Associations among Limited Neck Flexion, Forward Head Posture, Round Shoulder Posture, and Neck and Shoulder Muscle Length in Patients with Neck Pain

Authors

  • Varatta Nanarnon Faculty of Physical Therapy, Mahidol University
  • Ladawan Thermworakul Faculty of Physical Therapy, Mahidol University
  • Varot Eakpinitpittaya Faculty of Physical Therapy, Mahidol University
  • Peemongkon Wattananon Spine Biomechanics Laboratory, Faculty of Physical Therapy, Mahidol University, Thailand

Keywords:

neck pain, forward head, round shoulder, muscle tightness, neck range of motion

Abstract

Patients with neck pain commonly have limited neck flexion. Theoretically, neck and shoulder muscles might be responsible for those abnormal postures, and limited neck flexion. This study aimed to determine (1) differences in neck range of motion among normal posture, forward head, round shoulder, and both abnormal postures, (2) associations between neck and shoulder muscle tightness and limited neck flexion, and (3) diagnostic accuracy of muscle tightness to predict limited neck flexion in patients with neck pain. This study used data from assessment forms for 838 patients with neck pain (mean age 48.3 years, 565 females). Range of neck motion, posture, and muscle length were recorded. Kruskal-Wallis test with post-hoc comparison was used to compare neck flexion among different postures; and Chi-square test was used to determine the association between muscle length and neck flexion. Additionally, diagnostic accuracy statistics (sensitivity, specificity, positive/negative likelihood ratio, and accuracy) were used to determine the ability of muscle tightness to predict limited neck flexion. Results showed that patients with forward head posture had greater limited neck flexion (p<0.05) than patients with normal or round shoulder posture. Chi-square test revealed upper trapezius, pectoralis major, and pectoralis minor muscles were significantly associated with limited neck flexion (p<0.05). Diagnostic accuracy demonstrated positive likelihood ratio of those muscles as 1.07, 1.09 and 1.18, respectively, and accuracy as 64.0%, 68.0% and 61.0%, respectively. Findings suggested correction of forward head posture could increase neck flexion. Upper trapezius, pectoralis major and minor muscles might be responsible for limited neck flexion. If patients had limited neck flexion, clinicians could assess and treatment these muscles to increase neck flexion, which should help reducing examination time and selecting a more effective intervention for patients with neck pain who have limited neck flexion.

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References

Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol 2010;24(6):783-92.

Genebra C, Maciel NM, Bento TPF, Simeão S, Vitta A. Prevalence and factors associated with neck pain: a population-based study. Braz J Phys Ther 2017;21(4):274- 80.

Janwantanakul P, Pensri P, Jiamjarasrangsri V, Sinsongsook T. Prevalence of self-reported musculoskeletal symptoms among office workers. Occup Med 2008; 58(6):436-8.

Cagnie B, Danneels L, Van Tiggelen D, De Loose V, Cambier D. Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur Spine J 2007;16(5):679-86.

Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med 2012;36(1):98-104.

Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles testing and function with posture and pain. 5th ed. Baltimore: Lippincott Williams & Wilkins; 2005.

Ariëns GA, Bongers PM, Douwes M, Miedema MC, Hoogendoorn WE, van der Wal G, et al. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Occup Environ Med 2001;58(3):200-7.

McDonnell MK. Movement system syndromes of the cervical spine. In: Sahrmann SaA, eds. Movement system impairment syndromes of the extremities, cervical and thoracic spines. Missouri: Elsevier Mosby; 2011. p. 51-74, 92-3.

Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach. Champaign, IL: Human Kinetics; 2010. p. 52-3, 105-8.

Wong CK, Coleman D, diPersia V, Song J, Wright D. The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. J Bodyw Mov Ther 2010;14(4):326-33.

Sahrmann S. Diagnosis and treatment of movement impairment syndromes St. Louis: Mosby; 2002.

Janda V. Muscles and motor control in cervicogenic disorders: assessment and management. New York: Churchill Livingstone; 1994.

Nejati P, Lotfian S, Moezy A, Moezy A, Nejati M. The relationship of forward head posture and rounded shoulders with neck pain in Iranian office workers. Med J Islam Repub Iran 2014;28:26.

Khayatzadeh S, Kalmanson OA, Schuit D, Havey RM, Voronov LI, Ghanayem AJ, et al. Cervical spine muscle-tendon unit length differences between neutral and forward head postures: biomechanical study using human cadaveric specimens. Phys Ther 2017;97(7):756-66.

Yoo WG, An DH. The relationship between the active cervical range of motion and changes in head and neck posture after continuous VDT work. Ind Health 2009; 47(2):183-8.

Paris SV. Introduction to evaluation and manipulation of the spine. St. Augustine, Florida: Institute Press; 1988.

Petty NJ. Neuromusculoskeletal examination and assessment: a handbook for therapists. Edinburgh: Elsevier/ Churchill Livingstone; 2006.

Magee DJ. Orthopedic physical assessment. 6th ed. St. Louis: Elsevier Saunders; 2014.

Kim DH, Kim CJ, Son SM. Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion. Osong Public Health Res Perspect 2018;9(6):309-13.

Quek J, Pua YH, Clark RA, Bryant AL. Effects of thoracic kyphosis and forward head posture on cervicalrange of motion in older adults. Man Ther 2013;18(1):65- 71.

Shahidi B, Johnson CL, Curran-Everett D, Maluf KS. Reliability and group differences in quantitative cervicothoracic measures among individuals with and without chronic neck pain. BMC Musculoskeletal Disorders 2012;13(1):215.

Johnson J. Postural correction. Champaign, IL: Human Kinetics; 2016.

Kang JI, Jeong DK, Choi H. Correlation between pulmonary functions and respiratory muscle activity in patients with forward head posture. J Phys Ther Sci 2018; 30(1):132-5.

Published

2023-04-21

How to Cite

นันอนนท์ ว., เติมวรกุล ล., เอกพินิจพิทยา ว., & วัฒนานนท์ พ. (2023). Associations among Limited Neck Flexion, Forward Head Posture, Round Shoulder Posture, and Neck and Shoulder Muscle Length in Patients with Neck Pain. Journal of Health Science of Thailand, 32(2), 240–251. Retrieved from https://thaidj.org/index.php/JHS/article/view/13615

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Section

Original Article (นิพนธ์ต้นฉบับ)

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