Head Posture and Neck Pain of Chronic Nontraumatic Origin: A Comparison Between Patients and Pain-Free Persons

Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons.ObjectiveTo compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals.DesignSingle-blind (assessor) cross-sectional study.SettingHospital and general community.ParticipantsConsecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40).InterventionsNot applicable.Main Outcome MeasuresThree 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.ResultsNP 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°±6.8°; pain-free, mean ± SD, 48.6°±7.1°; P<.05; confidence interval [CI] for the difference between groups, 0.9°–6.3°). 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°±6.7°; pain-free, mean ± SD, 51.8°±5.9°; P<.01; CI for the difference between groups, 1.8°–9.7°) but no difference for the older group (NP, mean ± SD, 44.8°±7.1°; pain-free, mean ± SD, 45.1°±6.7°; P>.05; CI for the difference between groups, –4.9°–4.2°). No other differences were found between patients and pain-free participants.ConclusionsYounger 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.