Assessment of forward head posture in individuals with and without chronic neck pain: A cross-sectional study

Chronic neck pain (CNP) is a leading cause of disability worldwide. Forward head posture (FHP) is a prevalent craniocervical posture, with controversy regarding its relationship with CNP. The craniovertebral angle (CVA) is commonly used to assess FHP.

To determine whether significant differences in head posture, assessed through the CVA, exist between adults with and without CNP. Secondary objectives include conducting an exploratory analysis of variables, evaluating intra- and interobserver reliability of CVA by novice evaluators and analyzing CVA correlations between sitting and standing.

Two-group cross-sectional study.

92 participants were evaluated (50 with CNP, 42 asymptomatic). CVA was measured in sitting and standing using photogrammetry. Sociodemographic data, musculoskeletal pain prevalence, pain intensity, general health, physical activity, and neck disability were collected. CVA intra- and interobserver reliability was assessed using Kinovea. Factors associated with CVA were identified using multiple linear regression analysis.

No association was found between FHP and CNP. Gender and BMI were associated with CVA. Women had significantly lower CVA than men seated (B= -2.5, p = 0.024) and standing (B= -2.0, p = 0.031). Overweight individuals had significantly lower CVA than normal-weight individuals seated and standing (B= -0.6, p < 0.001 for both). Inter- and intra-reliability in both positions was excellent (all ICC > 0.90). A correlation was observed between sitting and standing measurements.

No significant association was found between CNP and FHP based on CVA. Sex, age and BMI demonstrated a substantial influence on head posture. CVA photogrammetry is reliable for novice evaluators.