Relationships between Sagitall Postures of Cervical Spine

and Shoulder and Presence of Neck and Shoulder Pain in Adolescents

R. M. Ruivo, P.

Pezarat-Correia and A. I. Carita

CIPER, Faculdade de Motricidade Humana, Universidade Técnica de Lisboa, Lisboa, Portugal

1 INTRODUCTION

Epidemiological studies have shown a high

prevalence of spinal postural deviations in children

and adolescents (Van et al., 2008), with a high self-

reported upper quadrant musculoskeletal pain

(UQMP) among adolescents (Diepenmaat et al.,

2006). The shoulder and neck regions are becoming

more and more cited in many references as the areas

of greatest discomfort in adults and adolescents

(Perry et al., 2008). The forward head posture

(FHP) is a forward inclination of the head with the

cervical spine hyperextension and is associated with

shortening of the upper trapezius, the posterior

cervical extensor muscles (suboccipital, semispinalis

and splenni), the sternocleidomastoid muscle and the

levator scapulae musculature (Lynch et al., 2010).

Whereas the rounded shoulder posture (RSP), is a

forward deviation of the shoulders, frequently

associated with a protracted, anterior tilted and

internally rotated scapula, and tightness of the

pectoralis minor muscle (Wang et al., 1999).  To

study the misalignments outlined above, the

photographic measurement of sagittal postures of

cervical spine and shoulder is becoming more and

more widespread, with plenty of studies confirming

the high reliability of this method –

photogrammetry. (Ferreira et al., 2010; McEvoy and

Grimmer, 2005) To assist in the postural assessment

from digitalized pictures, some specific software has

been developed such as PAS/SAPO (Postural

Assessment Software) (Ferreira et al., 2010).

2 OBJECTIVES

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. The relationships were also explored

between three postural angles and presence of neck

and shoulder pain. Gender differences were also

considered.

3 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), (figure

1) were measured with photogrammetry and PAS

software.

Figure 1: Adhesive marker placement and postural angle,

a. sagitall head; b. cervical angle; c. shoulder angle.

Based on previous findings of (Yip et al., 2008) and

(Diab and Moustafa, 2012), someone is considered

to have FHP if the cervical angle is less than 50º. In

what concerns shoulder angle, subjects with a RSP

have a significant smaller shoulder angle when

compared with normal subject. In a study of (Brink

et al., 2009) with adolescents 15-17 years old,

reported a mean shoulder angle value of 51º ± 17.

We considered 52º as the reference angle for RSP.

American shoulder and elbow surgeons shoulder

assessment (ASES) were used to asses shoulder pain

whereas for headache assessment, students were

requested to answer yes or no to the following

question: do you regularly feel neck pain?

4 STATISTICAL ANALYSIS

All statistical analyses were made using specific

software (SPSS version 20) and a statistical

significance level of p < 0.05 was defined.

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

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

 2013 SCITEPRESS (Science and Technology Publications, Lda.)

The data were analyzed using descriptive

statistics such as the mean, standard deviation, and

percentage. In order to analyze differences in

genders, and between patients with and without neck

pain in the three postural angles, the ASES scores

independent-samples t-test was applied. A chi-

square test was used to assess the relationship

between the forward head and cervical pain.

5 RESULTS

A separate preparatory study to confirm the inter

and intra-rater reliability of computerized

photogrammetry using the PAS was done with all

ICC values reporting good and very good reliability.

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 HT and CV angle than girls (18.7 ± 7.07 Vs

16.15±6.04, and 48.43±4.91Vs 46.56±5.24

respectively) and adolescents with neck pain

revealed lower mean sagittal and cervical angle than

adolescents without neck pain (15.3±6.3 Vs

18.5±6.5, and 46,4 ±5.6Vs 47,96±4,8 respectively).

An adolescent with forward head (FH) has 1.945

more chance to have headache than an adolescent

without FH. 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.

6 CONCLUSIONS

This data shows that forward head and rounded

shoulder are common postural disorders in

adolescents, especially girls. Neck pain is prevalent

in adolescents, especially girls and is associated with

forward head posture. Preventing and managing of

upper quadrant musculoskeletal pain should be

implemented in the early ages.

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