Forward Head Posture Linked to Altered Spine Alignment

TOPLINEAdults with forward head posture (FHP) showed increased upper cervical extension and greater cervicothoracic and overall forward spinal alignment, while lumbar and pelvic measures remained largely unchanged.METHODOLOGYResearchers conducted a retrospective radiographic analysis to compare head-to-pelvis sagittal alignment in adults with and without FHP.They included 201 adults referred for low back pain who had standing lateral EOS images from a tertiary orthopedic outpatient spine clinic.Patients with cranio­vertebral angle less than 51° were classified as having FHP, yielding 38 adults with FHP (mean age, 66.2 years; 60.5% men) and 163 without FHP (mean age, 54 years; 56.4% men).Researchers used standing EOS images to measure sagittal balance parameters from head to pelvis, including upper cervical angles (C0-C1, C0-C2, C1-C2), subaxial cervical lordosis (C2-C7), T1 slope, thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis.TAKEAWAYAdults with vs without FHP had a greater mean C0-C2 angle (27.7° vs 18.1°; P < .001), mean C1-C2 angle (36.5° vs 31.8°; P = .003), and lower mean occipital protuberance to C2 distance (25 vs 28 mm; P = .006).T1 slope was higher in those with vs without FHP (mean, 41.5° vs 31.7°; P < .001), as was thoracic kyphosis (mean, 49.5° vs 42.4°; P = .008). Adults with FHP also had greater mean cervical- and whole-spine vertical axis (P < .001 for both).Lumbar lordosis and pelvic parameters did not differ significantly between adults with vs without FHP.In adults with FHP, upper cervical measures and T1 slope showed more and stronger links to thoracic, pelvic, and global alignment, while subaxial cervical (C2-C7) associations with global alignment were not observed.IN PRACTICE"[The] findings suggest that clinical evaluation of FHP should not rely solely on subaxial cervical or lumbo-pelvic parameters," the authors of the study wrote.SOURCEThe study was led by Katterine N. Rios-Peralta, University College Dublin, Dublin, Ireland. It was published online on August 5 in BMC Musculoskeletal Disorders.LIMITATIONSThe older age in the FHP cohort may have affected the results. Patients were referred for low back pain; thus, the findings may not apply to people without symptoms. The cross-sectional study design prevented establishing any cause-effect relationships.DISCLOSURESThe study was supported by BECAL Becas al Exterior Don Carlos Antonio Lopez, the Deutscher Akademischer Austauschdienst, and the German Research Foundation. The authors reported no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.