA, an independent t test, one-way ANOVA, and multiple linear regression analysis were conducted, respectively.

RESULTS

The body region in which the greatest number of symptoms of work-related musculoskeletal disorders was recognised was the neck (89.0%). In the multiple linear regression model, which adjusted for other factors associated with musculoskeletal disorders, dental hygienists with poor indirect vision skills showed relatively small SSPA value (P < .05). However, indirect vision skills were not associated with the CVA value.

CONCLUSIONS

Good indirect vision skills contribute to the prevention of rounded shoulders in dental hygienists. Therefore, where possible, dental hygienists should perform clinical procedures using indirect vision with a dental mirror to maintain a balanced posture and reduce flexion of the back or the neck. A dental hygiene curriculum should include training to improve clinical skills, as well as education regarding dental ergonomics and a monitoring system to determine whether ergonomic principles are well observed.

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

PURPOSE OF REVIEW

Forward head posture (FHP) is the most common cervical postural fault in the sagittal plane that is found with different severity levels in almost all populations. Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.

RECENT FINDINGS

A total of 15 cross-sectional studies were eligible for inclusion for this systematic review and meta-analysis. Ten studies compared FHP between a group of asymptomatic participants and a group of participants with neck pain and an overall mean difference (MD) of 4.84 (95% CI = 0.14, 9.54), indicating a significant between-group difference, contrary to adolescent (MD = - 1.05; 95% CI = - 4.23, 2.12). Eight studies showed significant negative correlations between FHP and neck pain intensity (r = - 0.55; 95% CI = - 0.69, - 0.36) as well as disability (r = - 0.42; 95% CI = - 0.54, - 0.28) in adults and older adults, while in adolescents, only lifetime prevalence and doctor visits due to neck pain were significant predictors for FHP. This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, 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. No association was found between FHP and most of neck pain measures in adolescents.

Sex and Height Influence Neck Posture When Using Electronic Handheld Devices

With increased tablet ownership in the United States comes increased levels of neck flexion compared to desktop or laptop computer use, and these neck postures have been linked to increases in neck pain. Importantly, tablet viewing postures can be achieved in multiple ways and could be determined by the morphology of the individual and/or other extraneous factors. In this study, we aim to preliminarily evaluate how neck postures vary during tablet use among individuals and link this variation to other factors such as sex, height, weight, presence/absence of temporomandibular joint disorder (TMD), and morphology of the head and neck. We analyzed two-dimensional landmarks placed on lateral-view radiographs of 22 participants (10 female and 12 male) seated in neutral, upright, fully flexed, semi-reclined, and reclined postures. We utilize geometric morphometric techniques, which are advantageous for evaluating shape variation and have not been extensively applied to biomechanical analyses. We found skeletal morphology to be significantly related to sex and height in all but the neutral posture (P < 0.05), and weight was marginally significantly related to shape in the semi-reclined posture (P = 0.047). Morphologically, male participants exhibited more flexion at the articulatio atlantooccipitalis than females, and females showed greater mandibular protrusion than males, although this result is likely related to height. No relationship was found between posture and TMD. This research establishes a framework for future work that uses geometric morphometric analyses to evaluate how neck postures vary in relation to TMD. Clin. Anat. 32:1061-1071, 2019. © 2019 Wiley Periodicals, Inc.

Thoracic Posture and Mobility in Mechanical Neck Pain Population: A Review of the Literature

Neck pain is a common condition with several proposed biomechanical contributing factors. Thoracic spine dysfunction is hypothesized as one of the predisposing factors, which necessitates the need to explore the contribution of thoracic posture and mobility toward neck pain. Accordingly, the present work aimed to review the existing literature investigating the presence of thoracic spine dysfunction in individuals with neck pain. A literature search was conducted in the three electronic databases of PubMed, CINAHL, and Web of Science. Studies published between 1990 and 2017 were considered. After reviewing the abstracts, two authors independently scrutinized the full-text documents for their relevance. The initial search yielded 2,167 articles, of which nine studies involving comparisons of neck pain patients and healthy controls were identified for the review. Increased thoracic kyphosis was positively correlated with the presence of forward head posture but not uniformly associated with neck pain intensity and disability. Thoracic mobility was reduced in the neck pain population, and the role of thoracic kyphosis as a risk factor for pain development could not be confirmed. Thus, an association exists between thoracic kyphosis and postural alteration in the cervical spine. The review favors the inclusion of thoracic spine assessment and treatment in mechanical neck pain patients. Further studies are needed to investigate the cause-effect relationship between thoracic posture and cervical dysfunction.

Influence of Forward Head Posture on Myotonometric Measurements of Superficial Neck Muscle Tone, Elasticity, and Stiffness in Asymptomatic Individuals With Sedentary Jobs

OBJECTIVE

The objective of the study was to assess the influence of forward head posture on the mechanical parameters and pressure pain threshold of superficial neck muscles in clinically nonsymptomatic individuals with sedentary jobs.

METHODS

Twenty-five office workers with forward head posture and 25 office workers with normal head posture were matched for sex, age, body mass index, and the nature and duration of their work and were compared at a single point. The study participants were divided into study groups on the basis of photometric craniovertebral angle measurements. The upper trapezius, sternocleidomastoid, and splenius capitis mechanical properties were assessed in the sitting position. Primary outcome measures were muscle stiffness (N/m), muscle tone (Hz), and muscle elasticity. The secondary variable was perceived pain threshold.

RESULTS

No significant differences between the groups were found for biomechanical properties and perceived pain threshold in the studied muscles.

CONCLUSION

Forward head posture has no impact on muscle stiffness, tone, and elasticity, nor does it increase the pressure sensitivity of superficial neck muscles in healthy, mildly symptomatic office workers. It is most likely that not incorrect posture of the cervical spine, but probably other factors combined with forward head posture, like comorbid acute and chronic cervical pain and musculoskeletal disorders or prolonged sitting, contribute to changes in active myofascial tone and tensegrity as well as increased pressure sensitivity of neck muscles.

Addition of a new three-dimensional adjustable cervical thoracic orthosis to a multi-modal program in the treatment of nonspecific neck pain: study protocol for a randomised pilot trial

BACKGROUND

Nonspecific neck pain (NSNP) is one of the most common musculoskeletal problems treated by orthopaedic physicians and physiotherapists. Posture has emerged as one of the major risk factors associated with NSNP, but most previous studies ignored correct posturing as an effective treatment. Therefore, one of the major challenges faced by clinicians is how to incorporate 3D posture findings into the treatment plane. The present study will evaluate the feasibility of conducting a larger randomized trial. This pilot study is designed to investigate the hypothesis that a multimodal programme supplemented with the addition of a 3D adjustable cervico thoracic posture corrective orthotic (CTPCO) will yield short- and long-term improvement on NSNP management outcomes.

METHODS/DESIGN

This pilot, single-blind, randomized controlled trial will divide 24 patients into two groups (study and control) using block randomization. Both groups will receive conventional treatment consisting of a moist hot pack, soft tissue mobilization, manual therapy and therapeutic exercise. The study group will undergo ambulatory mirror-image functional re-training wearing a 3D adjustable CTPCO. The primary outcome is feasibility, including recruitment (e.g., time to complete enrolment, recruitment rate), patient retention and adherence to treatment allocation (e.g., session attendance, home practice, use of non-study treatments). The secondary outcomes used to assess the effectiveness of the treatment will include neck pain (measures using the visual analogue scale (VAS)) and neck disability (measures using the neck disability index (NDI)), among other outcome measures, compared between the experimental and control groups. Three-dimensional posture parameters of head measurements will be provided by a Global Posture System (GPS). The outcome measures for determining the treatment effect will be assessed at three intervals: pre-treatment, after 10 weeks of intervention and after 3 months at follow-up.

DISCUSSION

This randomized controlled pilot trial will inform the design of a future full-scale trial. The outcomes will provide some resources for the incorporation of ambulatory mirror-image functional re-training intervention compared to a control group intervention for neck pain, disability and 3D posture parameters.

TRIAL REGISTRATION

Prospectively registered at ClinicalTrials.gov, NCT03331120 . Registered on 22 October 2017.

Changes in the Sagittal Cranio-Cervical Posture Following a 12-Week Intervention Using a Simple Spinal Traction Device

STUDY DESIGN

Non-controlled clinical trial.

OBJECTIVE

To assess the efficacy of a simple home spinal traction device on sagittal cranio-cervical posture and related symptoms.

SUMMARY OF BACKGROUND DATA

Forward head protraction (FHP) and cranio-cervical malalignment were shown to be consequential in the development adverse musculoskeletal radiographic findings and symptoms in that region.

METHODS

Participants (n = 13, 18-36-year-old) were drawn from a mildly symptomatic population, all presented with cranio-cervical malalignment and considerable FHP. Participants used a simple home spinal traction device for 12 weeks, 10 min/d. Sagittal cervical radiographs and the SF36 health survey were obtained pre/post intervention and guideline compliance was recorded. Radiographic evaluation included typical measurements of sagittal cranio-cervical alignment and FHP (e.g., atlas plane line, vertical axis line, sagittal cranial angle, absolute rotation angle). Standard paired samples t tests, chi-squared, and effect size analyses were used to assess pre- and post-intervention changes.

RESULTS

Each of the key radiographic variables recorded significant moderate to very large positive changes as a result of the intervention. Similarly, Chi-squared analyses indicated that saggital cervical spine configuration tended to become more lordotic (P = 0.007), with four participants shifting from a kyphotic to a lordotic presentation. SF36 health survey data demonstrated mostly significant positive changes throughout all tested domains, and moderate positive changes were recorded across all radiographic cranio-cervical mesured paramenters (e.g., decreased FHP, increased cervical lordosis, and cranial extention). Participants indicated high level of protocol compliance.

CONCLUSION

This study has demonstrated that the unsupervised daily use of a simple home spinal traction device (Thoracic Pillow) proved effective in bringing positive plastic changes to the sagittal cranio-cervical alignment and reduction in symptoms in the tested population during a short intervention period.

LEVEL OF EVIDENCE

3.

A systematic review with meta-analysis on functional changes associated with neck pain in adolescents

BACKGROUND

Neck pain (NP) is highly prevalent in young people, but there has been no systematic review synthetizing the functional changes associated with this in adolescents. The aim of the present study was to identify and assess critically the evidence on the functional changes associated with NP in adolescents, specifically for: (a) posture; (b) postural control; (c) range of motion; (d) proprioception; (e) muscle function; and (f) sensory threshold.

METHODS

We searched PubMed, ScienceDirect, Web of Science, PEdro, Scielo, Scopus and Academic Search Premier databases for relevant studies. Two reviewers screened studies for inclusion and assessed the quality of the included studies. One reviewer extracted relevant data from the included studies. A meta-analysis was performed for studies that measured forward head posture (FHP).

RESULTS

Ten studies were included and a total of 15 comparisons for different variables were made. When compared with adolescents without NP, those with NP showed no differences in cervicothoracic posture or FHP. However, statistically significant differences were found for range of motion: weighted mean difference (WMD) from -14.0° (-21.1° to -1.1°) to 9.4° (2.8° to 16.0°); flexor muscle endurance: WMD -11.4 (-21.8 to -0.9) s; extensor muscle endurance: WMD -42.0 (-77.8 to -6.3) s; joint repositioning error for right and left rotation: WMD 1.9° (0.8° to 2.9°) and 2.4° (1.3° to 3.5°), respectively; and pressure pain threshold: WMD from -15.6 (-18.5 to -12.8) to -9.3 (-11.3 to 7.2) N/ cm².

CONCLUSION

There is very limited to limited evidence that there is no difference in posture between adolescents with and without NP, and that there is a difference for range of motion, muscle function, proprioception and pressure pain threshold.

Posture, muscle endurance and ROM in individuals with and without neck pain

Abstract Introduction: Factors such as postural changes, reduced neck muscle endurance and reduced range of motion (ROM) are common characteristics attributed to people with neck pain. Objective: (a) Identify differences in postural, muscular endurance and ROM characteristics between individuals with and without neck pain and (b) relate the presence and intensity of neck pain with the characteristics of static posture, muscular endurance and cervical ROM. Method: A cross-sectional study with 60 subjects equally divided into two groups with respect to the presence of neck pain carrying out the following evaluations: (1) static postural evaluation by digital photogrammetry; (2) the neck flexor endurance test; and (3) evaluation of cervical ROM using a fleximeter. The data were analyzed with independent t-tests, the Mann-Whitney U test, and the Spearman and Tau of Kendall correlation tests (α < 0.05). Results: There were no statistical differences between individuals with and without neck pain regarding the postural, muscle endurance and cervical ROM characteristics. No statistically significant correlations were found between pain and posture, muscle endurance and cervical ROM. Conclusion: Individuals with neck pain do not appear to present differences in their postural, neck flexor muscle endurance or cervical ROM characteristics when compared to individuals without neck pain, and neck pain appears to be unrelated to these variables.

Analysis of Head Posture and Activation of the Cervical Neck Extensors During a Low-Load Task in Women With Chronic Migraine and Healthy Participants

OBJECTIVE

The purpose of this study was to investigate the correlation between head and neck posture and superficial neck flexor and extensor activity during performance of the craniocervical flexion test (CCFT) in women with migraine and healthy controls.

METHODS

Fifty-two women with episodic migraine, 16 with chronic migraine, and 23 healthy controls participated. Head and neck posture were determined by assessing the craniovertebral (CV) angle and cervical lordosis angle. Surface electromyography signals were recorded bilaterally from sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles as participants performed the CCFT. Differences in electromyogram activity and posture among groups were compared with analyses of variance. Correlations between posture and electromyogram activity were analyzed with the Pearson correlation coefficient.

RESULTS

Both migraine groups had a significant increase in splenius capitis muscle activity, when acting as an antagonist, at the last stage of CCFT (F = 4.687; P = .012) compared with controls. No differences among groups were observed for head and neck posture. No significant correlation was found in the episodic migraine group. Moderate correlations between the CV angle and upper trapezius activity at the majority stages of the CCFT (-0.61 < r < -0.65, all P < .05) were observed within the chronic migraine group: the more extended the head posture, the higher the activity of the upper trapezius muscle. The CV angle also was correlated with upper trapezius muscle activity at the first stage of the CCFT and with splenius capitis muscle activity at the last stages (-0.42 < r < -0.52; P < .05).

CONCLUSION

An extended (forward) head posture was moderately correlated with an increased in electrical activity of superficial neck extensor muscles, particularly the upper trapezius, when acting as an antagonist, during the performance of the CCFT in women with chronic but not episodic migraine.

Physical risk factors for adolescent neck and mid back pain: a systematic review

Background

Besides low back pain (LBP), also neck pain (NP) and mid back pain (MBP) are common health issues in adolescence. Psychological factors are regarded as main risk factors for spinal pain in adolescence, but recent studies suggest that the importance of physical factors might be underestimated. The purpose of this study was to summarize the results of studies on physical risk factors for adolescent NP and MBP.

Methods

Cross-sectional and prospective English studies on NP and MBP in adolescents aged 10 to 18 were searched by a professional librarian in Medline (OvidSP), Premedline (PubMed), EMBASE, Cochrane, CINAHL, PEDro and PsycINFO up to October 2016. Studies that were restricted to self-report via questionnaires were excluded.

Results

Eight cross-sectional studies could be included in this review. Some aspects of sagittal alignment in sitting (increased lumbar lordosis) and standing (anteroposition of the head, sway-back posture) were associated with NP. Study comparability was impeded by inconsistent definitions of NP and MBP and a wide variety of outcome measures.

Conclusions

This systematic review indicates that prospective studies using a consistent definition of NP and MBP are needed. Such studies might further investigate sagittal alignment in sitting and standing as possible risk factors for NP and MBP in adolescence using a consistent terminology for the outcomes and longitudinal research designs.

Electronic supplementary material

The online version of this article (10.1186/s12998-018-0206-y) contains supplementary material, which is available to authorized users.

Review of scapular movement disorders among office workers having ergonomic risk

BACKGROUND

Work-related musculoskeletal disorders are the most common health problems which affect millions of office workers.

OBJECTIVE

The objective of this study is to determine scapular positioning at rest and different anatomical planes, the assessment of pain, postural changes and the functionality of upper extremity that is caused by the lack of ergonomic principles among office workers of civil servants in TRNC (Turkish Republic of Northern Cyprus).

METHODS

183 individuals participated in the study and 2 groups were created by grand scores of Rapid Upper Limb Assessment (RULA) tool. Scapular dyskinesis, pain of upper extremity and back, physical functions and symptoms of upper extremity, the self-rated neck disability, cervical and upper thoracic posture of workers were assessed.

RESULTS

The difference between pain situation and the results of upper extremity and neck disability scores of the participants among the groups was significant (p< 0.05). No significant difference has been found statistically among the postural angle values of individuals (p> 0.05). A significant statistical difference has been found among the groups when the results of Lateral Scapular Slide Test (LSST) is examined (p< 0.05).

CONCLUSIONS

Working environment and conditions cause the wrong of working posture and thus, lead individuals to spend more energy together with physical difficulty, and consequently affect general health.

A radiographic investigation of cervical spine kinematics when reading a tablet in a reclined trunk position

The purpose of this study was to use radiographic measurements to compare cervical spine kinematics in various tablet computer reading postures. Radiographs were taken of twenty-two participants reading a tablet computer in five different postures. The lower cervical spine was more flexed in the semi-reclined (-8.2 ± 3.8°) and the reclined (-14.9 ± 4.0°) tablet positions compared to an upright (-4.43 ± 4.8°) tablet posture. Of the tablet reading positions, the reclined position had the lowest gravitational moment arm (5.2 ± 2.3 cm) and a skull angle closest to neutral (-9.4 ± 11.4°), while exhibiting the largest extension in the C1-C2 joint (34.4 ± 9.1°). Altering trunk position when reading a tablet could reduce the load required to support the head, but could put the head in a more forward head posture, stretch the cervical extensor muscles, and potentially result in pain.

Cluster subgroups based on overall pressure pain sensitivity and psychosocial factors in chronic musculoskeletal pain: Differences in clinical outcomes

Objective: We aimed to empirically derive psychosocial and pain sensitivity subgroups using cluster analysis within a sample of individuals with chronic musculoskeletal pain (CMP) and to investigate derived subgroups for differences in pain and disability outcomes. Methods: Eighty female participants with CMP answered psychosocial and disability scales and were assessed for pressure pain sensitivity. A cluster analysis was used to derive subgroups, and analysis of variance (ANOVA) was used to investigate differences between subgroups. Results: Psychosocial factors (kinesiophobia, pain catastrophizing, anxiety, and depression) and overall pressure pain threshold (PPT) were entered into the cluster analysis. Three subgroups were empirically derived: cluster 1 (high pain sensitivity and high psychosocial distress; n = 12) characterized by low overall PPT and high psychosocial scores; cluster 2 (high pain sensitivity and intermediate psychosocial distress; n = 39) characterized by low overall PPT and intermediate psychosocial scores; and cluster 3 (low pain sensitivity and low psychosocial distress; n = 29) characterized by high overall PPT and low psychosocial scores compared to the other subgroups. Cluster 1 showed higher values for mean pain intensity (F_(2,77) = 10.58, p < 0.001) compared with cluster 3, and cluster 1 showed higher values for disability (F_(2,77) = 3.81, p = 0.03) compared with both clusters 2 and 3. Conclusions: Only cluster 1 was distinct from cluster 3 according to both pain and disability outcomes. Pain catastrophizing, depression, and anxiety were the psychosocial variables that best differentiated the subgroups. Overall, these results call attention to the importance of considering pain sensitivity and psychosocial variables to obtain a more comprehensive characterization of CMP patients' subtypes.

Spinal kinematics during smartphone texting - A comparison between young adults with and without chronic neck-shoulder pain

To advance our understanding about the association between smartphone use and chronic neck-shoulder pain, the objective of this study was to compare spinal kinematics between different text-entry methods in smartphone users with and without chronic neck-shoulder pain. Symptomatic (n = 19) and healthy participants (n = 18) were recruited and they performed three tasks: texting on a smartphone with one hand, with two hands, and typing on a desktop computer. Three-dimensional kinematics were examined in the cervical, thoracic and lumbar regions for each task. This study suggests that altered kinematics may be associated with pain since significantly increased angles of cervical right side flexion during smartphone texting and greater postural changes in cervical rotation were found during all text-entry tasks in the symptomatic group. Two-handed texting was associated with increased cervical flexion while one-handed texting was correlated with an asymmetric neck posture, indicating both text-entry methods are not favorable in terms of spinal postures.

Thera-Band application changes muscle activity and kyphosis and scapular winging during knee push-up plus in subjects with scapular winging: The cross-sectional study

Scapular winging (SW) is defined as increased prominence of the whole medial border of the scapula. Many researchers recently recommended knee push-up plus (KPP) for enhancing serratus anterior (SA) activation. However, during push-up plus, thoracic kyphosis (TK) may usually occur as a compensatory movement. Thus, the purpose of this study was to investigate the effect of Thera-Band application during KPP on rectus abdominis (RA) activity, TK angle (TKA), SA activity, and amount of SW in subjects with SW.Fifteen subjects performed KPP with Thera-Band applied to different posterior body parts (no Thera-Band, in the occiput, and in the thoracic region). Electromyography was used to record the RA and SA activities. Image J software was used to calculate the compensatory TKA during KPP, and a scapulometer was used to measure SW in the quadruped position. One-way repeated-measures analysis of variance was used to test for significance.KPP with Thera-Band in the occiput showed significantly lower RA activity (P = .001) and TKA (P < .001) than KPP with no Thera-Band. SA activity (P = .020, P = .047) and SW (P < .001, P < .001) were significantly lower with Thera-Band applied to the occiput and thoracic regions than in KPP with no Thera-Band.Thera-Band applied to the occiput and thorax can be beneficial as it decreases RA and SA muscle activity and reduces TKA and SW during KPP in subjects with SW.

The contribution of thoracic vertebral deformity and arthropathy to trunk pain in patients with chronic obstructive pulmonary disease (COPD)

BACKGROUND

Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing misalignment of joints between the ribs and vertebrae. The purpose of this study was to determine if thoracic vertebral deformity and arthropathy were independent contributors to trunk pain in COPD patients compared to people with a significant smoking history.

METHOD

Participants completed the Brief Pain Inventory (BPI) on the same day as chest CT scans and spirometry. Current and ex-smokers were separated into COPD (n = 91) or non-COPD (n = 80) groups based on spirometry. Subsequently, CT images were assessed for thoracic vertebral deformity, bone attenuation values, and arthropathy of thoracic vertebral joints.

RESULTS

The trunk area was the most common pain location in both COPD and non-COPD groups. Thoracic vertebral deformity and costotransverse joint arthropathy were independent contributors to trunk pain in COPD patients (adjusted OR = 3.55 and 1.30, respectively) whereas alcohol consumption contributed to trunk pain in the non-COPD group (adjusted OR = 0.35 in occasional alcohol drinkers; 0.08 in non-alcohol drinkers). The spinal deformity index and the number of narrowed disc spaces were significantly positively related to the BPI intensity, interference, and total scores significantly in COPD patients.

CONCLUSION

Trunk pain, at least in part, is caused by thoracic vertebral deformity, and costotransverse and intervertebral arthropathy in patients living with COPD. The results of this study provided the foundation for the management of pain, which requires further exploration.

Upper torso pain and musculoskeletal structure and function in women with and without large breasts: A cross sectional study

BACKGROUND

Women with large breasts frequently experience upper torso pain secondary to their breast size. Evidence is lacking on the underlying causes of this pain. This study investigated whether upper torso pain and musculoskeletal structure and function differed between women with large breasts and women with small breasts.

METHODS

A linear regression, adjusting for body mass, compared the upper torso pain, thoracic flexion torque due to breast mass, thoracic kyphosis, shoulder active range-of-motion, and scapular retraction muscle strength of 27 women with large breasts (bilateral breast volume>1200ml, age 45.9y SD 9.9y, BMI 29.0kg/m² SD 3.8kg/m²) and 26 women with small breasts (bilateral breast volume <800ml, age 43.8y SD10.9y, BMI 23.3kg/m² SD 2.9kg/m²).

FINDINGS

Women with large breasts reported a higher upper torso pain score (46.6, 95%CI 33.3-58.0 versus 24.1, 95%CI 12.5-37.8), accompanied by a larger flexion torque (5.9Nm, 95%CI 4.5-5.8Nm versus 0.9Nm, 95%CI 0.8-2.4Nm), greater thoracic kyphosis (34°, 95%CI 31-38° versus 27°, 95% CI 24-31°), decreased shoulder elevation range-of-motion (160°, 95%CI 158-163° versus 169°, 95%CI 166-172°), and decreased scapular retraction endurance-strength (511.4s, 95%CI 362.2-691.3s versus 875.8s, 95%CI 691.5-1028.4s) compared to the women with small breasts.

INTERPRETATION

Differences in the upper torso posture, range-of-motion, and muscle strength of women with large breasts provides insight into underlying causes of their musculoskeletal pain. This information can be used to develop evidence-based assessment and treatment strategies to relieve and prevent symptom progression.

The Effects of Forward Head Posture on Neck Extensor Muscle Thickness: An Ultrasonographic Study

OBJECTIVE

This study aimed to compare neck extensor muscle thickness, thickness changes, and strength between participants with forward head posture (FHP) and controls with normal head posture (NHP).

METHODS

Twenty college students with FHP (mean age 21.30 ± 2.36 years) and 20 students with NHP (mean age 21.85 ± 2.78 years) participated in this case-control study. The thickness of neck extensor muscles was measured at rest and at maximal voluntary isometric contraction (MVIC). In addition, the craniovertebral angle (CVA) was calculated. To compare thickness changes between the 2 groups and among 5 muscles, a 2-way repeated measures analysis of variance was applied. In addition, Pearson's correlation test was performed to investigate the relationship between neck extensor MVIC and CVA.

RESULTS

The FHP group demonstrated lower MVIC compared with the NHP group (P = .03). Semispinalis capitis showed the smallest thickness changes during neck extensor MVIC in FHP compared with the controls (P < .001). However, no significant difference in terms of muscle thickness was observed between the 2 groups at the state of rest (P = .16-.99). A positive association was also found between the MVIC and CVA (P = .02).

CONCLUSIONS

Semispinalis capitis had less thickness changes during MVIC of neck extensors in individuals with FHP compared with those with NHP. This indirectly implies lower activity of this muscle in FHP condition. This study finding may help researchers develop therapeutic exercise protocols to manage FHP.

The Influence of Natural Head Position on the Cervical Sagittal Alignment

Introduction

This study investigated the relationship between the parameters related to the natural head position and cervical segmental angles and alignment of patients with neck pain.

Material and Methods

The lateral radiographs of the cervical spine were collected from 103 patients and were used to retrospectively analyze the correlation between the natural head position, cervical local sagittal angles, and alignment. Sagittal measurements were as follows: cervical curvature classification, slope of McGregor's line (McGS), local sagittal angles (C0–C2 angle, C2–C5 angle, C5–C7 angle, and C2–C7 angle), T1 slope, center of gravity of the head to sagittal vertical axis (CG–C7 SVA), and local sagittal alignment (C0–C2 SVA and C2–C7 SVA).

Results

McGS was significantly correlated to C0–C2 angle (r = 0.57), C0–C2 SVA (r = −0.53), C2–C7 SVA (r = −0.28), and CG–C7 SVA (r = −0.47). CG–C7 SVA was also significantly correlated to curvature type (r = 0.27), C5–C7 angle (r = −0.37), and C2–C7 angle (r = −0.39).

Conclusions

A backward shift with an extended head position may accompany a relatively normal curvature of the cervical spine. The effect of posture control in relieving abnormal mechanical state of the cervical spine needs to be further confirmed by biomechanical analysis.

Relationships among head posture, pain intensity, disability and deep cervical flexor muscle performance in subjects with postural neck pain

Objectives

Information Technology (IT) professionals working with computers gradually develop forward head posture and, as a result, these professionals are susceptible to several neck disorders. This study intended to reveal the relationships between pain intensity, disability, head posture and deep cervical flexor (DCF) muscle performance in patients with postural neck pain.

Methods

A cross-sectional study was conducted on 84 IT professionals who were diagnosed with postural neck pain. The participants were recruited with a random sampling approach. A Visual Analogue Scale (VAS), the Northwick Park Neck Pain Questionnaire (NPQ), the Modified Head Posture Spinal Curvature Instrument (MHPSCI), and the Stabilizer Pressure Biofeedback Unit were used to measure neck pain intensity, neck disability, head posture, and DCF muscle performance, respectively.

Results

The Pearson correlation coefficient revealed a significantly strong positive relationship between the VAS and the NPQ (r = 0.734). The cranio-vertebral (CV) angle was found to have a significantly negative correlation with the VAS (r = −0.536) and a weak negative correlation with the NPQ (r = −0.389).

Conclusion

This study concluded that a smaller CV angle corresponded to greater neck pain intensity and disability. Furthermore, there is no significant relationship between CV angle and DCF muscle performance, indicating that head posture re-education through postural correction exercises would not completely correct the motor control deficits in DCF muscles. In addition, a suitable exercise regimen that exclusively targets the deep cervical flexor muscle to improve its endurance is warranted.

Myofascial Release Therapy in the Treatment of Occupational Mechanical Neck Pain: A Randomized Parallel Group Study

OBJECTIVE

As myofascial release therapy is currently under development, the objective of this study was to compare the effectiveness of myofascial release therapy with manual therapy for treating occupational mechanical neck pain.

DESIGN

A randomized, single-blind parallel group study was developed. The sample (n = 59) was divided into GI, treated with manual therapy, and GII, treated with myofascial release therapy. Variables studied were intensity of neck pain, cervical disability, quality of life, craniovertebral angle, and ranges of cervical motion.

RESULTS

At five sessions, clinical significance was observed in both groups for all the variables studied, except for flexion in GI. At this time point, an intergroup statistical difference was observed, which showed that GII had better craniovertebral angle (P = 0.014), flexion (P = 0.021), extension (P = 0.003), right side bending (P = 0.001), and right rotation (P = 0.031). A comparative analysis between therapies after intervention showed statistical differences indicating that GII had better craniovertebral angle (P = 0.000), right (P = 0.000) and left (P = 0.009) side bending, right (P = 0.024) and left (P = 0.046) rotations, and quality of life.

CONCLUSIONS

The treatment of occupational mechanical neck pain by myofascial release therapy seems to be more effective than manual therapy for correcting the advanced position of the head, recovering range of motion in side bending and rotation, and improving quality of life.

Cervical Spine Muscle-Tendon Unit Length Differences Between Neutral and Forward Head Postures: Biomechanical Study Using Human Cadaveric Specimens

BACKGROUND

Forward head posture (FHP) may be associated with neck pain and poor health-related quality of life. Literature describes only qualitative muscle length changes associated with FHP.

OBJECTIVE

The purpose of this study was to quantify how muscle-tendon unit lengths are altered when human cadaveric specimens are placed in alignments representing different severities of FHP.

DESIGN

This biomechanical study used 13 fresh-frozen cadaveric cervical spine specimens (Occiput-T1, 54±15 y).

METHODS

Specimens' postural changes simulating increasing FHP severity while maintaining horizontal gaze were assessed. Specimen-specific anatomic models derived from computed tomography-based anatomic data were combined with postural data and specimen-specific anatomy of muscle attachment points to estimate the muscle length changes associated with FHP.

RESULTS

Forward head posture was associated with flexion of the mid-lower cervical spine and extension of the upper cervical (sub-occipital) spine. Muscles that insert on the cervical spine and function as flexors (termed "cervical flexors") as well as muscles that insert on the cranium and function as extensors ("occipital extensors") shortened in FHP when compared to neutral posture. In contrast, muscles that insert on the cervical spine and function as extensors ("cervical extensors") as well as muscles that insert on the cranium and function as flexors ("occipital flexors") lengthened. The greatest shortening was seen in the major and minor rectus capitis posterior muscles. These muscles cross the Occiput-C2 segments, which exhibited extension to maintain horizontal gaze. The greatest lengthening was seen in posterior muscles crossing the C4-C6 segments, which exhibited the most flexion.

LIMITATIONS

This cadaver study did not incorporate the biomechanical influence of active musculature.

CONCLUSIONS

This study offers a novel way to quantify postural alignment and muscle length changes associated with FHP. Model predictions are consistent with qualitative descriptions in the literature.

MUSCULAR PRESSURE PAIN THRESHOLD AND INFLUENCE OF CRANIOCERVICAL POSTURE IN INDIVIDUALS WITH EPISODIC TENSION-TYPE HEADACHE

ABSTRACT Objective: The objective of this study was to analyze the pressure pain threshold (PPT) of the sternocleidomastoid (SCM), suboccipital (SO) and upper trapezius (UT) muscles and the craniocervical posture in individuals with episodic tension-type headache (ETTH). Methods: This study was a cross-sectional, non-randomized study with 60 young adults (77% female) comprising both sexes and an age range of 18-27 years. Individuals were distributed into a control group (G1) and individuals with ETTH (G2). The frequency of headaches per month was recorded. A pressure dynamometer was used to evaluate the PPT. Photogrammetry was used to evaluate the cervical lordosis (CL) and cephalic protrusion (CP). The data were statistically analyzed. Results: There were differences in the PPT, where the UT, SO and SCM muscles presented lower sensitivity to pain, respectively. The SCM muscle presented a lower PPT in G2. The CL and CP angles were significantly lower in G2. Conclusion: Individuals with ETTH exhibited a significantly lower PPT in the SCM and SO muscles than in the UT muscle. Nevertheless, individuals with ETTH presented with the SCM muscle being more sensitive to pain as well as higher CL and CP than individuals without symptomatology.

Analysis of the cranio-cervical curvatures in subjects with migraine with and without neck pain

OBJECTIVE

To investigate the differences in head and cervical spine alignment between subjects with migraine and healthy people.

DESIGN

A cross-sectional, observational study.

PARTICIPANTS

Fifty subjects with migraine and 50 matched healthy controls.

MAIN OUTCOMES MEASURES

The presence of neck pain and neck pain-related disability was assessed. Four angles (high cervical angle, low cervical angle, atlas plane angle and cervical lordosis Cobb angle) as well as four distances (anterior translation distance, C0 to C1 distance, C2 to C7 posterior translation and hyoid triangle) were calculated using digitalised radiographs and analysed using K-Pacs^® software.

RESULTS

Subjects with migraine reported a longer history of neck pain symptoms, and higher pain intensity and neck-pain-related disability than controls (P<0.01). Patients exhibited a smaller anterior translation distance (mean difference: 4.9mm, 95% confidence interval 1.8 to 8.8; P<0.001) and hyoid triangle (difference: 3.0mm, 95% confidence interval 1.0 to 5.0; P=0.02) than healthy controls. When the presence or the absence of neck pain was included in the analysis, the differences did not change. Differences in anterior translation and hyoid triangle distances were considered clinically relevant for subjects with migraine suffering from neck pain.

CONCLUSION

Subjects with migraine exhibited straightening of cervical lordosis curvature. The presence of neck pain did not influence head posture in subjects with and without migraine.

Confiabilidade intra e interexaminador da avaliação do alinhamento da cabeça nas posições sentado e em pé

RESUMO Objetivou-se verificar a confiabilidade intra e interexaminador dos ângulos de anteriorização e de inclinação da cabeça nas vistas anterior e lateral nas posições sentado e em pé e se as medidas independem da posição utilizada. Participaram 78 sujeitos com 23,5±5,8 anos, 63,7±10,3 kg e 166,5±8,2 cm de estatura. Os sujeitos foram fotografados nas posturas em pé e sentado, seguindo o protocolo do Software para Avaliação Postural (SAPO). Foram analisados o alinhamento horizontal da cabeça nas vistas anterior e lateral (AHC_A; AHC_L) e o alinhamento vertical da cabeça na vista lateral (AVC_L). Três avaliadores analisaram as imagens, repetindo essa análise sete dias depois. O coeficiente de correlação intraclasse (ICC) e o teste t pareado foram aplicados, com nível de significância de p≤0,05. Na análise da confiabilidade interexaminadores, dos seis ângulos avaliados, três foram classificados como excelentes, um como aceitável e apenas um como não aceitável. Quanto ao nível de confiabilidade intraexaminador, em dez avaliações o ICC foi classificado como excelente, em seis como muito bom, em uma como aceitável e somente em uma como não aceitável. Não foram observadas diferenças entre as posições sentado e em pé nas diversas avaliações realizadas no estudo. Concluiu-se que as avaliações dos ângulos de anteriorização e inclinação da cabeça nas vistas anterior e lateral e nas posições sentado e em pé mostraram-se confiáveis quando realizadas por examinadores diferentes ou pelo mesmo examinador em dias diferentes. Adicionalmente, constatou-se que os resultados das avaliações independem da posição utilizada.

The relationship between changes of cervical sagittal alignment after anterior cervical discectomy and fusion and spino-pelvic sagittal alignment under roussouly classification: a four-year follow-up study

Background

Anterior cervical discectomy and fusion (ACDF) is widely used in the treatment of cervical degenerative disease; however, the variation of cervical sagittal alignment changes after ACDF has been rarely explored. The purpose of this study is to determine the relationship between changes of cervical sagittal alignment after ACDF and spino-pelvic sagittal alignment under Roussouly classification.

Methods

A cohort of 133 Chinese cervical spondylotic patients who received ACDF from 2011 to 2012 was recruited. All patients were categorized with Roussouly Classification. Lateral X-ray images of global spine were obtained, and preoperative and postoperative parameters were measured and analyzed, including C2–C7 angles (C2–C7), C0–C7 angles (C0–C7), external auditory meatus (EAM) tilt, sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), spinal sacral angles (SSA), Superior adjacent inter-vertebral angle (SAIV), inferior adjacent inter-vertebral angle (IAIV) and et al. The Wilcoxon signed-rank test was used for intragroup comparisons preoperatively and at postoperative 48 months.

Results

Among the parameters, C2–C7 and C0–C7 showed significant increase, while EAM TK, and IAIV decreased significantly. In type I, EAM and TK decreased significantly, however SS showed a significant increase; in type II, TK showed a significant decrease, but SSA showed a significant increase; in type III, a significant increase of C0–C7 was observed with a significant decrease in EAM, nevertheless, LL, SS and SSA showed significant decreases; and in type IV, C2–C7 showed a significant increase and EAM decreased significantly. The percentage of lordotic alignment in cervical spine increased, which was presenting in type I, III and IV. Nevertheless, the amount of patients with straight cervical alignment increased in type II.

Conclusion

The backward movement of head occurs is the compensatory mechanism in cervical sagittal alignment modifications after ACDF. The compensatory alteration of spino-pelvic sagittal alignment varied in different Roussouly type.

Investigation of associations between recurrence of major depressive disorder and spinal posture alignment: A quantitative cross-sectional study

The aim of this study was to investigate associations between poor spinal posture and the recurrence of major depressive episodes and severity of symptoms in patients with major depressive disorder (MDD). This was a cross-sectional quantitative study of MDD patients. Outpatients were recruited from consecutive admissions at a mood disorders unit of a tertiary psychiatric hospital. Of 136 MDD patients, 72 (53 women, 19 men; mean age, 42.4±9.1years) met all the criteria and completed the study. Forty-one patients were classified with a recurrent episode (RE) of MDD and 31 with a single episode (SE). Quantitative assessments of postural deviations were made using photogrammetry, including kyphosis, shoulder protraction, and head inclination. The severity of depressive episodes was assessed using the Hamilton Depression Rating Scale. The diagnosis and classification of patients were performed according to DSM-IV-TR and SCID criteria. Multivariate analysis of variance indicated that the RE group had greater anterior head inclination (35.39; SD: 1.57), greater scapular abduction (1.69; SD: 0.93), and worse thoracic kyphosis (139.38; SD: 1.19) than the SE group (p<0.001 for all). Multivariate analysis of covariance showed an interaction between the severity of depressive symptoms and the degree of thoracic kyphosis (p=0.002). Recurrence of depressive episodes is associated with measures of postural misalignment.

Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents

BACKGROUND

There is conflicting evidence on the association between sagittal neck posture and neck pain.

OBJECTIVE

The purposes of this study were: (1) to determine the existence of clusters of neck posture in a cohort of 17-year-olds and (2) to establish whether identified subgroups were associated with biopsychosocial factors and neck pain.

DESIGN

This was a cross-sectional study.

METHODS

The adolescents (N=1,108) underwent 2-dimensional photographic postural assessment in a sitting position. One distance and 4 angular measurements of the head, neck, and thorax were calculated from photo-reflective markers placed on bony landmarks. Subgroups of sagittal sitting neck posture were determined by cluster analysis. Height and weight were measured, and lifestyle and psychological factors, neck pain, and headache were assessed by questionnaire. The associations among posture subgroups, neck pain, and other factors were evaluated using logistic regression.

RESULTS

Four distinct clusters of sitting neck posture were identified: upright, intermediate, slumped thorax/forward head, and erect thorax/forward head. Significant associations between cluster and sex, weight, and height were found. Participants classified as having slumped thorax/forward head posture were at higher odds of mild, moderate, or severe depression. Participants classified as having upright posture exercised more frequently. There was no significant difference in the odds of neck pain or headache across the clusters.

LIMITATIONS

The results are specific to 17-year-olds and may not be applicable to adults.

CONCLUSION

Meaningful sagittal sitting neck posture clusters were identified in 17-year-olds who demonstrated some differences with biopsychosocial profiling. The finding of no association between cluster membership and neck pain and headaches challenges widely held beliefs about the role of posture in adolescent neck pain.

Effect of the craniocervical brace on craniocervical angle, thoracic kyphosis angle, and trunk extensor muscle activity during typing in subjects with forward head posture

BACKGROUND

The relationship between forward head posture (FHP) and thoracic kyphosis has been a subject of interest in the rehabilitation field for visual display terminal workers.

OBJECTIVE

The aim of this study was to investigate the immediate effects of the craniocervical brace use on craniocervical angle (CCA), thoracic kyphosis angle (TKA), and trunk extensor muscle activity.

METHODS

Twelve young male subjects with forward head posture (21.6±1.9 years) participated in this study. We compared CCA & TKA and trunk extensor muscle activity between with and without application of the craniocervical brace during visual display terminal work.

RESULTS

When wearing the craniocervical brace, the subjects demonstrated significantly greater CCA at the start and the end of the task and less change in CCA during the task (p < 0.05). While non-significantly less TKA was seen at the start of the task, significantly less TKA was observed at the end of the task when using the craniocervical brace (p < 0.05). The craniocervical brace use also led to significantly less change in TKA (p < 0.05). There was no significant difference in the trunk extensor muscle activity.

CONCLUSIONS

Use of the craniocervical brace decreased FHP immediately, lessened thoracic kyphosis over time, and prevented the worsening of FHP and thoracic kyphosis during visual display terminal work.

Effect of sitting posture on respiratory function while using a smartphone

[Purpose] The purpose of this study was to investigate respiratory function in different sitting postures while using a smartphone. [Subjects and Methods] Fifty healthy volunteers were recruited. Participants were divided into 2 groups, a control group of participants who spent time as they liked for 1 hour, and a smartphone group of participants who spent time using a smartphone in a sitting position for 1 hour. To investigate changes in respiratory function, we measured forced vital capacity, forced expiratory volume in 1 second, ratio of forced expiratory volume in 1 second to forced vital capacity, and peak expiratory flow. [Results] There was a statistically significant difference in forced vital capacity and forced expiratory volume in 1 second between the control group and smartphone group. [Conclusion] The clinical implication of our findings is that the posture assumed while using a smartphone leads to reduced respiratory function.

Cervico-occipital Posture in Women With Migraine: A Case-Control Study

STUDY DESIGN

Case-control study.

BACKGROUND

Previous studies have assessed forward head posture in patients with migraine using photographs. To date, no study has compared postural differences using both radiographs and photographs.

OBJECTIVE

To determine the differences in head extension posture between women with migraine and healthy women assessed with radiographic and photographic measures.

METHODS

Thirty-three women (mean ± SD age, 32 ± 11.3 years) with migraine and 33 matched controls (age, 33 ± 12.6 years) participated. Radiographs were used to measure the high cervical angle (HCA), the angle between the most inferior line from the occipital surface to the posterior portion of C1 and the posterior surface of the odontoid process of C2, and the vertical distance between C0 and C1 (C0-C1). Photographs and commercially available software were used to assess the craniovertebral angle (CVA).

RESULTS

None of the outcomes differed significantly between women with migraine and control participants. Outcomes for women with migraine were HCA, 66.1° (95% confidence interval [CI]: 64.2°, 68.1°); CVA, 46.1° (95% CI: 45.0°, 47.1°); and C0-C1, 8.5 mm (95% CI: 7.7, 9.2). Outcomes for the control group were HCA, 67.9° (95% CI: 66.5°, 69.3°); CVA, 44.5° (95% CI: 43.2°, 45.7°); and C0-C1, 8.7 mm (95% CI: 7.9, 9.4). Relationships between the frequency (r = -0.42, P = .01, R (2) = 10%) of migraine and the HCA were found.

CONCLUSION

This study demonstrated that women with migraine did not exhibit forward head posture compared to women with no history of headache in either radiographic or photographic postural analysis. However, there was a weak association of the frequency of migraine attacks with a variation in the HCA as assessed by radiographs.

LEVEL OF EVIDENCE

Differential diagnosis/symptom prevalence, level 4.