Physical Therapy Korea
eISSN 2287-982X
QR Code
eISSN 2287-982X
Article
Article Tools
Share this article on :
Starts or metrics
Article
Review Article
Split Viewer
Phys. Ther. Korea 2024; 31(2): 104-113
Published online August 20, 2024
https://doi.org/10.12674/ptk.2024.31.2.104
© Korean Research Society of Physical Therapy
Biomechanical Variances in the Development of Forward Head Posture
Yasemin Deniz1 
, PT, MSc, Esra Pehlivan2 , PT, PhD, Eda Cicek3 , PT, MSc
1Department of Physical Therapy, College of Health Science, Sun Moon University, Asan, Korea, 2Department of Physiotherapy and Rehabilitation, Faculty of Hamidiye Health Sciences, University of Health Sciences, Istanbul, Turkiye, 3Department of Arts and Physical Education, Healthy and Exercise Science, Inha University, Incheon, Korea
Correspondence to: Yasemin Deniz
E-mail: yyasemindeniz@gmail.com
https://orcid.org/0009-0000-2769-7942
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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: Biomechanical analysis, Forward head posture, Kinematic analysis, Kinetic analysis, Sagittal alignment
PDF
Standard view
Export citation
Share Article
Review Article
Phys. Ther. Korea 2024; 31(2): 104-113
Published online August 20, 2024 https://doi.org/10.12674/ptk.2024.31.2.104
Copyright © Korean Research Society of Physical Therapy.
Biomechanical Variances in the Development of Forward Head Posture
Yasemin Deniz1 , PT, MSc, Esra Pehlivan2 , PT, PhD, Eda Cicek3 , PT, MSc
1Department of Physical Therapy, College of Health Science, Sun Moon University, Asan, Korea, 2Department of Physiotherapy and Rehabilitation, Faculty of Hamidiye Health Sciences, University of Health Sciences, Istanbul, Turkiye, 3Department of Arts and Physical Education, Healthy and Exercise Science, Inha University, Incheon, Korea
Correspondence to:Yasemin Deniz
E-mail: yyasemindeniz@gmail.com
https://orcid.org/0009-0000-2769-7942
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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: Biomechanical analysis, Forward head posture, Kinematic analysis, Kinetic analysis, Sagittal alignment
Fig 1.
Download
Fig 2.
Download
-
Table 1 . General characteristics of the selected studies.
Study Criteria for
recognizing FHPGeneral characteristics of participants Outcomes Main outcomes Khayatzadeh et al. [13], 2017 SVA 13 Fresh-frozen cadaveric cervical spine specimens (9 males, 4 females)
Age = 54 ± 15 yearsMuscle length, segmental angular motion Kinematic changes:
C0–C2: Hyperextension occurs
C2–C7: Flexion occurs
Muscle length changes:
Shortened muscles:
Occipital extensor muscles
Cervical flexor muscles
Elongated muscles:
Occipital flexor muscles
Cervical extensor musclesPatwardhan et al. [16], 2015 SVA 10 Cadaveric cervical spines (occiput–T1)
Age = 54 (21–59) yearsSegmental angular motion Forward head displacement:
Displacement: 4 cm forward
Resulting extension:
Approximately 12 degrees of extension between
the occiput and C1
Approximately 12 degrees of extension between
C1 and C2
Resulting flexion:
Approximately 10 degrees of flexion below C5–C6
Study findings on SVA (sagittal vertical axis):
Subaxial spinal vertebrae (below C2): Increased SVA results in flexion
Axial vertebrae (C0–C2): Increased SVA results in hyperextensionLin et al. [10], 2022 1. CVA for NHP = 55
2. CVA for slight FHP = 55° > and < 45°
3. CVA for severe FHP 45° > and 35° <6 Cadavers(4 males and 2 females)
Age = 86.2 ± 8.7 yearsDeep neck muscle length Comparison of neutral posture to slight (FHP):
Shortening observed:
Upper SSC muscle
RCP muscles
Lengthening observed:
Longus capitis muscle
Splenius cervicis muscle
Comparison of neutral posture to severe FHP:
Shortening observed:
All occipital extensors (excluding OCS)
Lengthening observed:
All cervical extensor muscles
Superior oblique part of the LCo muscle
Comparison of slight FHP to severe FHP:
Elongation observed:
Superior oblique part of the LCo muscleFercho et al. [18], 2023 N = 25(11 females and 15 males)
Age = 23.36 ± 2.79 yearsSegmental angular motion Sitting posture while using a phone:
C0–C1 Joint:
33.33 degrees of flexion
Subaxial spinal segments:
1.05 degrees of extension
Standing while using a phone:
C0–C1 region:
27.50 degrees of flexion
Subaxial spinal segments:
2.50 degrees of flexion
Walking while using a phone:
C0–C1 region:
32.03 degrees of flexion
Subaxial vertebrae:
3.30 degrees of extensionEun et al. [19], 2020 CVA < 48° FHP = 24 (15 males)
CVA = 44.8° ± 2.0°
NHP = 27 (10 males)
CVA = 52.5° ± 3.0°
Age = 32.6 ± 4.8 years (for all participants)Muscle strength (UCE, LCE, UCF, LCF) Statistical observations:
Significant decreases:
Strength of LCE
Strength of UCF
Non-significant changes:
Strength of LCF
Strength of UCE
Significant increase in ratio:
LCF strength to LCE strength in the FHP group
No significant change in ratio:
UCF strength to UCE strengthBokaee et al. [11], 2017 CVA < 48° FHP = 35 females
Age = 24.94 years (5.13)
CVA = 43.76°
NHP = 35 females
Age = 25.18 years (5.52)
CVA = 54.26°Cervical muscle thickness (RCP, OCS, SSC, SCM, and LCo) Statistical observations:
Significant increase:
Thickness of the SCM muscle in the FHP group
Non-significant changes:
Increases in the thickness of other muscles
(RCP, OCS, SSC, LCo) in the FHP groupGoodarzi et al. [9], 2015 CVA FHP (n = 20)
CVA = 43.43° ± 2.58°
Age = 21.30 ± 2.36 years
NHP (n = 20)
CVA = 55.90° ± 2.25°
Age = 21.85 ± 2.87 yearsExtensor muscles thickness at rest (multifidus, SSCe, SSC, Sca and UT) Statistical observations on muscle groups:
No statistically significant changes:
Occipital extensor muscles
Cervical extensor muscles
Thickness observations in the occipital extensor muscle group:
Muscles found to be thinner:
Sca muscle
SSC muscle
p-values:
The p-values for the Sca and SSC muscles indicated
that these muscles were thinner compared to
other muscles in the occipital extensor group.Goodarzi et al. [20], 2018 CVA < 49° FHP (n = 20)
CVA = 43.43° ± 2.58°
Age = 21.30 ± 2.36 years
NHP (n = 20)
CVA = 55.90° ± 2.25°
Age = 21.85 ± 2.87 yearsDifference in thickness change of extensor muscles during contraction and relaxation (multifidus, SSCe, SSCa, Sca and UT) Change in muscle thickness between rest and isometric muscle contraction:
Statistically significant decrease:
SSC muscle within the occipital extensor muscle
groupQuek et al. [21], 2013 CVA N = 51 (29 females, 22 males)
Age = 66 ± 4.9 years (60–78)
CVA = 45.6° ± 6.7° (31–59)ARoM for upper and general cervical rotation and cervical flexion CVA was found to be significantly correlated with increased cervical flexion (Spearman r = 0.30) and general rotation RoM (r = 0.33), but no significant association was observed with upper cervical rotation RoM (r = 0.15). FHP, froward head posture; NHP, neutral head posture; ARoM, active range of motion; SVA, sagittal vertical axis; CVA, craniovertebral angle; UCE, upper cervical extensor; LCE, lower cervical extensor; UCF, upper cervical flexor; LCF, lower cervical flexor; RCP, rectus capitis posterior; OCS, oblique capitis superior; SCM, sternocleidomastoid; LCo, longus coli; UT, upper trapezius; Sca, splenius capitis; SSC, semispinalis capitis; SSCe, semispinalis cervicis..