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Biomechanical Variances in the Development of Forward Head Posture

  • Yasemin Deniz (Department of Physical Therapy, College of Health Science, Sun Moon University) ;
  • Esra Pehlivan (Department of Physiotherapy and Rehabilitation, Faculty of Hamidiye Health Sciences, University of Health Sciences) ;
  • Eda Cicek (Department of Arts and Physical Education, Healthy and Exercise Science, Inha University)
  • Received : 2024.04.23
  • Accepted : 2024.06.13
  • Published : 2024.08.20

Abstract

Forward Head Posture (FHP) involves the anterior positioning of the head relative to the shoulders, often associated with muscular imbalances. It is known that individuals with FHP experience shortening of craniocervical extensors and cervical flexors. However, contrary to the understanding of flexion in the craniocervical extension subaxial region, a study has reported flexion in the craniovertebral spinal vertebrae among individuals with FHP. The aim of this study was to examine the consistency of biomechanical study results conducted for FHP. The relevant studies were investigated in PubMed and Google Scholar databases using the keywords "forward head posture OR cervical sagittal alignment OR cervical spine AND biomechanics OR kinetic analysis OR kinematic analysis." During the research selection process, only nine studies relevant to the purpose of our study were identified. Out of these nine studies, four conducted kinematic analysis related to FHP formation, while six conducted kinetic analysis. During the comparison of these studies, five inconsistencies were identified. Biomechanical studies on FHP reveal conflicting findings, suggesting potential variability in the biomechanics of FHP formation across individuals. However, drawing definitive conclusions requires further exploration through additional biomechanical investigations on FHP in the future.

Keywords

Acknowledgement

YD would like to express her appreciation for the financial support of the Ministry of Education, which made it possible to obtain a master's degree through the Korean Government Scholarship Program.

References

  1. Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons. Arch Phys Med Rehabil 2009;90(4):669-74. 
  2. Yip CH, Chiu TT, Poon AT. The relationship between head posture and severity and disability of patients with neck pain. Man Ther 2008;13(2):148-54. 
  3. Alowa Z, Elsayed W. The impact of forward head posture on the electromyographic activity of the spinal muscles. J Taibah Univ Med Sci 2020;16(2):224-30. 
  4. 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. 
  5. Lau KT, Cheung KY, Chan KB, Chan MH, Lo KY, Chiu TT. Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Man Ther 2010;15(5):457-62. 
  6. Kalmanson OA, Khayatzadeh S, Germanwala A, Scott-Young M, Havey RM, Voronov LI, et al. Anatomic considerations in headaches associated with cervical sagittal imbalance: a cadaveric biomechanical study. J Clin Neurosci 2019;65:140-4. 
  7. Naz A, Bashir MS, Noor R. Prevalance of forward head posture among university students. Rawal Med J 2018;43(2):260-2. 
  8. Titcomb DA, Melton BF, Miyashita T, Bland HW. The effects of postural education or corrective exercise on the craniovertebral angle in young adults with forward head posture: a randomized controlled trial. Int J Exerc Sci 2023;16(1):954-73. 
  9. Goodarzi F, Karimi N, Rahnama L, Khodakarim L. Differences in cervical extensor muscles thickness on subjects with normal head posture and forward head posture: an ultrasonography study. J Rehabil Sci Res 2015;2(2):23-6. 
  10. Lin G, Wang W, Wilkinson T. Changes in deep neck muscle length from the neutral to forward head posture. A cadaveric study using Thiel cadavers. Clin Anat 2022;35(3):332-9. 
  11. Bokaee F, Rezasoltani A, Manshadi FD, Naimi SS, Baghban AA, Azimi H. Comparison of cervical muscle thickness between asymptomatic women with and without forward head posture. Braz J Phys Ther 2017;21(3):206-11. 
  12. Patwardhan AG, Havey RM, Khayatzadeh S, Muriuki MG, Voronov LI, Carandang G, et al. Postural consequences of cervical sagittal imbalance: a novel laboratory model. Spine (Phila Pa 1976) 2015;40(11):783-92. 
  13. 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. 
  14. Martini ML, Neifert SN, Chapman EK, Mroz TE, Rasouli JJ. Cervical spine alignment in the sagittal axis: a review of the best validated measures in clinical practice. Global Spine J 2021;11(8):1307-12. 
  15. Yang S, Feuchtbaum E, Werner BC, Cho W, Reddi V, Arlet V. Does anterior shoulder balance in adolescent idiopathic scoliosis correlate with posterior shoulder balance clinically and radiographically? Eur Spine J 2012;21(10):1978-83. 
  16. Patwardhan AG, Khayatzadeh S, Havey RM, Voronov LI, Smith ZA, Kalmanson O, et al. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J 2018;27(Suppl 1):25-38. 
  17. Beange KHE, Chan ADC, Beaudette SM, Graham RB. Concurrent validity of a wearable IMU for objective assessments of functional movement quality and control of the lumbar spine. J Biomech 2019;97:109356. 
  18. Fercho J, Krakowiak M, Yuser R, Szmuda T, Zielinski P, Szarek D, et al. Kinematic analysis of the forward head posture associated with smartphone use. Symmetry 2023;15(3):667. 
  19. Eun J, Kwon O, Hwang U, Jung S, Ahn S. Comparison of upper and lower cervical muscle strengths between subjects with and without forward head posture. Phys Ther Korea 2020;27(4):272-7. 
  20. Goodarzi F, Rahnama L, Karimi N, Baghi R, Jaberzadeh S. The effects of forward head posture on neck extensor muscle thickness: an ultrasonographic study. J Manipulative Physiol Ther 2018;41(1):34-41. 
  21. Quek J, Pua YH, Clark RA, Bryant AL. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther 2013;18(1):65-71. 
  22. Haughie LJ, Fiebert IM, Roach KE. Relationship of forward head posture and cervical backward bending to neck pain. J Man Manip Ther 1995;3(3):91-7. 
  23. Simons DG, Travell JG, Simons LS. Travell & Simons' myofascial pain and dysfunction: the trigger point manual. 2nd ed. Vol. 1, Upper half of body. Lippincott Williams & Wilkins; 1999. 
  24. Bakkum BW, Cramer GD. Muscles that influence the spine. In: Cramer GD, Darby SA editors. Clinical anatomy of the spine, spinal cord, and ans. 3rd ed. Elsevier; 2014; 98-134. 
  25. Levangie PK, Norkin CC. Joint structure and function: a comprehensive analysis. 5th ed. F. A. Davis; 2011. 
  26. Alghadir AH, Iqbal ZA. Effect of deep cervical flexor muscle training using pressure biofeedback on pain and forward head posture in school teachers with neck pain: an observational study. Biomed Res Int 2021;2021:5588580. 
  27. Nam KS, Kwon JW. The effects of head position in different sitting postures on muscle activity with/without forward head and rounded shoulder. J Korean Soc Phys Ther 2014;26(3):140-6. 
  28. Jung B, Black AC, Bhutta BS. Anatomy, head and neck, neck movements. In: Aboubakr S, Abu-Ghosh A, Adibi Sedeh P, Aeby TC, Aeddula NR, Agadi S, et al. editors. StatPearls. Stat-Pearls Publishing; 2023. 
  29. Aroeira RMC, Furlan RMMM, de Melo Pertence AE, de Las Casas EB, Greco M. Relationship between head posture and lumbar curve in a sitting position: a biomechanical study. Fisioter Mov 2017;30(3):453-61.