Is forward head posture relevant to cervical muscles performance and neck pain? A case-control study

Leila Ghamkhar, Amir Hossein Kahlaee, Leila Ghamkhar, Amir Hossein Kahlaee

Abstract

Background: Forward head posture (FHP) and muscular dysfunction are likely contributing factors to chronic neck pain (CNP) but there are inconsistent findings on the relevance of these factors to clinical CNP characteristics.

Objective: To compare FHP, cervical muscles size and endurance between CNP and asymptomatic participants and to investigate their association with pain and disability and relative involvement of deep/superficial and flexor/extensor muscles.

Methods: Thirty-two patients with CNP and 35 asymptomatic participants were included in this case-control study. FHP in standing, extensor and flexor muscles endurance and dimensions were assessed using digital photography, clinical tests and ultrasonographic imaging, respectively. The visual analog scale and neck disability index were also used to evaluate CNP patients' clinical characteristics.

Results: Deep flexor (mean difference=0.06, 95% CI=0.02-0.11) and extensor muscles size (mean difference=0.07, 95% CI=0.01-0.12) were found to be significantly smaller in CNP patients. CNP patients also demonstrated lower levels of flexor (mean difference=14.68, 95% CI=3.65-25.72) and global extensor endurance capacity. FHP was neither different between the groups nor correlated with any of the dependent variables. Neither FHP nor endurance was correlated with pain/disability. Extensor endurance in both groups and flexor endurance in the asymptomatic group showed significant correlations with muscles size.

Conclusions: FHP was found neither different between groups nor correlated with muscle performance or CNP clinical characteristics. While cervical endurance was found lower in CNP patients, it did not show any association with pain/disability. The muscular size-endurance relationship seems to become more complex in the presence of NP. While deep muscles seem to be differentially affected in the presence of CNP, the alterations do not seem to be uniform in the flexor and extensor groups.

Keywords: Chronic neck pain; Extensor muscles; Flexor muscles; Head posture; Muscle endurance; Ultrasonography.

Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
An illustration of the assessment of the FHP defined as the cranio-cervical angle (A) and clinical flexor (B) and extensor (C) endurance tests performance.
Figure 2
Figure 2
A sample of US image of the cervical flexor and extensor muscles in one of the subjects from the CNP group: (A) LCO, longus colli; (B) SCM, sternocleidomastoid; LCA, longus capitis; (C) SSCer, semispinalis cervicis; MF, multifidus; (D) Sp Cap, splenius capitis; SSCap, semispinalis capitis. CA, carotid artery; IJV, internal jugular vein; Thy, thyroid gland; SP, spinous process.

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