Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis

Babina Rani; Abhijit Paul; Anil Chauhan; Pranita Pradhan; Mandeep S Dhillon

doi:10.1007/s43465-023-00820-x

Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis

Indian J Orthop. 2023 Jan 18;57(3):371-403. doi: 10.1007/s43465-023-00820-x. eCollection 2023 Mar.

Authors

Babina Rani¹, Abhijit Paul¹, Anil Chauhan², Pranita Pradhan³, Mandeep S Dhillon⁴

Affiliations

¹ Department of Physical Rehabilitation and Medicine (Physiotherapy), PGIMER, Physiotherapy OPD, Ground Floor, New OPD Block, Sector 12, Chandigarh, 160012 India.
² Evidence Based Health Informatics Unit, Department of Telemedicine, PGIMER, Chandigarh, India.
³ MLIS, ICMR Advanced Centre for Evidence Based Child Health, PGIMER, Chandigarh, India.
⁴ Department of Orthopedics, PGIMER, Chandigarh, India.

Abstract

Background: Neck pain (NP) is common in all age groups and adversely affects the patients' entire lifestyle. There exists inconclusive evidence relating faulty craniocervical posture with pain-related disability. This review aims to determine whether sagittal head and neck posture differs in NP and pain-free subjects, to critically appraise the correlation of posture with NP.

Methods: Of 3796 articles identified at primary search from CINAHL, PubMed, Google Scholar, EMBASE, 26 were included based on eligibility criteria. Mean pooled difference (MPD) and effect size (ES) were calculated to establish relationship among studies, to assess postural correlation with NP measures [Visual Analogue Scale (VAS), Numeric Pain Rating Scale (NPRS), neck disability index (NDI), Northwick Park NP Questionnaire (NPQ)] and for age- and gender-wise variation. Risk of bias was assessed using Newcastle-Ottawa Quality Assessment Scale.

Results: Craniovertebral angle (CVA) had a significant MPD of - 2.93(95% CI - 4.95 to - 0.91). Sagittal head angle (SHA) and forward head posture (FHP) had an insignificant MPD of 1.15 (95% CI - 1.16 to 3.46) and - 0.26 (95% CI - 1.89 to 1.36), respectively. Age- and gender-wise CVA difference was found to be 2.36° and 2.57°, respectively. ES was significant for correlation between CVA and pain intensity [NPRS: - 0.44 (95% CI - 0.61 to - 0.26); VAS: - 0.31 (95% CI - 0.46 to - 0.16)], and between CVA and disability [NDI: - 0.18 (95% CI - 0.31 to - 0.05); NPQ: - 0.47 (95% CI - 0.61 to - 0.320)].

Conclusion: CVA differs for age, gender, and pain vs pain-free subjects, and correlates negatively with NP measures. Other surrogate measures (SHA, cranial and cervical angles, FHP) warrant further research.

Prospero registration: PROSPERO 2021 CRD42021275485.

Keywords: Craniocervical posture; Head and neck posture; Neck pain; Posture.

© Indian Orthopaedics Association 2023, corrected publication 2023Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Publication types

Review