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  • Title: Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons.
    Author: Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI.
    Journal: Arch Phys Med Rehabil; 2009 Apr; 90(4):669-74. PubMed ID: 19345785.
    Abstract:
    OBJECTIVE: To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals. DESIGN: Single-blind (assessor) cross-sectional study. SETTING: Hospital and general community. PARTICIPANTS: Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images. RESULTS: NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean +/- SD, 45.4 degrees +/-6.8 degrees ; pain-free, mean +/- SD, 48.6 degrees +/-7.1 degrees ; P<.05; confidence interval [CI] for the difference between groups, 0.9 degrees -6.3 degrees ). Dividing the population according to age into younger (</=50y) and older (>50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean +/- SD, 46.1 degrees +/-6.7 degrees ; pain-free, mean +/- SD, 51.8 degrees +/-5.9 degrees ; P<.01; CI for the difference between groups, 1.8 degrees -9.7 degrees ) but no difference for the older group (NP, mean +/- SD, 44.8 degrees +/-7.1 degrees ; pain-free, mean +/- SD, 45.1 degrees +/-6.7 degrees ; P>.05; CI for the difference between groups, -4.9 degrees -4.2 degrees ). No other differences were found between patients and pain-free participants. CONCLUSIONS: Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful.
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