Clinical measurement of head and shoulder posture variables

A reliable method that is practical for clinical use for measuring head posture in standing has not been demonstrated in the literature. The purposes of this study were: 1) to produce a reliable method for measuring sagittal plane head and shoulder posture that is practical for clinical use and 2) to perform a pilot study to compare means between a nonpatient sample and a sample of people who have a history of recurring cervical pain. A method of measuring sagittal plane postural alignment of the head and shoulder in relationship to the lateral malleolus was developed using a carpenter's tri-square with a line level attached to the horizontal arm and a goniometer with a line level attached to the horizontal arm. Horizontal measures were taken with the tri-square from a vertical reference point to the tragus of the ear, to the shoulder axis, and to the lateral malleolus. Angular measures were taken with the goniometer of C7-tragus with the horizontal and tragus-corner of the eye with the horizontal. A reliability study was performed by two therapists with 15 non-patient subjects. Intraclass correlation coefficients measuring interrater reliability for horizontal and angular measures were as follows: 1) tragus to lateral malleolus: R = .87; 2) shoulder to lateral malleolus: R = .91;3) tragus to shoulder: R = .7;4) angle tragus-eye-horizon: R = .68; and 5) angle C7-tragus-horizon: R = .34. In the pilot study, 41 nonpatient subjects (11 males and 30 females, 20-45 years) and 10 patient subjects with cervical pain (one male and nine females, 23-43 years) were measured. Means calculated for horizontal distances (in cm) were: 1) tragus to lateral malleolus (nonpatients: 8.14; patients: 6.65);2) shoulder to lateral malleolus (nonpatients: 5.47; patients: 5.98); and 3) tragus to shoulder (nonpatients: 2.78; patients: .56). Means calculated for angular measures were: 1) tragus-eye-horizon (nonpatients: 18.78 degrees; patients: 21.57 degrees) and 2) C7-tragus-horizon (nonpatients: 49.34 degrees; patients: 49.43 degrees). No statistically significant differences were found between the two samples in this pilot study using an independent two-sample t test. This study demonstrates a reliable and practical method for taking postural measurements in the clinic and describes a pilot study for comparing a patient and a nonpatient sample.