The magnitude of sagittal head posture displacement and patient demographics predict rehabilitation outcomes in patients with chronic nonspecific neck pain

Abstract

A multicenter, prospective consecutive case series study was conducted in 5 physiotherapy clinics in the UAE from January 2021 to March 2023 to assess rotations and translations of head posture parameters as potential predictors of conservative therapy outcomes in patients with chronic non-specific neck pain (CNSNP). Eighty-six patients (mean age 35 yrs., 65% male) with CNSNP underwent conservative therapy. All participants received a detailed examination including a computerized cervical spine posture analysis and demographic data was collected. Interventions included specific exercises, diathermy, longitudinal traction, education, a detailed exercise program, ergonomic advice, and medications. Interventions were applied 3 times per week for 8 weeks. Follow-up was 6-months after final treatment. A successful outcome was based on a minimum improvement of the following four outcomes using the patient centered outcome questionnaire (PCOQ): (1) reduction of pain by 17.5 points (0-100 NRS); (2) fatigue reduction by 7.5 points; (3) distress reduction by 5 points; and (4) interference reduction by 9.5 points. At 6-month follow-up it was found that success rates for pain, fatigue, distress, and interference were above 60% for the total participants. The logistic regression for predicting overall success in combined outcomes based on age, gender, smoking status, marital status, and sagittal head translation was: (1) Age: the odds ratio (0.69) suggests that as age increases, the likelihood of overall success decreases (p = 0.001); (2) Sex: females have higher odds of overall success compared to males (OR = 2.71, p < 0.001); (3) Smoking status and marital status: neither of these factors were statistically significant predictors of overall success; (4) Sagittal head translation: each unit increase (more anterior) in this abnormal posture reduced the odds of success by 13%, showing a strong and significant effect (OR = 0.13, p < 0.001). Overall, our findings indicate that younger age, female sex, and less sagittal head translation all had a statistically significant impact on the likelihood of success of 6-month outcomes in patients suffering CNSNP.

Keywords: CVA; Case series; Cervical spine; Disability; Forward head posture; Neck pain; Posture.

Fig. 1

Boxplot for posture parameters across genders. CVA(°) craniovertebral angle, Sagittal head translation (in.), Coronal head translation left and right (in.), Lateral angulation lateral head tilt left or right (°), M males, F females.

Fig. 2

Variable inflation factor (VIF) plot for postural variables. A bar graph visually representing VIF values across postural predictors, illustrating significant multicollinearity for values that exceed the threshold of 5 (red dashed line).

Fig. 3

Boxplot of sagittal head translation distance in inches, for: (1) all patients, (2) in successful outcome patients and, (3) in those with lack of success or failure at 6-months.

Fig. 4

Two measurements of forward head posture. (1) The craniovertebral angle (CVA°) is measured using two landmarks: the tragus of the ear and the C7 spinous process (marked in yellow). A line (marked in red) is then extended horizontally from the C7 spinous process, and another connects the C7 to the tragus; this intersection creates the CVA. (2) Sagittal head translation (SHT) in inches. A vertical line is constructed at the center of the glenohumeral joint and the horizontal offset of the tragus of the ear is measured as the SHT in inches. Image created using DAZ3d studio version 4.22.0.16 (https://www.daz3d.com/introducing-genesis-9).

Fig. 5

Coronal head translation (CHT) left and right measured in inches. CHT can be assessed in anterior and posterior views in the PSM app. The figure above shows the CHT (marked in red) of the head from the true vertical plumbline (marked in black). Image created using DAZ3d studio version 4.22.0.16 (https://www.daz3d.com/introducing-genesis-9).

Fig. 6

Lateral head angulation (LHA°) to the left and right (coronal plane bending) can be assessed in either the anterior and posterior views. The figure above shows the LHA (marked in red) of the head from the true vertical plumbline. Image created using DAZ3d studio version 4.22.0.16 (https://www.daz3d.com/introducing-genesis-9).