Associations among Limited Neck Flexion, Forward Head Posture, Round Shoulder Posture, and Neck and Shoulder Muscle Length in Patients with Neck Pain
Keywords:
neck pain, forward head, round shoulder, muscle tightness, neck range of motionAbstract
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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