Measurement of Cervical Posture in the Sagittal Plane

Efficacy of posture correction band vs. McKenzie's exercises on pulmonary function and chest expansion in asymptomatic population with forward head posture

BACKGROUND

Poor posture and sedentary lifestyle cause Forward Head Posture (FHP). To correct this, a Posture Correction Band (PCB) is commonly used. However, the efficacy of PCB vs. McKenzie's Exercises on pulmonary function and chest expansion in asymptomatic individuals with FHP was not known.

OBJECTIVE

This study aimed to determine the efficacy of PCB vs. McKenzie's Exercises on the Pulmonary function and chest expansion in asymptomatic population with FHP.

METHODOLOGY

A Randomized control trial was conducted on forty-two subjects with FHP. Subjects were divided in two groups. G1 group was educated as per McKenzie's exercises to perform once daily for a month. The Pulmonary function test and chest expansion of this group was performed before and after the McKenzie exercises. G2 group wore PCB for 2 h daily for a month and their PFT and chest expansion was recorded before and after the trial. FVC, FEV1, FEV1/FVC ratio, PEFR and Chest expansion were measured.

RESULTS

The P-value of FVC, FEV1, FEV1/FVC ratio and PEFR between the groups (treatment group) was significant as 0.000, 0.000, 0.000 and 0.02 respectively. The chest expansion was non-significant between the groups (treatment group) with P-value as 0.553, 0.493 and 0.699 at axillary, 4th intercostal and xiphisternum level respectively. The P-value of FVC, FEV1, FEV1/FVC ratio and PEFR between the groups (control group) was non-significant as 0.682, 0.149, 0.424 and 0.414 respectively. The chest expansion was also non-significant between the groups (control group) with P-value as 0.853, 0.651 and 0.763 at axillary, 4th intercostal and xiphisternum level.

CONCLUSION

The study concluded that there were significant effects of both Posture Correction Band and Mc'Kenzie exercises on pulmonary function with greater difference seen with PCB and non-significant effects on chest expansion in terms of P-values in treatment group.

Reliability and Validity of Non-radiographic Methods of Forward Head Posture Measurement: A Systematic Review

Forward head posture measurement can be conducted using various methods and instruments. The selection of the appropriate method requires the factors of validity and reliability to be considered. This systematic review reports on the reliability and validity of the non-radiographic methods examined for measuring forward head posture. The review identified relevant studies following a systematic search of electronic databases. The studies were assessed for quality by two independent reviewers using a critical appraisal tool. The studies’ data were extracted and assessed, and the results were synthesized qualitatively using a level of evidence approach. Twenty-one studies met the eligibility criteria and were included in the review. Both reliability and validity were investigated for five studies, whereas reliability only was investigated for 17 studies. In total, 11 methods of forward head posture measurement were evaluated in the retrieved studies. The validity of the methods ranged from low to very high. The reliability of the methods ranged from moderate to excellent. The strongest levels of evidence for reliability support the use of classic photogrammetry. For validity, the evidence is not conclusive. Further studies are required to strengthen the level of evidence on the reliability and validity of the remaining methods. It is recommended that this point be addressed in future research.

Evaluating Differences Between Participants With Various Forward Head Posture With and Without Postural Neck Pain Using Craniovertebral Angle and Forward Shoulder Angle

OBJECTIVE

The purpose of this study was to investigate differences between individuals with various forward head posture (FHP) severities with and without postural neck pain using craniovertebral angle and forward shoulder angle.

METHOD

Ninety participants age 20 to 50 years were categorized into the following 4 groups based on observational method and presence or absence of postural neck pain: (1) slight FHP group without pain, (2) slight FHP group with pain, (3) moderate-to-severe FHP group without pain, and (4) moderate-to-severe FHP group with pain. A digital imaging technique was used to measure the craniovertebral angle and forward shoulder angle in a standing position.

RESULTS

A 1-way analysis of variance test showed a significant difference for craniovertebral angle in the 4 groups (F = 22.04, P < .001). Tukey's test showed the difference in this variable was significant between slight FHP groups (with or without pain) and moderate-to-severe FHP groups (with or without pain) (P < .001). Although overall F indicated a significant difference (F = 4.11, P < .009) of the forward shoulder angle in 4 groups, Tukey's test revealed this was only significantly different in 2 groups: slight FHP with pain and moderate-to-severe FHP with pain (P = .005).

CONCLUSION

The craniovertebral angle in the 2 groups of moderate-to-severe FHP was significantly smaller than that in the 2 groups of slight FHP. However, the forward shoulder angle in the group of moderate-to-severe FHP with pain was only significantly smaller than that in slight FHP with pain. The results showed that including pain as a factor of categorization did not lead to a significant difference between various groups regarding craniovertebral angle and forward shoulder angle.

The association between forward head posture and non-specific neck pain: A cross-sectional study

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.

Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study

BACKGROUND

Teaching is one of the professions where incidence and prevalence of neck pain is high. Prolonged use of computers, which has further increased due to online teaching amid pandemic, is known to cause neck pain and alter posture, while people with forward head posture (FHP) are prone to develop neck pain and related disability. Research has shown that impairment of deep cervical flexor (DCF) muscles leads to insufficiency in coordination, activation, overload, and poor support on cervical structures that further lead to development of neck pain and altered neck posture. The objective of this study was to see the effect of DCF muscle training using pressure biofeedback on pain and FHP in school teachers with neck pain.

METHODS

This observational study was conducted at medical center in school premises. Fifty-five school teachers aged between 25 and 40 years with experience of more than 5 years were invited to participate in this study. Subjects were divided in two groups. Both the groups received conventional exercises while in experimental group DCF muscle training using pressure biofeedback was given additionally. Pain and FHP were assessed using NPRS and cranio-vertebral angle using digital photograph technique, respectively, at baseline and end of four weeks of treatment.

RESULTS

Although pain and FHP improved in both the groups, mean improvement in both the measures was more in the group that also received DCF training using pressure biofeedback.

CONCLUSIONS

This study shows that although pain and FHP improved following conventional exercises in school teachers with neck pain, mean improvement was more significant among those who received additional DCF muscle training using pressure biofeedback.

Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study

OBJECTIVE

The purpose of this study was to determine whether sagittal neck sitting posture subgroup membership in late adolescence was a risk factor for persistent neck pain (PNP) in young adults.

METHODS

There were 686 participants enrolled in the Raine Study at the 17- and 22-year follow-ups. At 17 years of age, posture was measured by photographs, and 4 subgroups of sitting neck posture were determined by cluster analysis. Height and weight were measured, and exercise frequency, depression, and PNP were assessed by questionnaire. At 22 years of age, participants answered questions about neck pain and occupation type. Logistic regression examined if neck posture subgroups at 17 years of age were a risk factor for PNP at 22 years of age, taking into account other factors.

RESULTS

Female sex (odds ratio [OR] = 1.75, 95% CI = 1.16-2.65) and PNP at 17 years of age (OR = 3.78, 95% CI = 2.57-5.57) were associated with PNP at 22 years of age. In females, neck posture subgroup at 17 years of age was a risk factor for PNP at 22 years of age. Compared with the upright subgroup, both the slumped thorax/forward head subgroup groups and the intermediate subgroup had decreased odds for PNP at 22 years of age (OR = 0.24, 95% CI = 0.08-0.76; OR = 0.38, 95% CI = 0.15-0.99, respectively). No association was found in males.

CONCLUSION

After taking into account PNP at 17 years, sitting neck posture at 17 was not a risk factor for PNP at 22 years of age in males, whereas in females, more relaxed postures (slumped thorax/forward head and Intermediate postures) were protective of neck pain compared with upright posture.

IMPACT

Females in late adolescence who sat in slumped thorax/forward head or intermediate posture rather than upright sitting posture had a lower risk of PNP as a young adult. The practice of generic public health messages to sit up straight to prevent neck pain needs rethinking.

Notions of "optimal" posture are loaded with meaning. Perceptions of sitting posture among asymptomatic members of the community

BACKGROUND

Notions of "optimal" posture are widespread in modern society and strongly interconnected with preconceived beliefs.

OBJECTIVES

To quantitatively evaluate spinal posture among members of the community during habitual sitting, and when asked to assume an "optimal" posture.

DESIGN

Observational study.

METHODS

Marker-based kinematic analyses of the head, spine, and pelvis were conducted on 100 individuals. Habitual sitting posture and self-perceived "optimal" posture, and whether participants believed that their habitual sitting reflected an "optimal" posture, were evaluated. The Wilcoxon signed-rank test assessed angular differences between the two postures adopted. Exploratory post-hoc analyses were conducted by using the Mann-Whitney U test to assess differences between genders.

RESULTS

None of the participants stated that their habitual sitting was "optimal". Statistically significant differences were observed in most of the measured angles (p < 0.001) between habitual and self-perceived "optimal" posture. In habitual sitting posture, a significant interaction with gender was found only in the thoracolumbar (p < 0.05) and pelvic (p < 0.001) angles, with small effect sizes. In self-perceived "optimal" posture females were more extended in the head, upper thoracic, lower thoracic, lumbar and pelvic (p < 0.01) regions, than the males.

CONCLUSIONS

A group of young, asymptomatic participants, consistently changed their habitual sitting posture to a more upright posture when asked to assume an "optimal" sitting posture, although the amount of change observed varied between spinal regions. These findings also highlight gender differences in not just habitual sitting posture, but also the degree to which habitual sitting posture is modified when trying to assume an "optimal" sitting posture.

Does forward head posture change subacromial space in active or passive arm elevation?

Objectives: Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.Methods: Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP. The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.Results: The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three. In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly. Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.Conclusions: The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.

The effect of backpack load position on photographic measures of craniovertebral posture in 150 asymptomatic young adults

BACKGROUND

Altering the horizontal position of the weight in a backpack will influence the magnitude of the external torque it creates but the effect on posture is unclear.

OBJECTIVE

To use photogrammetry to determine if changes in the horizontal position of a fixed backpack weight affect external measures of craniovertebral posture in 150 asymptomatic young adults.

METHODS

A backpack was attached to a steel frame with a bar protruding posteriorly. A fixed load (5% body mass) was placed at three distances along the bar -0 m, 0.20 m, and 0.40 m. Sagittal and frontal plane photogrammetry was used to measure the craniovertebral angle (CVA), upper cervical gaze angle (UCGA) and lateral head tilt angle (LHTA). A comparison was made across unloaded (no backpack) and loaded conditions.

RESULTS

There was a significant decrease in the CVA between unloaded and loaded conditions. Changes in the UCGA were small and, while significant, may not have practical importance. There were no differences in the LHTA between the conditions.

CONCLUSIONS

Changes in the horizontal position of a fixed load affect external measures of craniovertebral posture so consideration needs to be given to not only the weight of a backpack but how the weight is positioned within the backpack.

Spine Cop: Posture Correction Monitor and Assistant

Back and spine-related issues are frequent maladies that most people have or will experience during their lifetime. A common and sensible observation that can be made is regarding the posture of an individual. We present a new approach that combines accelerometer, gyroscope, and magnetometer sensor data in combination with permanent magnets assembled as a wearable device capable of real-time spine posture monitoring. An independent calibration of the device is required for each user. The sensor data is processed by a probabilistic classification algorithm that compares the real-time data with the calibration result, verifying whether the data point lies within regions of confidence defined by a computed threshold. An incorrect posture classification is considered if both accelerometer and magnetometer classify the posture as incorrect. A pilot trial was performed in a single adult test subject. The combination of the magnets and magnetometer greatly improved the posture classification accuracy (89%) over the accuracy obtained when only accelerometer data were used (47%). The validation of this method was based on image analysis.

Comparison of Ultrasonic Thickness of Masseter Muscle Between Individuals With and Without Severe Forward Head Posture: A Cross-Sectional Study

OBJECTIVE

In this cross-sectional descriptive-analytical study, we sought to compare the ultrasonic thickness of the masseter muscle in people with severe forward head posture vs people without forward head posture, and to determine sex differences in muscle thickness.

METHODS

Thirty-eight volunteers (19 with normal head postures and 19 with severe forward head postures), aged 18 to 35 years, entered the study. The severity of the forward head posture was measured by a plumb line and the craniovertebral angle drawn on the recorded images. Based on the recorded images, the masseter muscle thickness was also measured by a 7.5-MHz linear transducer using an ultrasound device in the seated position with 3 mouth positions (closed, half open, and fully open).

RESULTS

The results showed that the head posture affects masseter thickness significantly (P = .01), with masseter thickness significantly lower in the participants without severe forward head postures compared to those with severe forward head postures in the closed, half-open, and fully open mouth positions (P < .05). Comparing the mean masseter thickness across sexes showed that the masseter muscle is significantly thicker in men compared to women (P = .01).

CONCLUSION

Head posture and thickness of the masseter muscle are linked, as the masseter muscle was thicker in all 3 positions in the participants with severe forward head postures.

Does the Degree of Trunk Bending Predict Patient Disability, Motor Impairment, Falls, and Back Pain in Parkinson's Disease?

Background: Postural abnormalities in Parkinson's disease (PD) form a spectrum of functional trunk misalignment, ranging from a "typical" parkinsonian stooped posture to progressively greater degrees of spine deviation. Objective: To analyze the association between degree of postural abnormalities and disability and to determine cut-off values of trunk bending associated with limitations in activities of daily living (ADLs), motor impairment, falls, and back pain. Methods: The study population was 283 PD patients with ≥5° of forward trunk bending (FTB), lateral trunk bending (LTB) or forward neck bending (FNB). The degrees were calculated using a wall goniometer (WG) and software-based measurements (SBM). Logistic regression models were used to identify the degree of bending associated with moderate/severe limitation in ADLs (Movement Disorders Society Unified PD Rating Scale [MDS-UPDRS] part II ≥17), moderate/severe motor impairment (MDS-UPDRS part III ≥33), history of falls (≥1), and moderate/severe back pain intensity (numeric rating scale ≥4). The optimal cut-off was identified using receiver operating characteristic (ROC) curves. Results: We found significant associations between modified Hoehn & Yahr stage, disease duration, sex, and limitation in ADLs, motor impairment, back pain intensity, and history of falls. Degree of trunk bending was associated only with motor impairment in LTB (odds ratio [OR] 1.12; 95% confidence interval [CI], 1.03-1.22). ROC curves showed that patients with LTB of 10.5° (SBM, AUC 0.626) may have moderate/severe motor impairment. Conclusions: The severity of trunk misalignment does not fully explain limitation in ADLs, motor impairment, falls, and back pain. Multiple factors possibly related to an aggressive PD phenotype may account for disability in PD patients with FTB, LTB, and FNB.

Surgeon's Neck Posture during Spine Surgeries: "The Unrecognised Potential Occupational Hazard"

STUDY DESIGN

Observational study.

PURPOSE

The purpose of this study is to analyze the surgeon's neck postures while performing lumbar spinal surgeries.

OVERVIEW OF LITERATURE

Lumbar spinal surgeries are on rising trend, and with increase in number of procedures, the average time spent by a spine surgeon performing surgical procedures is also increasing. The effect of operating posture on the surgeon's neck is largely unknown. From the studies conducted on usage of smartphones, abnormal neck postures, especially the forward head posture (FHP), were found to adversely affect the cervical spine of individuals. The present study analyzes the neck position of spine surgeons during lumbar spine surgeries.

METHODOLOGY

Sixty video recordings (25 open transforaminal lumbar interbody fusions [TLIFs] and 35 lumbar decompression [LD] procedures - 15 with headlight and 20 with operating microscope) of surgeries performed by three spine surgeons of different heights were analyzed. Running videos of the surgeries were recorded concentrating on the surgeons with reflective markers taped to their surface landmarks corresponding to C7 spinous process, tragus of the ear, and outer canthus of the eye. Video recordings were standardized by a fixed video recorder in the same operating theater. Snapshots from the video were obtained whenever the surgeon changes the position. Head flexion angle (HFA), neck flexion angle (NFA), and cervical angle (CA) were measured and analyzed.

RESULTS

During TLIF, HFA and NFA were significantly higher during the phases of decompression and fusion (P < 0.05). The average CA of all surgeons was lower, thereby adversely affecting the cervical spine (20.15° ± 5.05°). During LD, CA showed significant difference between usage of microscope and headlight (P < 0.001).

CONCLUSION

Surgeon's FHP is frequently caused by a compromise between the need to perform surgery with hands, without elevating the arms, and simultaneous control of gaze at surgical field. The usage of microscope was found to reduce the stress on neck while performing surgery.

Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.

Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years

BACKGROUND

Digital photogrammetry provides measurements of body angles or distances which allow for quantitative posture assessment with or without the use of external markers. It is becoming an increasingly popular tool for the assessment of the musculoskeletal system. The aim of this paper is to present a structured method for the analysis of posture and its changes using a standardized digital photography technique.

MATERIAL AND METHODS

The purpose of the study was twofold. The first one comprised 91 children (44 girls and 47 boys) aged 7-10 (8.2 ± 1.0), i.e., students of primary school, and its aim was to develop the photographic method, choose the quantitative parameters, and determine the intraobserver reliability (repeatability) along with the interobserver reliability (reproducibility) measurements in sagittal plane using digital photography, as well as to compare the Rippstein plurimeter and digital photography measurements. The second one involved 7782 children (3804 girls, 3978 boys) aged 7-10 (8.4 ± 0.5), who underwent digital photography postural screening. The methods consisted in measuring and calculating selected parameters, establishing the normal ranges of photographic parameters, presenting percentile charts, as well as noticing common pitfalls and possible sources of errors in digital photography.

RESULTS

A standardized procedure for the photographic evaluation of child body posture was presented. The photographic measurements revealed very good intra- and inter-rater reliability regarding the five sagittal parameters and good reliability performed against Rippstein plurimeter measurements. The parameters displayed insignificant variability over time. Normative data were calculated based on photographic assessment, while the percentile charts were provided to serve as reference values. The technical errors observed during photogrammetry are carefully discussed in this article.

CONCLUSIONS

Technical developments are allowed for the regular use of digital photogrammetry in body posture assessment. Specific child positioning (described above) enables us to avoid incidentally modified posture. Image registration is simple, quick, harmless, and cost-effective. The semi-automatic image analysis, together with the normal values and percentile charts, makes the technique reliable in terms of child's posture documentation and corrective therapy effects' monitoring.

Clinical assessment of subacromial shoulder impingement - Which factors differ from the asymptomatic population?

BACKGROUND

To date, the significance of factors purported to be associated with subacromial shoulder impingement (SSI) and what differences, if any, are present in those with SSI compared to a matched asymptomatic population has not been identified. Gaining information about differences between people with SSI and asymptomatic people may direct clinicians towards treatments that impact upon these differences.

OBJECTIVE

Compare the assessment findings of factors suggested to be associated with SSI; passive posterior shoulder range, passive internal rotation range, resting cervical and thoracic postures, active thoracic range in standing and scapula positioning between cases experiencing SSI and a matched asymptomatic group (controls).

STUDY DESIGN

Case Control Study.

METHOD

Fifty one SSI cases and 51 asymptomatic controls were matched for age, gender, hand dominance and physical activity level. The suggested associated factors were measured bilaterally. Independent t-tests were used to compare each of these measurements between the groups. Any variables for which a significant difference was identified, were then included in a conditional logistic regression analysis to identify independent predictors of SSI.

RESULTS

The SSI group had significantly increased resting thoracic flexion and forward head posture, as well as significantly reduced upper thoracic active motion, passive internal rotation range and posterior shoulder range than the matched asymptomatic group. No independent predictors of SSI were identified in conditional logistic regression analysis.

CONCLUSION

Thoracic posture, passive internal rotation range and posterior shoulder range were significantly different between cases experiencing SSI and a matched asymptomatic group.

LEVEL OF EVIDENCE

Level 3a.

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.

Comparison of isometric force of the craniocervical flexor and extensor muscles between women with and without forward head posture

OBJECTIVE

The stability of the craniocervical (CC) area is provided by CC muscles. Muscle imbalance between forces of these muscles may lead to forward head posture (FHP). FHP is one of the most prevalent abnormal postures in patients with neck pain. The aim of the present study was to compare isometric force of the CC flexor and extensor muscles between women with and without FHP.

METHOD

Isometric force of the CC flexor and extensor muscles was measured by a custom-made device and compared between 70 women with and without FHP (35 in each group).

RESULTS

No significant difference was observed between the two groups regarding isometric force of the CC flexor and extensor muscles, but the ratio of the isometric force of the CC muscles (flexor to extensor) revealed significant difference between the two groups, and it was greater in the control group compared with that in the FHP group.

DISCUSSION

The ratio of isometric force of the CC muscles (flexor to extensor) may be a good indicator for assessment of patients with FHP. This ratio may also be valuable to follow the results of therapeutic intervention for these patients.

Effect of exams period on prevalence of Myofascial Trigger points and head posture in undergraduate students: Repeated measurements study

BACKGROUND

Myofascial Trigger points (MTrPs) may be caused or aggravated by many factors, such as mental stress associated with exams and impaired posture.

AIM

To compare the prevalence and sensitivity of MTrPs, and forward head position (FHP) during exam period vs. mid-semester among physical therapy students.

METHODS

39 physical therapy students were palpated for MTrPs in neck and shoulder muscles and were photographed laterally for FHP measurement during the academic semester and during the academic examination period.

RESULTS

The subjects showed higher prevalence of active MTrPs in the right Trapezius and Levator Scapula muscles, and higher prevalence of latent MTrPs in the left Sternocleidomastoideus and Levator Scapula muscles during exams, as well as a higher rate of tenderness in suboccipital musculature.

CONCLUSIONS

Physical therapy students show greater prevalence of MTrPs during exams. The authors recommend implementing preventative programs towards the examination period.

Measurement of craniovertebral angle by the Modified Head Posture Spinal Curvature Instrument: A reliability and validity study

The Modified Head Posture Spinal Curvature Instrument (MHPSCI) is an extension of the Head Posture Spinal Curvature Instrument. Two specific modifications were made in the original design by adding a third arm projecting horizontally from the protractor to objectively fix the pivot exactly over the C7 vertebra and the addition of a spirit-level to properly align the instrument. In order to demonstrate reliability and validity, this study was conducted using patients with postural neck pain (N = 65) and healthy subjects (N = 20). All the subjects were working at a selected Information Technology Industry in India and had been recruited using a criterion-based sampling approach. The craniovertebral (CV) angle of each subject was evaluated by two raters consecutively. The measurements were taken by using both MHPSCI and the standard photographic method in a standardized sitting posture for the purpose of establishing criterion-validity of the instrument. The results of this study indicate a good inter-rater reliability (ICC = 0.76; CI = 0.65-0.84) as well as intra-rater reliability (ICC = 0.87; CI = 0.82-0.91) between three successive CV angle measurements (with 2 minutes interval between each measurement) through MHPSCI. While keeping the digital photographic measurement as a standard, this study established that the MHPSCI is a valid tool for measuring the CV angle as shown by non-significant difference (p > 0.01) and high correlation between the two methods (r = 0.79-0.84). This study demonstrates that the MHPSCI is a reliable and valid instrument for measuring CV angle in subjects with or without postural neck pain.

Reliability of photographic posture analysis of adolescents

[Purpose] Postural problems of adolescents needs to be evaluated accurately because they may lead to greater problems in the musculoskeletal system as they develop. Although photographic posture analysis has been frequently used, more simple and accessible methods are still needed. The purpose of this study was to investigate the inter- and intra-rater reliability of photographic posture analysis using MB-ruler software. [Subjects and Methods] Subjects were 30 adolescents (15 girls and 15 boys, mean age: 16.4±0.4 years, mean height 166.3±6.7 cm, mean weight 63.8±15.1 kg) and photographs of their habitual standing posture photographs were taken in the sagittal plane. For the evaluation of postural angles, reflective markers were placed on anatomical landmarks. For angular measurements, MB-ruler (Markus Bader- MB Software Solutions, triangular screen ruler) was used. Photographic evaluations were performed by two observers with a repetition after a week. Test-retest and inter-rater reliability evaluations were calculated using intra-class correlation coefficients (ICC). [Results] Inter-rater (ICC>0.972) and test-retest (ICC>0.774) reliability were found to be in the range of acceptable to excellent. [Conclusion] Reference angles for postural evaluation were found to be reliable and repeatable. The present method was found to be an easy and non-invasive method and it may be utilized by researchers who are in search of an alternative method for photographic postural assessments.

Reliability and validity of cervical position measurements in individuals with and without chronic neck pain

OBJECTIVES

The cervical range of motion device (CROM) has been shown to provide reliable forward head position (FHP) measurement when the upper cervical angle (UCA) is controlled. However, measurement without UCA standardization is reflective of habitual patterns. Criterion validity has not been reported. The purposes of this study were to establish: (1) criterion validity of CROM FHP and UCA compared to Optotrak data, (2) relative reliability and minimal detectable change (MDC95) in patients with and without cervical pain, and (3) to compare UCA and FHP in patients with and without pain in habitual postures.

METHODS

(1) Within-subjects single session concurrent criterion validity design. Simultaneous CROM and OP measurement was conducted in habitual sitting posture in 16 healthy young adults. (2) Reliability and MDC95 of UCA and FHP were calculated from three trials. (3) Values for adults over 35 years with cervical pain and age-matched healthy controls were compared.

RESULTS

(1) Forward head position distances were moderately correlated and UCA angles were highly correlated. The mean (standard deviation) differences can be expected to vary between 1·48 cm (1·74) for FHP and -1·7 (2·46)° for UCA. (2) Reliability for CROM FHP measurements were good to excellent (no pain) and moderate (pain). Cervical range of motion FHP MDC95 was moderately low (no pain), and moderate (pain). Reliability for CROM UCA measurements was excellent and MDC95 low for both groups. There was no difference in FHP distances between the pain and no pain groups, UCA was significantly more extended in the pain group (P<0·05).

DISCUSSION

Cervical range of motion FHP measurements were only moderately correlated with Optotrak data, and limits of agreement (LOA) and MDC95 were relatively large. There was also no difference in CROM FHP distance between older symptomatic and asymptomatic individuals. Cervical range of motion FHP measurement is therefore not recommended as a clinical outcome measure. Cervical range of motion UCA measurements showed good criterion validity, excellent test-retest reliability, and achievable MDC95 in asymptomatic and symptomatic participants. Differences of more than 6° are required to exceed error. Cervical range of motion UCA shows promise as a useful reliable and valid measurement, particularly as patients with cervical pain exhibited significantly more extended angles.

The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study

OBJECTIVE

The purpose of this study was to determine the immediate and long-term effects of a multimodal program, with the addition of forward head posture correction, in patients with chronic discogenic lumbosacral radiculopathy.

METHODS

This randomized clinical study included 154 adult patients (54 females) who experienced chronic discogenic lumbosacral radiculopathy and had forward head posture. One group received a functional restoration program, and the experimental group received forward head posture corrective exercises. Primary outcomes were the Oswestry Disability Index (ODI). Secondary outcomes included the anterior head translation, lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, pelvic inclination, leg and back pain scores, and H-reflex latency and amplitude. Patients were assessed at 3 intervals (pretreatment, 10-week posttreatment, and 2-year follow-up).

RESULTS

A general linear model with repeated measures indicated a significant group × time effect in favor of the experimental group on the measures of ODI (F = 89.7; P < .0005), anterior head translation (F = 23.6; P < .0005), H-reflex amplitude (F = 151.4; P < .0005), H-reflex latency (F = 99.2; P < .0005), back pain (F = 140.8; P < .0005), and leg pain (F = 72; P < .0005). After 10 weeks, the results revealed an insignificant difference between the groups for ODI (P = .08), back pain (P = .29), leg pain (P = .019), H-reflex amplitude (P = .09), and H-reflex latency (P = .098). At the 2-year follow-up, there were significant differences between the groups for all variables adopted for this study (P < .05).

CONCLUSIONS

The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.

Anatomical landmark position--can we trust what we see? Results from an online reliability and validity study of osteopaths

BACKGROUND

Practitioners traditionally use observation to classify the position of patients' anatomical landmarks. This information may contribute to diagnosis and patient management.

OBJECTIVES

To calculate a) Inter-rater reliability of categorising the sagittal plane position of four anatomical landmarks (lateral femoral epicondyle, greater trochanter, mastoid process and acromion) on side-view photographs (with landmarks highlighted and not-highlighted) of anonymised subjects; b) Intra-rater reliability; c) Individual landmark inter-rater reliability; d) Validity against a 'gold standard' photograph.

DESIGN

Online inter- and intra-rater reliability study.

SUBJECTS

Photographed subjects: convenience sample of asymptomatic students; raters: randomly selected UK registered osteopaths.

METHODS

40 photographs of 30 subjects were used, a priori clinically acceptable reliability was ≥0.4. Inter-rater arm: 20 photographs without landmark highlights plus 10 with highlights; Intra-rater arm: 10 duplicate photographs (non-highlighted landmarks). Validity arm: highlighted landmark scores versus 'gold standard' photographs with vertical line. Research ethics approval obtained.

RATERS

Osteopaths (n = 48) categorised landmark position relative to imagined vertical-line; Gwet's Agreement Coefficient 1 (AC1) calculated and chance-corrected coefficient benchmarked against Landis and Koch's scale; Validity calculation used Kendall's tau-B.

RESULTS

Inter-rater reliability was 'fair' (AC1 = 0.342; 95% confidence interval (CI) = 0.279-0.404) for non-highlighted landmarks and 'moderate' (AC1 = 0.700; 95% CI = 0.596-0.805) for highlighted landmarks. Intra-rater reliability was 'fair' (AC1 = 0.522); range was 'poor' (AC1 = 0.160) to 'substantial' (AC1 = 0.896). No differences were found between individual landmarks. Validity was 'low' (TB = 0.327; p = 0.104).

CONCLUSION

Both inter- and intra-rater reliability was 'fair' but below clinically acceptable levels, validity was 'low'. Together these results challenge the clinical practice of using observation to categorise anterio-posterior landmark position.

The Intra- and Inter-rater Reliabilities of the Forward Head Posture Assessment of Normal Healthy Subjects

[Purpose] Assessment of posture is an important goal of physical therapy interventions for preventing the progression of forward head posture (FHP). The purpose of this study was to determine the inter- and intra-rater reliabilities of the assessment of FHP. [Subjects and Methods] We recruited 45 participants (20 male subjects, 25 female subjects) from a university student population. Two physical therapists assessed FHP using images of head extension. FHP is characterized by the measurement of angles and distances between anatomical landmarks. Forward shoulder angle of 54° or less was defined as FHP. Intra- and inter-rater reliabilities were estimated using Kendall's Taub correlation coefficients. [Results] Intra-class correlation of intra-rater measurements indicated an excellent level of reliability (0.91), and intra-class correlation of inter-rater measurements showed a good level of reliability in the assessment of FHP (0.75). [Conclusion] Assessment of FHP is an important component of evaluation and affects the design of the treatment regimen. The assessment of FHP was reliably measured by two physical therapists. It could therefore become a useful method for assessing FHP in the clinical setting. Future studies will be needed to provide more detailed quantitative data for accurate assessment of posture.

Severidade da desordem temporomandibular e sua relação com medidas cefalométricas craniocervicais

INTRODUÇÃO: Sabe-se que existe uma relação entre a Desordem Temporomandibular (DTM) e a postura craniocervical, porém, além de os estudos apresentarem resultados inconclusivos, a severidade dos sinais e sintomas de DTM não é considerada. OBJETIVO: Correlacionar índices de severidade da DTM com medidas cefalométricas craniocervicais. MATERIAIS E MÉTODOS: Participaram da pesquisa 32 mulheres entre 19 e 35 anos com diagnóstico de DTM (RDC/TMD). A severidade dos sinais e sintomas da DTM foi avaliada pelo Índice Temoromandibular proposto por Pehling, calculado com base nos achados do exame físico do RDC/TMD (eixo I). A postura craniocervical foi avaliada por cefalometria, por meio de 11 medidas referentes à posição da cabeça, coluna cervical, mandíbula e osso hioide. A normalidade dos dados foi testada pelo teste de Lilliefors e as correlações foram realizadas pelo coeficiente de Spearman. RESULTADOS: Foram encontradas correlações negativas e moderadas entre o ângulo CVT/Hor e os Índices Muscular (p = 0,0288) e Temporomandibular (p = 0,0394); entre o ângulo CPL/Hor (anteriorização) quando correlacionado aos Índices Funcional (p = 0,0482) e Muscular (p = 0,0086) e entre distância do hioide à terceira vértebra cervical (Hy/C3) e o Índice Funcional (p = 0,0155). CONCLUSÕES: Constatou-se associação entre a maior severidade do quadro clínico da DTM e a projeção anterior da cabeça, a flexão da coluna cervical baixa e a menor distância do osso hioide à terceira vértebra cervical. Essa relação sugere que as alterações posturais craniocervicais podem contribuir para a maior intensidade dos sinais e sintomas e perpetuação da DTM.