Scapular Depression at Rest: Implications for Cervical Pain and Functional Outcomes

The Effect of Depressed Scapular Position at Rest on the Neck Pain and Function

The purpose of this study is to explore whether depressed scapular alignment is associated with increased neck pain and decreased cervical functional capacity, and to investigate the correlation between the mean vertical scapular distance of both scapulae at rest, neck pain intensity, and cervical function.

Study Overview

• Status: Completed
• Conditions: Neck Pain; Neck Disability
• Intervention / Treatment: Other: Assessment of the Vertical Scapular Position at Rest; Other: Measurement of the Mean Vertical Scapular Distance at Rest; Other: The Arabic version of Bournemouth questionnaire for neck pain (BQN); Other: The Arabic Version of Copenhagen Neck Functional Disability Scale (CNFDS)

Detailed Description

Introduction Neck pain is a major global health problem affecting a large portion of the adult population, with a worldwide prevalence ranging from 16.7% to 75.1%. The economic burden associated with neck pain is substantial, manifested through job-related issues, absenteeism, reduced productivity, and elevated treatment costs. In the United States alone, approximately 25.5 million individuals missed an average of 11.4 working days due to neck pain in 2012, and in 2016, healthcare expenditures related to neck pain reached approximately $134.5 billion, making it one of the most costly health conditions in the country.

While pain intensity has its socioeconomic consequences, also neck dysfunction constitutes an equally important dimension of this condition. Impaired neck function has been linked to deficits in cervical range of motion, proprioception, and muscular endurance, all of which can compromise daily activities, work performance, and overall quality of life. Among the multiple biomechanical factors influencing neck pain and function, the scapular position has gained growing attention. The scapula plays a critical role in maintaining postural alignment and providing a stable base for neck and shoulder movement.

Studies have shown initial evidence that individuals with neck pain may demonstrate altered scapular alignment when compared with healthy controls, though the limited sample sizes in such studies constrain the strength of these conclusions and warrant further investigation.

Also altered scapular alignment has been associated with decreased pressure pain thresholds (PPT) in the upper trapezius region, indicating heightened sensitivity to pain. Moreover, it may alter the length-tension relationship of the upper trapezius and levator scapulae muscles, potentially compromising cervical stability and movement efficiency. Such biomechanical alterations may manifest as reduced neck functional capacity, including limited range of motion and diminished performance in daily activities.

Assessment of scapular position and its influence on the cervical region has been carried out through several approaches, including comparisons of scapular resting alignment in individuals with and without neck pain, the analysis of how altering scapular positioning affects both pain and neck function, and the evaluation of pressure pain threshold in the upper trapezius as an indicator of sensitization. Despite these efforts, the relationship between depressed scapular position at rest, neck pain, and cervical function remains insufficiently explored, highlighting the need for further research to clarify this interaction. To our knowledge, the correlation between the mean vertical scapular distance of both scapulae at rest, neck pain and cervical function is not yet investigated or studied.

In this study, the investigator tried to shed some light on the effect of the depressed scapular position at rest on the neck region in terms of pain intensity, cervical function and to understand the correlation between the mean vertical scapular distance of both scapulae at rest, neck pain and cervical function which will help us to explore new measurements to be used in the diagnosis and the prognosis of patients with neck pain and cervical dysfunction.

Study Design: Cross-Sectional Observational study

Study groups

Included subjects were divided according to the vertical scapular position at rest into two groups:

1. - Control group (A): 64 subjects with normal scapular position at rest.
2. - Study group (B): 64 subjects with depressed Scapular position at rest.

Each participant was assessed once on the same day of enrollment. No follow-up assessments will be performed.

Statistical Analysis Statistical analysis was performed through the statistical package for social sciences (SPSS) version 20 for windows.

Statistical Procedures

The following statistical procedures were conducted:

1. Descriptive statistics was used to summarize and describe the main features of a dataset and conducted in terms of mean and standard deviation.
2. Unpaired t test was conducted for comparison of the subject characteristics between groups.
3. Shapiro Wilktest was conducted for testing normality of data.
4. One way MANOVA was used for comparison of the Mean Vertical Scapular Distance of both scapulae at rest (Z), Non-Derangement Mechanical Neck Pain, and Cervical Function between groups.
5. Spearman correlation coefficient was conducted to investigate the correlation between the Mean Vertical Scapular Distance of both scapulae at rest (Z), Non-Derangement Mechanical Neck Pain, and Cervical Function.
6. The level of significance for all statistical tests was set at p < 0.05.

• Study Type: Observational
• Enrollment (Actual): 128

Contacts and Locations

Study Locations

• Egypt
  • Giza Governorate
    • Cairo, Giza Governorate, Egypt, 11251
      • The Faculty of Physical Therapy at Cairo University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The Faculty of Physical Therapy at Cairo University

Description

Inclusion Criteria:

1. - Young adults with age from 18 to 30 years old.
2. - Subjects with Body Mass Index less than 30

Exclusion Criteria:

1. - Cervical spine surgeries, fractures or pathologic trauma, Subjects with cervical or shoulder neurological movement disorder, Tempromandibular surgery, psychosocial problem.
2. - A documented diagnosis of scoliosis or a posterior rib hump greater than five degrees on forward bending as measured with the scoliometer (ATR ≥ 5°).
3. - Known or measured Leg Length Discrepancy (LLD) greater than 1 cm.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Control Group; Subjects with Normal Scapular Position at Rest	Other: Assessment of the Vertical Scapular Position at Rest; Assessment of the Vertical Scapular Position at Rest using a Laser level meter, a tripod head, a camera and adhesive round stickers.; Other: Measurement of the Mean Vertical Scapular Distance at Rest; Measurement of the Mean Vertical Scapular Distance at Rest of both Scapulae using the Protractor - T8 method; Other: The Arabic version of Bournemouth questionnaire for neck pain (BQN); The Arabic version of Bournemouth questionnaire for neck pain (BQN) to measure Non Derangement Mechanical Neck Pain; Other: The Arabic Version of Copenhagen Neck Functional Disability Scale (CNFDS); The Arabic Version of Copenhagen Neck Functional Disability Scale (CNFDS) to measure cervical function
Study Group; Subjects with Depressed Scapular Position at Rest	Other: Assessment of the Vertical Scapular Position at Rest; Assessment of the Vertical Scapular Position at Rest using a Laser level meter, a tripod head, a camera and adhesive round stickers.; Other: Measurement of the Mean Vertical Scapular Distance at Rest; Measurement of the Mean Vertical Scapular Distance at Rest of both Scapulae using the Protractor - T8 method; Other: The Arabic version of Bournemouth questionnaire for neck pain (BQN); The Arabic version of Bournemouth questionnaire for neck pain (BQN) to measure Non Derangement Mechanical Neck Pain; Other: The Arabic Version of Copenhagen Neck Functional Disability Scale (CNFDS); The Arabic Version of Copenhagen Neck Functional Disability Scale (CNFDS) to measure cervical function

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck Pain	The Arabic version of Bournemouth questionnaire for neck pain (BQN) will be used to measure Neck Pain. The lowest score is 0 and the highest score is 70. High scores reflect severe pain and lower life quality.	Baseline
Cervical Function	The Arabic Version of Copenhagen Neck Functional Disability Scale (CNFDS) will be used to measure cervical function. The lowest score is 0 and the highest score is 30. Worse disability is indicated by higher scores.	Baseline
The Vertical Scapular Distance at Rest for both Scapulae	The Vertical Scapular Distance at Rest will be measured using a Protractor (the Protractor - T8 method). The spinous process of T8 (SPT8) and the inferior angle of the scapula (IAS) serving as the primary anatomical landmarks of interest. Two horizontal lines are drawn at these two anatomical landmarks representing their horizontal levels, then the vertical distance between these two levels is measured three times, then their mean was recorded, the spirit level of the protractor ensures that the level of the measurement was the same at all times. this process was done for the right and the left scapulae, and the mean of the two scapulae measurements was calculated.	Baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Axial Trunk Rotation (ATR)	A Scoliometer will be used to measure the axial trunk rotation (ATR) in degrees. While standing, participants were asked to expose their trunks, Then they asked to perform Adam's forward bending test with their hands clasped together until their backs were parallel to the ground. In order to get the ATR values, a scoliometer was used placing its center (notch) above the spinous process and perpendicular to the spine. The thoracic hump and the lumbar hump were the sites of interest for measuring ATR values.	Baseline
Leg Length Discrepancy (LLD)	A standard tape measure will be used to measure leg length discrepancy (LLD) in centimeters. The measurement was taken from the anterior superior iliac spine (ASIS) to the distal tip of the medial malleolus and the reading was taken to the closest 5 mm.	Baseline

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): December 20, 2023
• Primary Completion (Actual): December 23, 2024
• Study Completion (Actual): February 10, 2025

Study Registration Dates

• First Submitted: March 17, 2026
• First Submitted That Met QC Criteria: March 17, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 23, 2026
• Last Update Submitted That Met QC Criteria: March 19, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Depressed scapular position at rest; The Protractor T8-method; Bournemouth questionnaire for neck pain (BQN); Copenhagen Neck Functional Disability Scale (CNFDS)
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Neck Pain
• Other Study ID Numbers: P.T.REC/012/006018

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No