Relationships between Sagitall Postures of Cervical Spine and Shoulder and Presence of Neck and Shoulder Pain in Adolescents

R. M. Ruivo, P. Pezarat-Correia, A. I. Carita


Purpose: This study characterized the postural alignment of the head and shoulder in the sagittal plane of Portuguese adolescents, 15-17 years old, in natural erect standing and explored the relationships between three postural angles and presence of neck and shoulder pain. Gender differences were also considered. Moreover, the reliability of the photographic measurement of the sagitall posture of cervical spine and shoulder was investigated. Methods: The study was conducted in 2 secondary schools in Portugal. 275 adolescent students (153 females and 122 males) ages 15-17 were evaluated. Sagittal head (HT), cervical (CV) and shoulder angle (SH), were measured with photogrammetry and PAS software. American shoulder and elbow surgeons shoulder assessment (ASES) were used to asses shoulder pain. Results: Mean values of HT, CV and SH angles were 17.26±6.7, 47.40±5.2 and 51.41±8.5º respectively. 68% of the adolescents studied revealed protraction of the head whereas 58% of them had protraction of the shoulder. The boys showed a significant higher mean CV and HT angle than girls and adolescents with neck pain revealed lower mean sagittal and cervical angle thant adolescents without neck pain. Neck pain is more prevalent in girls with 52,9% of them self-reporting to feel neck pain regularly, contrasting with the 19% for the boys. Conclusions: This data shows that forward head and rounded shoulder are common postural disorders in adolescents, especially girls. Neck pain is prevalent in adolescents, specially girls and is associated with forward head posture.


  1. Brink, Y., Crous, L. C., Louw, Q. A., Grimmer-Somers, K., & Schreve, K. (2009). The association between postural alignment and psychosocial factors to upper quadrant pain in high school students: a prospective study. Manual therapy, 14(6), 647-53. doi:10.1016/j.math.2009.02.005.
  2. Diab, A. a, & Moustafa, I. M. (2012). The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clinical rehabilitation, 26(4), 351- 61. doi:10.1177/0269215511419536.
  3. Diepenmaat, a C. M., van der Wal, M. F., de Vet, H. C. W., & Hirasing, R. a. (2006). Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Pediatrics, 117(2), 412-6. doi:10.1542/ peds.2004-2766.
  4. Ferreira, E. A. G., Duarte, M., Maldonado, E. P., Burke, T. N., & Marques, A. P. (2010). Postural assessment software (PAS/SAPO): Validation and reliabiliy. Clinics (São Paulo, Brazil), 65(7), 675-81. doi:10.1590/S1807-59322010000700005.
  5. Lynch, S. S., Thigpen, C. a, Mihalik, J. P., Prentice, W. E., & Padua, D. (2010). The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. British journal of sports medicine, 44(5), 376-81. doi:10.1136/bjsm. 2009.066837.
  6. McEvoy, M. P., & Grimmer, K. (2005). Reliability of upright posture measurements in primary school children. BMC musculoskeletal disorders, 6, 35. doi:10.1186/1471-2474-6-35.
  7. Perry, M., Smith, a., Straker, L., Coleman, J., & O'Sullivan, P. (2008). Reliability of sagittal photographic spinal posture assessment in adolescents. Advances in Physiotherapy, 10(2), 66-75. doi:10.1080/14038190701728251.
  8. Van Niekerk, S.-M., Louw, Q., Vaughan, C., GrimmerSomers, K., & Schreve, K. (2008). Photographic measurement of upper-body sitting posture of high school students: a reliability and validity study. BMC musculoskeletal disorders, 9, 113. doi:10.1186/1471- 2474-9-113.
  9. Wang, C., Mcclure, P., Pratt, N. E., & Nobilini, R. (1999). Stretching and Strengthening Exercises their effect on three-dimensional scapular kinematics. Arch Phys Med Rehabil. 80(8): 923-9.
  10. Yip, C. H. T., Chiu, T. T. W., & Poon, A. T. K. (2008). The relationship between head posture and severity and disability of patients with neck pain. Manual therapy, 13(2), 148-54. doi:10.1016/j.math. 2006.11.002.

Paper Citation

in Harvard Style

M. Ruivo R., Pezarat-Correia P. and I. Carita A. (2013). Relationships between Sagitall Postures of Cervical Spine and Shoulder and Presence of Neck and Shoulder Pain in Adolescents . In - icSPORTS, ISBN , pages 0-0

in Bibtex Style

author={R. M. Ruivo and P. Pezarat-Correia and A. I. Carita},
title={Relationships between Sagitall Postures of Cervical Spine and Shoulder and Presence of Neck and Shoulder Pain in Adolescents},
booktitle={ - icSPORTS,},

in EndNote Style

JO - - icSPORTS,
TI - Relationships between Sagitall Postures of Cervical Spine and Shoulder and Presence of Neck and Shoulder Pain in Adolescents
SN -
AU - M. Ruivo R.
AU - Pezarat-Correia P.
AU - I. Carita A.
PY - 2013
SP - 0
EP - 0
DO -