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Abstract: 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. Objective: To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals. Design: Single-blind (assessor) cross-sectional study. Setting: Hospital and general community. Participants: Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40). Interventions: Not applicable. Main Outcome Measures: Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images. Results: NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean ± SD, 45.4°±6.8°; pain-free, mean ± SD, 48.6°±7.1°; P<.05; confidence interval [CI] for the difference between groups, 0.9°–6.3°). Dividing the population according to age into younger (≤50y) and older (>50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean ± SD, 46.1°±6.7°; pain-free, mean ± SD, 51.8°±5.9°; P<.01; CI for the difference between groups, 1.8°–9.7°) but no difference for the older group (NP, mean ± SD, 44.8°±7.1°; pain-free, mean ± SD, 45.1°±6.7°; P>.05; CI for the difference between groups, –4.9°–4.2°). No other differences were found between patients and pain-free participants. Conclusions: Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful. [Copyright &y& Elsevier]

Aims: Neck pain is a common complaint and accounts for a significant proportion of individuals seeking physiotherapy. Assessment for patients with neck pain normally involves a judgment of head posture. Head posture is considered important as deviations from 'normal' may have detrimental biomechanical and physiological implications and provide clues as to optimal interventions. However, studies comparing head posture between patients with neck pain and asymptomatic individuals have shown conflicting results. This article critically appraises the role of head posture assessment for patients with neck pain. Methods: The rationale for a relationship between head posture and neck pain is discussed; clinical assessment of head posture—including issues around surrogate measures, validity and reliability—is explored, and studies comparing patients with neck pain and asymptomatic individuals are examined. Finally, studies investigating techniques to correct head posture are appraised. Findings and conclusions: It is unclear whether the assessment of head posture through observation is valid and/or reliable and whether therapeutic interventions to improve head posture result in gains for the patient. There is a need for further research exploring the links between these factors, and practitioners should be encouraged to re-appraise the value of assessing head posture for patients with neck pain. [ABSTRACT FROM AUTHOR]