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

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

Babina Rani  1 , Abhijit Paul  1 , Anil Chauhan  2 , Pranita Pradhan  3 , Mandeep S Dhillon  4
Affiliations
Review

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

Babina Rani et al. Indian J Orthop. .

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.

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Conflict of interest statement

Conflict of InterestON behalf of all the authors, the corresponding author states that there is no conflict of interest. The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart
Fig. 2
Fig. 2
Forest plot of craniovertebral angle (photographically analyzed). Comparison between Neck pain and Control (pain-free) subjects
Fig. 3
Fig. 3
Forest plot of sagittal head angle. Comparison between neck pain and control (pain-free) subjects
Fig. 4
Fig. 4
Forest plot of FHP. Comparison between neck pain and control (pain-free) subjects
Fig. 5
Fig. 5
Meta-analysis of age-wise variation in Craniovertebral Angle. Comparison between young (10–50 years) and elderly (> 50 years) subjects with neck pain
Fig. 6
Fig. 6
Meta-analysis of gender-wise variation in craniovertebral Angle. Comparison between female and male subjects with neck pain
Fig. 7
Fig. 7
a, b Meta-analysis of correlation of craniovertebral angle with neck pain Intensity measured through a NPRS and b VAS. c, d Meta-analysis of correlation of craniovertebral angle with neck pain disability measured through c NDI and d NPQ
Fig. 8
Fig. 8
Funnel plot of craniovertebral angle (photographically analyzed)
See this image and copyright information in PMC

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