1 |
Poussa et al. [17] (2004) |
Cohort study |
1,060 4th grade school children (age, 10–13 years) in Finland, were assessed annually till the age of 21.9 years. |
1. Body weight & height, trunk asymmetry in degrees, TK, and LL were assessed every year. |
1. Cumulative lifetime neck pain incidence was 58% in males and 78% in females. |
With drop-outs over time total 430 children assessed |
2. At the last examination, a questionnaire was given for history of neck pain. |
2. Amongst people having neck pain, majority recalled <8 days with pain. Only one-fifth experienced >30 days of pain. |
3. Presence of neck pain. Its overall duration in the previous year, location and incidence of neck pain in the last year was determined. |
3. A predictor for the incidence of neck pain was short stature at the age of 11 years. |
4. Neck pain predictors were analyzed with a logistic regression model. |
4. An inverse association between neck pain history and current body height was found at 22-year age (OR, 0.62; 95% CI, 0.45–0.86). |
5. Male sex was protective against neck pain (OR, 0.28; 95% CI, 0.18–0.44). |
6. No other anthropometric measures were found to be predictors of neck pain. |
2 |
Szeto et al. [15] (2005) |
Case-control study |
Female office workers assigned into case (n=23) and control (n=20) groups. All subjects were experienced, touch-typists. |
1. Upper body postures and movements during a 1-hour typing task were recorded using the Vicon 370 ver. 3.1 (Oxford Metrics, Oxford, UK), 3D motion measurement, and analysis system. |
1. Case subjects had a mean head flexion 3.9º more than controls. This greater head–neck flexion in cases was maintained over the whole 1-hour typing task. |
Subjects with current and past complaints of discomfort in neck and shoulder within the past 7 days and with discomforts lasting >3 months in the previous year were assigned to the case group. |
2. Six infra-red cameras were used to record the video at a sampling frequency of 60 Hz. |
2. Significant between-group differences present for flexion range, side flexion median, and rotation median postures. |
A significant difference in their mean age of about 5 years was present. Twenty-one subjects in the case group still had a similar mean age (35.8±4.6 years). |
3. Reflective markers were placed over the head–neck segment, thorax segment, and shoulder segment. |
3. Cases and controls had thoracic postures and movements generally within 1º of each other, and a multivariate analysis of variance found no signifi- cant effect of group (nor time). |
Subjects were comparable regarding their physical build, their work backgrounds, and their computer experience. |
4. The subject was instructed to adjust the screen height, key- board height, and chair height until a reasonably comfortable and erect posture was attained. |
4. Cases had about 1º more right shoulder flexion and 3º less right shoulder abduction. |
5. A standardized typing package was given for the common 1-hour typing task. |
5. Significant correlation found between head flexion and side flexion angles and right UT activity (rho=0.366, p=0.024; rho=0.336, p=0.039). |
6. Synchronized kinematics and electromyography signals were captured at the 5th, 20th, 35th, 50th, and 60th minutes of the typing task. Each data capture was for a 60-second duration. |
6. Significant correlation seen between right shoulder abduction angle and right UT activity (rho=0.348, p=0.032). |
7. Subjects rated the task related discomfort in 10 upper body regions (left/right neck, upper back, shoulder, elbow, and wrist/hand) on a scale of 0–10 immediately after each capture. |
3 |
Lau et al. [4] (2010) |
Cross-sectional correlation study |
Subjects in the age group 20 to 50 years |
1. Subjects filled in the Chinese version of the NPQ and NPRS. |
1. The neck pain group showed a significantly higher UTA than the non-neck pain group. |
The control group consisted of subjects who had no neck pain in the last 6 months, scor- ing zero on the NPRS and <10% on the NPQ |
2. Cervical and thoracic spine postures were measured from a lateral photograph. |
2. The CVA of the neck pain group was significantly smaller than the controls. |
Participants in the neck pain group were diag- nosed by physicians. Their pain intensity was >3 on the NPRS, and they had a score >10% on the NPQ. |
3. Thoracic spine sagittal posture (UTA) was measured as an angle between the horizontal line and a line drawn between the seventh cervical spinous process and the seventh thoracic spinous process. |
3. Positive correlation was present between UTA and presence of neck pain (rho=0.63; 95% CI, 0.45–0.76; p<0.01). |
Gender and age were comparable between both groups. |
4. Cervical spine sagittal posture was measured as an angle be- tween a line drawn from the tragus of the ear to the seventh cervical vertebra subtended to the horizontal, i.e., the CVA. |
4. Negative correlation between the CVA and pres- ence of neck pain (rho=0.56; 95% CI, 0.71–0.36; p<0.01) |
5. Two sessions were arranged to measure the above. |
5. A greater UTA and a smaller CVA were likely to be found in the subjects with neck pain. |
6. After the adjustment of age and gender, the UTA (OR, 1.37; p<0.01) and the CVA (OR, 0.86; p=0.04) were significant predictors for the presence of neck pain. |
7. UTA was not a significant predictor for neck pain intensity on NPRS (p=0.31) and NPQ (p=0.16). |
4 |
Quek et al. [13] (2013) |
Cross-sectional |
51 Older adults having cervical dysfunction |
1. Disability was measured using the NDI. |
1. Older age was associated with the reduction in cervical ROM (Spearman r=0.41 and r=0.51 for general and upper cervical rotation, respectively). |
Age (yr): 66±4.9 (range, 60–78) |
2. The flexicurve method was used to measure TK. The flexicurve was aligned according to C7, and S2 spinous processes and the flexicurve’s shape was aligned to the spinal curvature. Next, the flexicurve was placed on a table, and a picture of the flexicurve imprint was taken using a 7.2 megapixels digital camera (Sony DSC-W110). |
2. The relationships between cervical ROM and CVA (lesser CVA indicates greater FHP) revealed positive associations between CVA and general cervical rotation (r=0.33, p=0.02), cervical flexion (r=0.30, p=0.03), and upper cervical rotation (r=0.15, p=0.31). |
Female=29, male=22 |
Height (m): 1.61±0.1 (range, 1.45–1.89) |
Mass (kg): 61±14.5 (range, 41–130) |
3. FHP was assessed from a digitized, lateral-view photograph of the subject in his/her usual standing posture. Once the photograph was obtained, ImageJ was used to measure FHP, quantified by the CVA (i.e., the angle between the horizontal line passing through C7 and a line extending from the tragus of the ear to C7). Lesser CVA indicates greater FHP. |
3. Significant negative association was found between TK and CVA (r=0.48, p<0.001). |
BMI (kg/m2): 23.4±3.8 (range, 17.1–36.4) |
4. TK was shown to be associated with FHP. |
Presently on pain medication (number): 7 |
Cervical pain intensity on VAS (/10): 2.0±1.7 (range, 0–6) |
4. Neck ROM was measured using the cervical ROM device. The following measurements were taken: (1) total active cervical flexion range in an upright sitting, (2) total active cervical rota- tion ROM in an upright sitting, and (3) passive upper cervical rotation in available full flexion in supine. |
5. FHP affected general cervical rotation and cervical flexion (but not upper cervical rotation). |
TK index: 10.6±2.3 (range, 5.1–16.4) |
CVA (°): 45.6±6.7 (range, 31–59) |
NDI (/100) 18.0±12.5 (range, 0–44) |
5 |
Tsunoda et al. [14] (2013) |
Case-control study |
329 Japanese subjects in a Japanese village |
1. Participants were asked to report the occurrence of NSP in the last 2 weeks. Participants answering “yes” were categorized into NSP group. |
1. Mean ages of subjects in both groups were significantly different (p<0.001). |
Prevalence of NSP (%): 52.0 |
2. Sagittal spinal alignment was evaluated using Spinal Mouse—an electronic, non-invasive computer-aided device. |
2. Significantly number of females complained of NSP than males (p<0.01). |
Age (yr): 65.5±10.7 |
3.The subject was asked to assume an upright position. Spinal Mouse was moved paravertebrally from C7 to S3. |
3. There was no significant association between TK angle and NSP (NSP group: 40.6°±10.8°, non-NSP group: 40°±11°). |
Gender (male/female): 125/204 |
4. TK angle, LL angle, and inclination of the line from T1 to S1 relative to a perpendicular line were calculated. |
4. Mean LL and mean inclination were significantly higher in NSP group. |
6 |
Nejati et al. [16] (2015) |
Case-control study |
The entire population of the full time was working employees of the Iran University of Medical Science (job included office work with a desktop computer; total=159 employees). |
1. Posture was assessed for each participant, in the office at the employee’s desks between the 4th and 5th hours of work by one investigator. |
1. Statistically significant differences between the symptomatic and asymptomatic groups, in CVA and HTA, were found only during work (CVA, p=0.04; HTA, p=0.02). |
Employees with chronic pain, soreness or ache experienced in a region between the inferior margin of the occipital bone and T1 for a period of >3 months were included in the symptomatic group, while all the other employees were assigned to the control group. |
2. Adhesive markers were attached to the spinous process of C7, T7, and tragus. |
2. In the looking forward task/neutral position, no significant differences found between groups (CVA, p=0.70; HTA, p=0.43). |
Mean age (yr): 39±8 |
3. The participants were made to type a standard text on their computers for about 5 minutes, and then researcher took a picture during last minutes of typing. |
3. The employees with neck pain showed a poor posture of cervical and thoracic spine at work. |
Work duration (yr): 14±8 |
4. A 2nd picture was taken where the researcher asked the participants to sit on their chairs and look forward ahead at a fixed point on the wall, 120 cm above the ground. |
4. Correlations were also found between the sagittal posture of the cervical and thoracic spine (CVA, HTA) and neck pain. |
Weight, height, and BMI also comparable in both groups |
5. Body Posture Analyzer software was used to assess photographic data. |
73% were females |
6. HTA and CVA were measured. |
7 |
Yu et al. [20] (2015) |
Case-control study |
A group of 120 asymptomatic subjects (including 63 males and 57 females; average age 23.2±6.3 years old) |
1. All preoperative full-length and lateral cervical X-rays of the spine were taken. Patients stood in a comfortable erect position with their hands on supports. A commercially available optical scanner (XR 650; GE Healthcare, Chicago, IL, USA) was used to digitize the films. |
1. Significant differences observed between the cervical alignments of different Roussouly types in both cohorts. |
A cohort of 121 cervical spondylitis cases (involving 80 men and 41 women; average age 53.3±10.6 years old) were recruited. |
2. Angles and distances were calculated using a custom computer application (PACS; GE Electrics, Boston, MA, USA) |
2. No correlation between cervical alignment and the value of PI in both asymptomatic and spondylotic groups (p >0.05) |
All cervical spondylotic cases were operated (anterior cervical discectomy/corporectomy with bone fusion or posterior laminoplasty). |
3. Global radiological parameters measured PI, SS, PT, spinalsacral angles, the ratio of hip to C7/hip to the sacrum, C0–C2 angle, T1 slope angle, LL, and TK. |
3. There were significant differences in T1 slope and TK between lordotic and kyphotic alignments (29.6°±6.2° vs. 20.6°±6.4°, p=0.00; 28.0°±8.4° vs. 19.7°±6.5°, p=0.00), and between straight and |
4. The cervical sagittal alignment was categorized into four types: lordosis, straight, sigmoid, and kyphosis. |
kyphotic alignments (26.3°±6.3° vs 20.6°±6.3°, p=0.01; 27.2°±6.1° vs. 19.7°±6.5°, p=0.00) in asymptomatic cohort. |
5. The degenerative changes of disc space narrowing, endplate sclerosis, osteophyte formation was recorded for each cervical disc space. |
4. In spondylotic patients, significant differences were found in T1 slope and TK between lordotic and straight cervical alignments (27.2°±7.8° vs. 22.4°±7.4°, p=0.04; 35.9°±10.1° vs. 29.7°±8.5°, p=0.01). |
6. All subjects in both cohorts were categorized with Roussouly Morphological Classification according to their PI, SS, PT, thoracic, and lumbar alignments. |
5. Multiple linear regression of all parameters showed that cervical angles were significantly related to the C0–C2, TK, and T1 slope (p=0.00, 0.01, and 0.00, respectively). |
8 |
Falla et al. [18] (2017) |
Case-control design |
People with chronic nonspecific neck pain, between 18 and 40 years |
1. A questionnaire on subject demographics and history, duration, and average intensity and localization of pain were administered. State-Trait Anxiety Inventory, the NDI, Tampa Scale of Kinesiophobia, and Medical Outcomes Study 36-item Short-Form Health Survey were also completed. |
1. The average speed during the self-selected speed condition was not associated with group or condition. |
14 Cases & 14 controls |
2. No interactions between group, speed, and condition for stride cadence. |
Cases-episodic, non-specific neck pain of >3 months in duration, with periods of aggravation and remission in the past 6 months, each episode of neck pain lasting at least a week, and having sufficiently intense pain to limit function. |
2. All subjects were made to walk on a treadmill at any selfselected speed and 3 km/hr and 5 km/hr with three different head orientations (head neutral, 30° of right rotation, and 30° of left rotation), i.e., a total of nine gait tasks. |
3. No significant interactions present between factors for stride length. |
Mean age (yr): 28±6.9 |
3. For precise tracking of head movement and orientations, subjects wore a custom-made helmet (weight, 280 g) equipped with three reflective spherical markers (diameter, 18 mm), and two presentation laser pointers mounted parallel to the subject’s view. |
4. For the neck rotation angles, no significant interactions observed. For trunk rotation, no interactions were observed; but there was a significant main effect for speed (F=83.19, p<0.001), with greater rotation during gait at 5 km/hr compared to both the self-selected speed and 3 km/hr (both: post hoc, p<0.001). |
78% females |
Height (cm): 173.3±10.1 |
4. The sequence of trials was randomized. |
5. Compared to the symptomatic group, controls displayed greater trunk rotations (post hoc, p<0.001), regardless of the speed or condition. |
Weight (kg): 67.4±9.5 |
5. For each condition, the subject walked 120 seconds. The subjects were allowed 30 seconds to adjust to the condition, and data acquisition started after 30 seconds and lasted for 90 seconds. |
6. Trunk rotation reduced even further in the patient group when the head was rotated compared to the extent of trunk movement seen in the neutral head condition. |
Pain duration (mo): 72±44.5 |
6. A motion-analysis system tracked 3D positions of the reflective markers with eight infrared digital video cameras capturing at 128 samples per second. |
7. No significant differences were observed for trunk rotation variability, between groups and conditions. |
NDI score: 36.1±14.1 |
7. Heel strike, stride length, strike cadence, neck & trunk rotations, and their variability were calculated. |
No significant differences were observed between groups for age, weight, or height. |
9 |
Kaya and Çelenay [19] (2017) |
Case-control |
132 Patients (age, 18–60 years) complaining of neck pain for >3 months |
1. Demographic data and physical characteristics collected. BMI was calculated. |
1. A higher sagittal curvature in the thoracic spine (p<0.001) and a lower sagittal thoracic mobility (p=0.013) was seen in neck pain group as compared to controls. |
56 Chronic neck pain group |
2. The intensity of neck pain was assessed using the VAS |
2. Neck pain intensity and thoracic curvature showed positive correlation (r=0.391, p<0.001). |
53 Control group. Controls included BMImatched healthy individuals with no previous neck pain. |
3. Sagittal thoracic posture and mobility were evaluated by Spinal Mouse, in the standing position. |
3. But thoracic mobility and neck pain intensity were negatively correlated (r=-0.260, p=0.006). |
4. Thoracic curvature was assessed in upright, maximum flexion, and maximum extension positions. |
4. Thoracic kyphotic curvature more than 45° is critical for chronic neck pain. |
5. The sagittal curvature and mobility between T1 and T2 was calculated with a software program. |
5. Similarly, the decrease in thoracic mobility >30° is critical for chronic neck pain. |