A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong

Effects of computer use on upper limb musculoskeletal disorders and function in academicians

Objectives. This study aimed to investigate the effects of academician's demographic characteristics and computer usage habits on upper limb musculoskeletal disorders (MSDs) and function. Methods. A cross-sectional observational study was conducted with 100 academicians. Data were collected using questionnaires, which included the patient-rated wrist evaluation questionnaire - Turkish version (PRWE-T), the Cornell musculoskeletal discomfort questionnaire - Turkish version (CMDQ-T), the upper extremity functional index - Turkish version (UEFI-T), demographic characteristics and average daily computer usage time. Results. A low-level significant correlation was found between the age of the individuals and the CMDQ-T forearm (p = 0.044; r = 0.202) and CMDQ-T wrist (p = 0.001; r = 0.337) scores. Women had higher CMDQ-T neck scores and lower UEFI-T scores than men (p < 0.05). Academicians who used computers for 6 h a day or more had higher PRWE-T and CMDQ-T neck, shoulder, upper arm and forearm scores, and had a lower UEFI-T score (p < 0.05). Conclusion. Neck, shoulder, upper arm and forearm symptoms were higher and upper extremity function was impaired in academicians who used computers for 6 h a day or more. Besides, gender and age were associated with upper limb MSDs and function, but occupation duration did not affect those outcomes in academicians.

The epidemiology of neck and low back pain in Iran: a national and sub-national analysis from 1990 to 2019

Background

Neck pain (NP) is a condition influenced by multiple factors. It places a significant burden on individuals suffering from NP and on social and economic systems. On a global scale, low back pain (LBP) stands out as a significant contributor to years lost to disability, and this burden is on the rise due to population growth and aging.

Methods

The Global Burden of Disease database was used to collect data on the prevalence, incidence, and years lived with disability (YLD) of NP and LBP between 1990 and 2019. Various factors, including age group, gender, Iran, and its 31 provinces, were used to classify the data.

Results

Iran accounted for 0.86 million incident cases of NP in 2019, with age-standardized incident rate per 100 000 population of 934.1. Tehran has the maximum age-standardized prevalence, incidence, and YLD. Iran accounted for the age-standardized incidence rate for LBP per 100 000 population of 3492.9, and it reduced to -8.35% from 1990. Mazandaran exhibits the highest levels of prevalence, incidence, and YLD for LBP in 2019. In Iran, the point prevalence of NP in 2019 was higher in females and increased with age up to 50-54 years for females and 70-74 years for males. However, there is only a slight difference between females and males in Iran regarding LBP prevalence.

Conclusions

In this study, the authors report the prevalence, incidence, YLD, and age-standardized rates for NP and LBP in the world's general population and Iran's population based on its sub-nations in 1990 and 2019.

Comparison of breathing pattern and diaphragmatic motion in patients with unilateral cervical radiculopathy and asymptomatic group

BACKGROUND

The associations between neck pain and respiratory dysfunction were clarified in patients with neck pain. There is dearth of evidence on pulmonary dysfunction and diaphragmatic excursion in patients with unilateral cervical radiculopathy (CR). The purpose of this study was to compare the breathing pattern and diaphragmatic excursion in patients with unilateral CR with those in an asymptomatic group.

METHODS

Twenty-five patients with unilateral CR and 25 asymptomatic individuals aged between 30 and 55 participated in this study. Diaphragmatic motion, breathing pattern, active cervical range of motion and kinesiophobia were investigated in both groups by using fluoroscopy, manual assessment of respiratory motion (MARM), cervical range of motion device, and Tampa scale of kinesiophobia. Statistical significance was set at 0.05.

RESULTS

No statistically significant differences were found between the two groups with regard to sex, age and body mass index. The mean excursion of the hemi diaphragm on the involved side (the side of CR) was significantly lower than that on the uninvolved side in patients with unilateral CR with a large effect size. The excursion of the involved hemi diaphragm in patients was reduced compared to the matched hemi diaphragm in the control group. There was no significant difference between the hemi diaphragms excursion in the control group. The results of the MARM variables showed that the volume of breathing and the percentage rib cage motion in normal and deep breathing were significantly different between the two groups, but there was no significant difference in the balance of breathing between the two groups. Additionally, the active cervical range of motion was reduced in these patients in comparison to the control group, and it was less on the involved side than on the uninvolved side.

CONCLUSION

The results of this study revealed a dysfunctional breathing pattern in normal and deep breathing and a unilateral reduction in diaphragmatic excursion on the side of radiculopathy in patients with unilateral CR compared to the control group.

Prolonged slumped sitting causes neck pain and increased axioscapular muscle activity during a computer task in healthy participants - A randomized crossover study

INTRODUCTION

Sitting posture may contribute to spinal pain. Effects of postures on pain, sensitivity and muscle activity during computer tasks were investigated.

METHODS

Twenty-five healthy participants, seated at a workstation without backrest, completed four, 15-min typing tasks: A)Upright with forearm-support; B)Upright without forearm-support; C)Slumped with forearm-support; D)Slumped without forearm-support. Participants rated pain every minute on a numerical rating scale (NRS). RMS-EMG was recorded from upper/lower trapezius (UT, LT), serratus anterior and anterior/middle deltoid. At baseline and after tasks, pressure pain thresholds (PPTs) were recorded bilaterally over the head, UT, and leg.

RESULTS

All tasks caused clinically relevant increased NRS (≥2/10) compared to baseline (P < 0.001). NRS was higher in Task-D (P < 0.003) and lower in Task-B (P < 0.005) than others. PPTs did not change from baseline. Task-D caused higher UT and LT RMS-EMG (P < 0.02) than other tasks.

CONCLUSION

A 15-min task caused pain irrespective of posture with some causing larger changes than others.

Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis

Background

Neck pain (NP) is common in all age groups and adversely affects the patients' entire lifestyle. There exists inconclusive evidence relating faulty craniocervical posture with pain-related disability. This review aims to determine whether sagittal head and neck posture differs in NP and pain-free subjects, to critically appraise the correlation of posture with NP.

Methods

Of 3796 articles identified at primary search from CINAHL, PubMed, Google Scholar, EMBASE, 26 were included based on eligibility criteria. Mean pooled difference (MPD) and effect size (ES) were calculated to establish relationship among studies, to assess postural correlation with NP measures [Visual Analogue Scale (VAS), Numeric Pain Rating Scale (NPRS), neck disability index (NDI), Northwick Park NP Questionnaire (NPQ)] and for age- and gender-wise variation. Risk of bias was assessed using Newcastle-Ottawa Quality Assessment Scale.

Results

Craniovertebral angle (CVA) had a significant MPD of - 2.93(95% CI - 4.95 to - 0.91). Sagittal head angle (SHA) and forward head posture (FHP) had an insignificant MPD of 1.15 (95% CI - 1.16 to 3.46) and - 0.26 (95% CI - 1.89 to 1.36), respectively. Age- and gender-wise CVA difference was found to be 2.36° and 2.57°, respectively. ES was significant for correlation between CVA and pain intensity [NPRS: - 0.44 (95% CI - 0.61 to - 0.26); VAS: - 0.31 (95% CI - 0.46 to - 0.16)], and between CVA and disability [NDI: - 0.18 (95% CI - 0.31 to - 0.05); NPQ: - 0.47 (95% CI - 0.61 to - 0.320)].

Conclusion

CVA differs for age, gender, and pain vs pain-free subjects, and correlates negatively with NP measures. Other surrogate measures (SHA, cranial and cervical angles, FHP) warrant further research.

PROSPERO Registration

PROSPERO 2021 CRD42021275485.

Prevalence, risk factors and quality of life impact of work-related musculoskeletal disorders among school teachers in Cairo, Egypt

BACKGROUND

School teachers constitute an occupational group which reported a high prevalence of work-related musculoskeletal disorders (WRMSDs). Different individual, occupational and psychosocial factors have been identified to influence the complex process of WRMSDs. WRMSDs represent an important and costly occupational health problem being responsible for a poor quality of life (QOL) of teachers. This study aimed to determine the prevalence, the risk factors, and the impact of WRMSDs on the QOL of teachers.

METHODS

310 full-time teachers from 15 public schools were surveyed using an interview questionnaire about their sociodemographic and occupational characteristics, the Nordic Musculoskeletal Questionnaire and the SF-36 Health Survey (SF-36).

RESULTS

Self-reported prevalence of WRMSDs at any body part over the past 12 months among teachers was 66.77%. Neck pain (56.1%) was the most prevalent WRMSD followed by shoulders (53.2%), low back (53.2%) and knees (50.6%) pain. Female gender, body mass index, the number of students per classroom, the number of classes per week, different adapted awkward postures and the lack of enough supervisor's psychological support at work were among the risk factors positively associated with WRMSDs. WRMSDs had a negative impact on the physical and mental QOL of teachers with WRMSDs as reflected by their lower scores on all scales of the SF-36 compared to their counterparts without WRMSDs (p ˂ 0.05).

CONCLUSION

WRMSDs were a highly prevalent problem among teachers in Cairo, Egypt and negatively influencing their physical and mental QOL. Different individual, occupational and psychosocial factors had been shown to be significant predictors for the occurrence of WRMSDs reflecting their complex nature and multifactorial etiology.

Prevalence and Risk Factors of Work-Related Upper Extremity Disorders among University Teaching Staff in Ethiopia, 2021: An Institution-Based Cross-Sectional Study

Background

Work-related upper extremity disorders (WRUEDs) are aches, pains, tension, and discomfort in the neck, shoulders, arms, wrists, hands, and fingers. The situation is escalating in educational sectors due to a lousy working environment intertwined with extracurricular deeds. However, empirical evidence focusing on academicians in higher education society is negligible. The purpose of this study is to examine the prevalence and risk factors of WRUEDs among university teaching staff in Ethiopia.

Materials and Methods

We conducted a cross-sectional study design from March to April 2021. A sample of 607 academicians were recruited using a stratified sampling technique, and a self-administered structured Nordic Musculoskeletal questionnaire was used to assess upper extremity disorders during the past 12 months. The collected data were entered into EpiData version 4.6 and analyzed using STATA version 14 software. The association between dependent and independent variables was computed with a binary logistic regression. The association was ascertained using an adjusted odds ratio (AOR) with a 95% confidence interval (CI) at a p value of <0.05.

Results

A total of 607 participants correctly completed the questionnaire (response rate of 95.44%). Age ranges from 21 to 70 with a mean of 32.39 (SD ± 6.80)) years, and the majority (76.28%) of them were males. The prevalence of WRUED during the last 12 months was 59.14% [95% CI (55.1, 63.1)]. There is no significant difference in prevalence between males and females (45.14% versus 14%), respectively; χ² = 0.001; p=0.974. Working more than 8 hours per day [AOR: 2.37; 95% CI (1.40, 4.00)], not performing physical exercise [AOR: 2.34; 95% CI (1.6, 3.45)], and job dissatisfaction [AOR: 2.50; 95% CI (1.69, 3.68)] were factors significantly increased the risk of experiencing WRUEDs.

Conclusion

This study divulged upper extremity disorder among university teaching staff is pervasive, with more than three-fifth of the academicians were suffering from the condition, and it also indicates that males experienced higher proportions of pain than females. The manifestation of upper extremity disorder was affected by working hours per day, physical activity, and job satisfaction. Optimizing working hours, having a group regular exercise, and proper management of workplace conditions related to job satisfaction are recommended to lessen the condition.

Investigating the Effect of Keyboard Distance on the Posture and 3D Moments of Wrist and Elbow Joints among Males Using OpenSim

Musculoskeletal disorders (MSDs) of the upper extremities and computer use are common in modern societies, and both show a growing trend. This study was conducted to determine the posture and 3D moments of wrist and elbow joints at different keyboard distances on a desk. Twelve healthy right-handed male volunteers attended the motion analysis laboratory. A keyboard was placed at three different distances from the participants’ bodies while performing a standard computer task. The workstation was adjusted according to ANSI/HFES-100-2007 standard for each participant to maintain a comfortable ergonomic posture for controlling confounding variables. Qualisys motion capture system, OpenSim (Ver. 4.1), and visual analog scale were used to collect and analyze the data. The highest levels of wrist flexion and radial deviation as well as elbow flexion and pronation were observed when the keyboard was at the edge of the desk. When the keyboard was 8 cm away from the edge of the desk, the right wrist flexion and radial deviation decreased 83% and 89%, respectively. In the left wrist, flexion and radial deviation decreased 94%. With increasing the distance of the keyboard from the edge of the desk, the right elbow flexion, pronation, and left elbow flexion decreased, 95%, 76%, and 85%, respectively. No significant difference was found for the left elbow pronation, wrist, and elbow joint moments, in the studied keyboard distances. However, a cut-off point has to be specified because large keyboard distances cause high extension and flexion of the limbs. The keyboard position relative to the body is an important parameter in computer work and has a significant impact on the posture of the upper extremities. A keyboard should be located at a distance that allows the upper extremities to remain in a neutral position so that the risk of MSDs is reduced.

Exploring the relationship between neck flexion and neck problems in occupational populations: a systematic review of the literature

A systematic review was conducted to evaluate the relationship between occupational neck flexion angles and neck problems. The synthesised findings were used to answer three research questions: (1) Is there a positive/negative relationship between neck flexion and neck problems? (2) What is the appropriate angular threshold for neck flexion as a risk factor for neck problems? (3) What are the gaps in our current knowledge? A review of 21 papers revealed (1) a consistent positive correlation between neck flexion and neck problems, and (2) a neck flexion angle of 20° as the most evidence-based (not necessarily the best) cut-off angle separating high- and low-risk neck flexion postures. Future research should focus on the (1) continuous collection of three-dimensional neck postures through longitudinal studies to quantify cumulative exposures of neck postures, and (2) development of standard descriptions of 'neck problems' and 'neck flexion' to facilitate the development of a dose-response relationship. Practitioner summary: Practitioners depend on thresholds for evaluating neck postural exposure using work assessment tools; however, the scientific basis for this is unclear. This systematic review investigated the angular threshold for neck flexion and found 20° of neck flexion with the greatest evidence-based support as the threshold for high-risk neck postural exposure.

University professors' mental and physical well-being during the COVID-19 pandemic and distance teaching

BACKGROUND

Strict strategies including lockdowns and working from home were adopted worldwide during the coronavirus (COVID-19) pandemic. University professors suddenly shifted to work from home adopting distance teaching.

OBJECTIVES

This study aimed to investigate Health-Related Quality of Life (HRQoL) and its associated occupational and health factors during COVID-19 among university professors.

METHODS

A cross-sectional design targeted university professors of all majors in Jordan. The study self-administered survey included demographics and lifestyle data, 12-item Short Form health survey (SF-12), Depression Anxiety Stress Scale (DASS 21), professor' evaluation of distance teaching, Neck Disability Index (NDI), and International Physical Activity Questionnaire (IPAQ). Descriptive analyses were conducted to demonstrate primary outcome measures data. Factors associated with HRQoL were determined using a multiple variable linear regression analysis.

RESULTS

A total of 299 university professors successfully completed the study. Participants' SF-12 physical health component score was 74.08 (±18.5) and 65.74 (±21.4) for mental health component. Higher depression, stress, neck disability, and weight change were significantly associated with lower HRQoL level. While higher satisfaction with distance teaching, health self-evaluation, and work load change were significantly associated with higher HRQoL level. The regression model explained 66.7%of the variance in professors' HRQoL (r2 = 0.667, F = 82.83, P < 0.001).

CONCLUSIONS

Jordanian university professors demonstrated good HRQoL and mental health levels during COVID-19 lockdown. Factors associated with professors' HRQoL should be considered by academic institutions in determining the best occupational setup of teaching activities in future pandemics.

Efficacy of Deep Cervical Flexor Muscle Training on Neck Pain, Functional Disability, and Muscle Endurance in School Teachers: A Clinical Trial

Background

Neck pain (NP) is a common work-related disorder, with high prevalence in the profession of teaching. The daily duties of a school teacher involve head-down postures while reading and writing, which expose them to the risk of developing NP. Deep cervical flexor (DCF) muscles have been reported to have lower endurance in patients with cervical impairment, which has additionally been associated with disability. There is limited evidence regarding the efficacy of training of DCF muscles in occupational NP. The objective of this study was to investigate the effects of DCF muscle training on pain, muscle endurance, and functional disability using pressure biofeedback in school teachers with NP.

Methods

Sixty-five teachers (age, 25-45 years) with more than 5 years of teaching experience participated in this study. They were randomly divided into two groups: the experimental (E) and control (C) groups. In the E group, the subjects underwent DCF muscle training using pressure biofeedback in addition to conventional exercises for neck pain, while those in the C group underwent conventional exercises only. Pain, muscle endurance, and disability were measured at day 0 (before the treatment) and days 14 and 42 after the treatment. Endurance of DCF muscles was measured by the craniocervical flexion test using pressure biofeedback, pain intensity was measured using the numeric pain rating scale, and functional disability was assessed using the neck disability index questionnaire. This study was performed in accordance with CONSORT guidelines.

Results

On day 0, there were no significant differences in the age, pain, muscle endurance, and disability levels between the groups. After initiating the intervention, although there were improvements in both groups, there was a statistically significant improvement in muscle endurance, pain, and disability in subjects who received additional training with pressure biofeedback.

Conclusions

Besides increasing muscle endurance, specific training of DCF muscles in addition to conventional exercises can improve neck pain and functional disability. These results should be further correlated clinically. A dedicated time for exercises at school could help prevent the development of NP in teachers. This trial is registered with ClinicalTrials.gov NCT03537300 May 24, 2018 (retrospectively registered).

Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers

BACKGROUND

The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers.

OBJECTIVES

To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses.

MAIN RESULTS

We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability. Physical work environment There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.096 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence). Individual approach There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term. Organisational level No studies evaluated the effects of interventions solely targeted at the organisational level. Multi-component approach There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence).

AUTHORS' CONCLUSIONS

Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.

Trapezius muscle activity variation during computer work performed by individuals with and without neck-shoulder pain

This study aimed at determining the extent to which individuals with neck-shoulder pain and non-symptomatic individuals differ in muscle activation patterns, when performing computer work, as quantified by exposure variation analysis (EVA). As a secondary aim, we also aimed to quantify the day-to-day reliability of EVA variables describing trapezius muscle activation in a non-symptomatic control group. Thirteen touch-typing computer users (pain: n = 5, non-symptomatic: n = 8) completed three pre-selected computer tasks in the laboratory. Upper trapezius muscle activity was recorded using electromyography and analyzed using EVA with five amplitude and five duration categories. Individuals with neck-shoulder pain spent less time at low amplitudes and exhibited longer uninterrupted periods of muscle activation compared to their non-symptomatic counterparts. Thus, non-symptomatic workers tended to switch between exposure levels more often than individuals with pain. For a majority of EVA variables, ICCs ranged from 0.6 to 0.9, and between-days coefficients of variation were between 0.4 and 2.2.

Neck posture is influenced by anticipation of stepping

BACKGROUND

Postural deviations such as forward head posture (FHP) are associated with adverse health effects. The causes of these deviations are poorly understood. We hypothesized that anticipating target-directed movement could cause the head to get "ahead of" the body, interfering with optimal head/neck posture, and that the effect may be exacerbated by task difficulty and/or poor inhibitory control.

METHOD

We assessed posture in 45 healthy young adults standing quietly and when they anticipated walking to place a tray: in a simple condition and in conditions requiring that they bend low or balance an object on the tray. We defined FHP as neck angle relative to torso; we also measured head angle relative to neck and total neck length. We assessed inhibitory control using a Go/No-Go task, Stroop task, and Mindful Attention Awareness Scale (MAAS).

RESULTS

FHP increased when participants anticipated movement, particularly for more difficult movements. Worse Stroop performance and lower MAAS scores correlated with higher FHP. False alarms on the Go/No-Go task correlated with a more extended head relative to the neck and with shortening of the neck when anticipating movement.

CONCLUSIONS

Maintaining neutral posture may require inhibition of an impulse to put the head forward of the body when anticipating target-directed movement.

Scapular Upward Rotator Morphologic Characteristics in Individuals With and Without Forward Head Posture: A Case-Control Study

OBJECTIVES

There are several reports suggesting that forward head posture contributes to alterations in scapular kinematics and muscle activity, leading to the development of shoulder problems. Currently, it is unknown whether forward head posture alters the thickness of the scapular muscles. The aim of this study was to compare the thickness of the serratus anterior and upper and lower trapezius muscles at rest and during loaded isometric contractions in individuals with and without forward head posture.

METHODS

Twenty individuals with forward head posture and 20 individuals with normal head posture participated in this case-control study. Three separate ultrasound images of the serratus anterior and upper and lower trapezius muscles were captured under 2 randomized conditions: at rest and during a loaded isometric contraction.

RESULTS

The thickness of each muscle significantly increased from rest to the loaded isometric contraction (P < .001). The only difference between the groups was that the thickness of the serratus anterior muscle at rest in the normal-posture group was larger than that in the forward-posture group (P = .01).

CONCLUSIONS

Forward head posture appears to be related to atrophy of the serratus anterior muscle, which may contribute to the development of shoulder problems. Further research is required to identify more about the association of forward head posture with the imbalance of shoulder girdle muscles and the impact of head posture on upper quadrant pain.

Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion

Objectives

The purpose of this study was to determine whether the cranial vertebral angle (CVA) and the range of motion (ROM) was different between participants with a forward head posture (FHP), with or without pain.

Methods

Forty-four participants who had FHP participated in this study. The FHP was assessed digitally by measuring a lateral view the CVA for each subject. A cervical ROM device measured the cervical ROM. The volunteers were allocated to either, with pain (n = 22), or without pain (n = 22) groups, and pain was evaluated using the Numeric Pain Rating Scale.

Results

The FHP in the pain group showed a significant difference in the CVA, and the cervical ROM in both flexion and extension, compared with those in the FHP without pain group (p < 0.05). Logistic regression analysis indicated that the occurrence of cervical area pain was higher amongst subjects who had a decreased CVA and flexion motion.

Conclusion

This study suggested that decreased CVA and cervical flexion range, were predictive factors for the occurrence of pain in the cervical region.

Is forward head posture relevant to cervical muscles performance and neck pain? A case-control study

BACKGROUND

Forward head posture (FHP) and muscular dysfunction are likely contributing factors to chronic neck pain (CNP) but there are inconsistent findings on the relevance of these factors to clinical CNP characteristics.

OBJECTIVE

To compare FHP, cervical muscles size and endurance between CNP and asymptomatic participants and to investigate their association with pain and disability and relative involvement of deep/superficial and flexor/extensor muscles.

METHODS

Thirty-two patients with CNP and 35 asymptomatic participants were included in this case-control study. FHP in standing, extensor and flexor muscles endurance and dimensions were assessed using digital photography, clinical tests and ultrasonographic imaging, respectively. The visual analog scale and neck disability index were also used to evaluate CNP patients' clinical characteristics.

RESULTS

Deep flexor (mean difference=0.06, 95% CI=0.02-0.11) and extensor muscles size (mean difference=0.07, 95% CI=0.01-0.12) were found to be significantly smaller in CNP patients. CNP patients also demonstrated lower levels of flexor (mean difference=14.68, 95% CI=3.65-25.72) and global extensor endurance capacity. FHP was neither different between the groups nor correlated with any of the dependent variables. Neither FHP nor endurance was correlated with pain/disability. Extensor endurance in both groups and flexor endurance in the asymptomatic group showed significant correlations with muscles size.

CONCLUSIONS

FHP was found neither different between groups nor correlated with muscle performance or CNP clinical characteristics. While cervical endurance was found lower in CNP patients, it did not show any association with pain/disability. The muscular size-endurance relationship seems to become more complex in the presence of NP. While deep muscles seem to be differentially affected in the presence of CNP, the alterations do not seem to be uniform in the flexor and extensor groups.

Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain

OBJECTIVES

To determine feasibility and potential of Alexander technique (AT) group classes for chronic neck pain and to assess changes in self-efficacy, posture, and neck muscle activity as potential mechanisms for pain reduction.

DESIGN

A single-group, multiple-baseline design, with two pre-tests to control for regression toward the mean, a post-test immediately after the intervention, and another post-test five weeks later to examine retention of benefits. Participants were predominately middle-aged; all had experienced neck pain for at least six months.

INTERVENTION

Participants attended ten one-hour group classes in AT, an embodied mindful approach that may reduce habitual overactivation of muscles, including superficial neck muscles, over five weeks.

OUTCOME MEASURES

(1) self-reports: Northwick Park Questionnaire (to assess neck pain and associated disability) and Pain Self-Efficacy Questionnaire; (2) superficial neck flexor activation and fatigue (assessed by electromyography and power spectral analysis) during the cranio-cervical flexion test; (3) posture during a video game task.

RESULTS

There were no significant changes in outcomes between pre-tests. All participants completed the intervention. After the intervention: (1) participants reported significantly reduced neck pain; (2) fatigue of the superficial neck flexors during the cranio-cervical flexion test was substantially lower; (3) posture was marginally more upright, as compared to the second pre-intervention values. Changes in pain, self-efficacy, and neck muscle fatigue were retained at the second post-test and tended to be correlated with one another.

CONCLUSIONS

Group AT classes may provide a cost-effective approach to reducing neck pain by teaching participants to decrease excessive habitual muscle contraction during everyday activity.

Musculoskeletal discomfort and use of computers in the university environment

This cross-sectional study investigated musculoskeletal discomfort and computer use in university staff, through the use of online questionnaires. Results showed a high prevalence of staff reported musculoskeletal discomfort during the preceding year (80%), with neck (60%), shoulder (53%) and lower back discomfort (47%) being the most common. Most believed discomfort was caused by work, although neck discomfort was significantly less in those reporting excellent mental health (OR 0.44, p < 0.01). Computer navigation was performed primarily by mouse (77%); however, using a touch pad increased the odds (OR 1.17, p < 0.01) of wrist discomfort and the belief it was caused by work (OR 1.19, p < 0.01). Few staff attended ergonomic training (16%) or requested workstation assessments (26%). However, high rates of staff reporting musculoskeletal discomfort sought professional treatment (range: 35.2% wrist/hand to 65.0% shoulder). Strategies are needed to address uptake of preventive measures and reduce reliance on medical treatments following musculoskeletal discomfort in universities.

The Reliabilities of Several Measurement Methods of Cervical Sagittal Alignment in Cases with Cervical Spine Rotation Using X-ray Findings in Cervical Spine Disorders

Introduction

Several measurement methods designed to provide an understanding of cervical sagittal alignment have been reported, but few studies have compared the reliabilities of these measurement methods. The purpose of the present study was to investigate the intraexaminer and interexaminer reliabilities of several cervical sagittal alignment measurement methods and of the rotated cervical spine using plain lateral cervical spine X-rays of patients with cervical spine disorders.

Methods

Five different measurement methods (Borden's method; Ishihara index method (Ishihara method); C2-7 Cobb method (C2-7 Cobb); posterior tangent method: absolute rotation angle C2-7 (ARA); and classification of cervical spine alignment (CCSA)) were applied by seven examiners to plain lateral cervical spine X-rays of 20 patients (10 randomly extracted cases from a rotated cervical spine group and 10 from a nonrotated group) with cervical spine disorders. Case 1 and Case 2 intraclass correlation coefficients (ICCs) were used to analyze intraexaminer and interexaminer reliabilities. The necessary number of measurements and the necessary number of examiners were also determined. The target coefficient of correlation was set at ≥0.81 (almost perfect ICC).

Results

In both groups, an ICC(1, 1) ≥ 0.81 was obtained with Borden's method, the Ishihara method, C2-7 Cobb, and ARA by all examiners. The necessary number of measurements was 1. With CCSA, a kappa coefficient of at least 0.9 was obtained. In both groups, with Borden's method, the Ishihara method, C2-7 Cobb, and ARA, the ICC(2, 1) was ≥0.9, indicating that the necessary number of examiners was 1. The standard error of measurement (SEM) was lowest with Borden's method, and the Ishihara method and C2-7 Cobb had almost the same values.

Conclusions

Among cervical sagittal alignment measurement methods for cervical spine disorders, regardless of cervical spine rotation, Borden's method, Ishihara method, and C2-7 Cobb offer stronger reliability in terms of the ICC and SEM.

Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial

Background

Although upper cervical and upper thoracic spine mobilization plus therapeutic exercises are common interventions for the management of forward head posture (FHP), no study has directly compared the effectiveness of cervical spine mobilization and stabilization exercise with that of thoracic spine mobilization and mobility exercise in individuals with FHP.

Methods

Thirty-two participants with FHP were randomized into the cervical group or the thoracic group. The treatment period was 4 weeks, with follow-up assessment at 4 and 6 weeks after the initial examination. Outcome measures including the craniovertebral angle (CVA), cervical range of motion, numeric pain rating scale (NPRS), pressure pain threshold, neck disability index (NDI), and global rating of change (GRC) were collected. Data were examined with a two-way repeated-measures analysis of variance (group × time).

Results

Participants in the thoracic group demonstrated significant improvements (p < .05) in CVA, cervical extension, NPRS, and NDI at the 6-week follow-up compared with those in the cervical group. In addition, 11 of 15 (68.8%) participants in the thoracic group compared with 8 of 16 participants (50%) in the cervical group showed a GRC score of +4 or higher at the 4-week follow-up.

Conclusions

The combination of upper thoracic spine mobilization and mobility exercise demonstrated better overall short-term outcomes in CVA (standing position), cervical extension, NPRS, NDI, and GRC compared with upper cervical spine mobilization and stabilization exercise in individuals with FHP.

Trial registration

KCT0002307, April 11, 2017 (retrospectively registered).

The effect of the shoulder stability exercise using resistant vibration stimulus on forward head posture and muscle activity

[Purpose] The purpose of this study was to analyze shoulder stabilization using resistant vibration stimulus during bodyblade exercise followed by forward head posture improvement. [Subjects and Methods] Craniovertebral angle and cranial rotation angle were measured with 24 patients who were diagnosed with forward head posture. The experimental group conducted bodyblade exercise for 6 weeks and all patients received conventional physical therapy. The craniovertebral angle and cranial rotation angle were measured using a diagnostic imaging device to measure the change in forward head posture. Sternocleidomastoid, upper trapezius and serratus anterior muscle activity were measured using surface electromyography, voluntary contraction was converting into a percentage and mean value was calculated. [Results] The experimental group showed a significant increase in the comparison of the results of both groups before and after the intervention. The comparing group showed no significant difference. The experimental group showed the significant difference in mean value after the intervention in the comparison between the groups. [Conclusion] Resistant vibration stimulus by bodyblade controlled shoulder muscle activity causing scapular stabilization followed by neck position stability improvement. Rehabilitation program that activates whole kinetic chain of proximal and distal muscles such as bodyblade will show more effective improvement when choosing rehabilitation program for neck and shoulder disease clinically.

Consequences and management of neck pain by female office workers: results of a survey and clinical assessment

Background

Neck pain is common in office workers. However, the functional consequences of this pain to the individual and how they are managed are not well known. The objective of this study is understand the impact of neck pain and the strategies female office workers use to manage their pain while remaining at work.

Methods

Female office workers with neck pain (n = 174) completed a survey about the impact of their neck pain, with 51 attending a university clinic for further assessment. Consequences of neck pain were evaluated with questions on self-reported work absence, workers' compensation claims, health care use, impact on work and leisure activity, and management strategies. Responses to survey questions were analysed using descriptive analyses.

Results

The results showed that during the preceding 12 months, 57.5 % of participants had consulted a health professional due to neck pain; 42 % had reduced their leisure activities; 22.4 % had reduced their work activity and 20.7 % had been absent from work. Only 5.2 % had ever submitted a workers' compensation claim and 9 % indicated changing jobs due to neck pain. Of the 51 participants who attended for further assessment, 35.3 % indicated they 'self-managed' their neck pain with conventional medical strategies. Common strategies utilized were: prescription or over-the-counter medications (82.5 %), physiotherapy (64.7 %) and visiting their general medical practitioner (54.9 %).

Conclusions

Although the severity of neck pain experienced by female office workers in this study was low, the impact on work and leisure was substantial. These workers tended to self-manage their pain by reducing work and/or leisure activity and utilizing passive coping strategies to remain at work. Physiotherapists are ideally suited to provide self-management strategies to ensure workers remain healthy while working.

Psychometric properties of the Fear-Avoidance Beliefs Questionnaire in patients with neck pain

Objectives: To translate the Fear-Avoidance Beliefs Questionnaire and investigate the validity and reliability of the Chinese version of the questionnaire in patients with neck pain.

Design: Observational cross-sectional and prospective study.

Setting: Physiotherapy outpatient departments.

Subjects: Four samples with 476 consecutive adult patients with neck pain from four physiotherapy centres.

Methods: The original questionnaire was translated into Chinese by forward and backward translation and reviewed by a panel of experts. The subjects completed the Chinese version of the fear-avoidance questionnaire, Northwick Park Neck Pain Questionnaire, Medical Outcomes 36-Item Short-Form Health Survey and their pain intensity was measured using an 11-point pain numerical rating scale. They were observed and measured at the beginning of physiotherapy, at week 3 and at week 6 after treatment began.

Results: The questionnaire had very good content validity and test-retest reliability with an intraclass correlation coefficient of 0.81 and Cronbach’s alpha coefficient of 0.90. Spearman’s correlation coefficients between fear-avoidance and the neck pain questionnaire, the health survey (physical), health survey (mental) and pain scale were 0.56, 0.45, 0.36 and 0.34, respectively. The standard response mean and effect size at week 6 were 0.38 and 0.32, respectively. Factor analysis yielded three factors which accounted for 61.6% of the total variance of the questionnaire.

Conclusion: The Fear-Avoidance Beliefs Questionnaire is a valid and reliable tool for patients with neck pain. It has been shown to demonstrate very good content validity, a high degree of test-retest reliability and internal consistency, good construct validity and medium responsiveness.

Effect of the different ages and visual display terminal use on repositioning and lumbar muscle activity during continuous sitting

[Purpose] The purpose of this study was to investigate the effect of different ages and visual display terminal (VDT) use on repositioning and lumbar muscle activity during continuous sitting. [Subjects] Thirteen males two groups: 7 males in their 20s, 6 males in their 40s participated in this study. [Methods] The two groups watched a lecture in a seated position under different conditions. L4 paraspinal muscle activity was recorded using a surface electromyography system. Repositioning was assessed using a video camera and Tekscan system. [Results] The repositioning times decreased significantly in the order to without a VDT in males in their 20s and 40s > with a VDT in males in their 20s > with a VDT in males in their 40s. The L4 paraspinal muscle activity significantly increased in order to without a VDT in males in their 20s and 40s < with a VDT in males in their 20s < with a VDT in males in their 40s. [Conclusion] The results of this study suggest that the number of repositioning movements during continuous sitting could affect lumbar muscle activity and could be an important factor for prevention of low back pain.

Effects of forward head posture on forced vital capacity and respiratory muscles activity

[Purpose] This study investigated the effects of forward head posture on forced vital capacity and deep breathing. [Subjects] Twenty-six subjects, divided into the two groups (normal and forward head posture groups), participated in this study. [Methods] Forced vital capacity and forced expiratory volume in 1 second were measured using respiratory function instrumentation that met the American Thoracic Society's recommendation for diagnostic spirometry. Accessory respiratory muscle activity during deep breathing was measured by electromyography. A Mann-Whitney test was used to compare the measure variables between the normal and forward head posture group. [Results] Forced vital capacity and forced expiratory volume in 1 second were significantly lower in the forward head posture group than in the normal group. Accessory respiratory muscle activity was also lower in the forward head posture group than in the normal group. In particular, the sternocleidomastoid and pectoralis major activity of the forward head posture group was significantly lower than that of normal group. Activities of the other muscles were generally decreased with forward head posture, but were not significantly different between the two groups. [Conclusion] These results indicate that forward head posture could reduce vital capacity, possibly because of weakness or disharmony of the accessory respiratory muscles.

Measurement of craniovertebral angle by the Modified Head Posture Spinal Curvature Instrument: A reliability and validity study

The Modified Head Posture Spinal Curvature Instrument (MHPSCI) is an extension of the Head Posture Spinal Curvature Instrument. Two specific modifications were made in the original design by adding a third arm projecting horizontally from the protractor to objectively fix the pivot exactly over the C7 vertebra and the addition of a spirit-level to properly align the instrument. In order to demonstrate reliability and validity, this study was conducted using patients with postural neck pain (N = 65) and healthy subjects (N = 20). All the subjects were working at a selected Information Technology Industry in India and had been recruited using a criterion-based sampling approach. The craniovertebral (CV) angle of each subject was evaluated by two raters consecutively. The measurements were taken by using both MHPSCI and the standard photographic method in a standardized sitting posture for the purpose of establishing criterion-validity of the instrument. The results of this study indicate a good inter-rater reliability (ICC = 0.76; CI = 0.65-0.84) as well as intra-rater reliability (ICC = 0.87; CI = 0.82-0.91) between three successive CV angle measurements (with 2 minutes interval between each measurement) through MHPSCI. While keeping the digital photographic measurement as a standard, this study established that the MHPSCI is a valid tool for measuring the CV angle as shown by non-significant difference (p > 0.01) and high correlation between the two methods (r = 0.79-0.84). This study demonstrates that the MHPSCI is a reliable and valid instrument for measuring CV angle in subjects with or without postural neck pain.

Characteristics of cervical position sense in subjects with forward head posture

[Purpose] The purpose of this study was to investigate the effect of forward head posture (FHP) on proprioception by determining the cervical position-reposition error. [Subjects and Methods] A sample population was divided into two groups in accordance with the craniovertebral angle: the FHP group and the control group. We measured the craniovertebral angle, which is defined as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The error value of the cervical position sense after cervical flexion, extension, and rotation was evaluated using the head repositioning accuracy test. [Results] There were significant differences in the error value of the joint position sense (cervical flexion, extension, and rotation) between the FHP and control groups. In addition, there was an inverse correlation between the craniovertebral angle and error value of the joint position sense. [Conclusion] FHP is associated with reduced proprioception. This result implies that the change in the muscle length caused by FHP decreases the joint position sense. Also, proprioception becomes worse as FHP becomes more severe.

Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain

Background:

There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences.

Objectives:

To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain.

Method:

This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males) aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES) was used to assess shoulder pain, whereas neck pain was self-reported with a single question.

Results:

Mean values of sagittal head, cervical, and shoulder angles were 17.2±5.7, 47.4±5.2, and 51.4±8.5º, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys.

Conclusions:

This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture.

Correlação entre postura da cabeça, intensidade da dor e índice de incapacidade cervical em mulheres com queixa de dor cervical

A dor cervical é o sintoma mais comum das disfunções cervicais, frequentemente relacionado à manutenção de posturas inadequadas. As alterações posturais da cabeça estão associadas à ocorrência de dor cervical, sendo a anteriorização a alteração mais comum. O objetivo foi investigar a correlação entre postura da cabeça, intensidade da dor e índice de incapacidade cervical - neck disability index (NDI). O grupo estudo (GE) foi composto por mulheres na faixa entre 20 e 50 anos com queixas de dor cervical por mais de três meses, e o grupo controle (GC), por mulheres assintomáticas. A intensidade da dor foi avaliada pela escala visual analógica (EVA), a incapacidade pelo NDI e a postura da cabeça pelo ângulo craniovertebral (CV). A normalidade dos dados foi verificada pelo teste de Lilliefors, e a comparação entre os grupos pelo teste t de Student para amostras independentes e a associação entre as variáveis pela correlação de Spearman. O nível de significância foi de 5%. O GE apresentou médias menores para o ângulo CV (p=0,02). O ângulo CV demonstrou correlação negativa com a EVA (r=-0,48) e o NDI (r=-0,15), sugerindo que quanto menor o ângulo, maior a intensidade da dor e a incapacidade cervical. O NDI e a EVA apresentaram correlação positiva (r=0,59). O ângulo CV em indivíduos com dor cervical foi significativamente menor que em assintomáticos, apresentando correlação moderada com o NDI e a dor.

The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial

Objective: To investigate the effect of forward head posture correction on pain and nerve root function in cases of cervical spondylotic radiculopathy.

Design: A randomized controlled study with six months follow-up.

Setting: University research laboratory.

Subjects: Ninety-six patients with unilateral lower cervical spondylotic radiculopathy (C5–C6 and C6–C7) and craniovertebral angle measured less than or equal to 50° were randomly assigned to an exercise or a control group.

Interventions: The control group ( n = 48) received ultrasound and infrared radiation, whereas the exercise group ( n = 48) received a posture corrective exercise programme in addition to ultrasound and infrared radiation.

Main outcome measures: The peak-to-peak amplitude of dermatomal somatosensory evoked potentials, craniovertebral angle, visual analogue scale were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at follow-up of six months).

Results: There was a significant difference between groups adjusted to baseline value of outcome at 10 weeks post-treatment for craniovertebral angle, pain, C6 and C7 peak-to-peak amplitude of dermatomal somatosensory evoked potentials P = 0.000, 0.01, 0.000, 0.001 respectively and at follow-up for all previous variables ( P = 0.000).

Conclusion: Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.

Changes in craniocervical and trunk flexion angles and gluteal pressure during VDT work with continuous cross-legged sitting

OBJECTIVES

This study investigated changes in craniocervical and trunk flexion angles and gluteal pressure on both sides during visual display terminal (VDT) work with continuous cross-legged sitting.

METHODS

The gluteal pressures of ten VDT workers, who were recruited from laboratories, were measured using a Teckscan system and videotaped using a single video camera to capture the craniocervical and trunk flexion angles during VDT work at 30 s, 10, 20 and 30 min.

RESULTS

The craniocervical angle was significantly increased at 10 and 20 min compared with the initial angle (p<0.05). The trunk flexion angle was significantly decreased at 30 s, 10, 20 and 30 min (p<0.05). The gluteal pressure of the crossed-leg side significantly increased at 30 s, 10 and 20 min (p<0.05). The gluteal pressure of the uncrossed-leg side significantly decreased at 30 s (p<0.05).

CONCLUSION

We found that cross-legged sitting during VDT work may exert disadvantageous postural effects resulting from craniocervical and trunk flexion angles and gluteal pressure. Therefore, this posture could not be recommended during long-term VDT work.

Head movements during two computer work tasks assessed by accelerometry

We investigated whether potential differences in head inclinations and accelerations for two highly similar computer work tasks could be detected using (1) a triaxial accelerometer and (2) a simulated uniaxial accelerometer. Ten subjects' head movements were registered with a triaxial accelerometer system for two similar document-management tasks at their work place: a fully electronic document-management task and one also involving paper documents. In situations where head movements were small, a triaxial accelerometer was able to discriminate between the different degrees of static work of the neck in terms of range of head inclinations and accelerations. A difference in head acceleration was also found by using a simulated uniaxial accelerometer. Thus, in terms of head movement and for work similar to this office work, potential dynamic differences in observationally similar work tasks can be investigated by using a triaxial accelerometer. For acceleration alone, a uniaxial accelerometer can also be used.

Changes in head and neck posture using an office chair with and without lumbar roll support

STUDY DESIGN

A repeated measures observational study.

OBJECTIVE

To investigate change in sagittal alignment of head and neck posture in response to adjustments of an office chair with and without a lumbar roll in situ.

SUMMARY OF BACKGROUND DATA

Forward head posture has been identified as a risk factor for neck pain, and there is evidence to show that ergonomic correction in sitting may reduce the incidence of pain. The effect placement of a lumbar roll has on cervical spine posture has not been previously investigated experimentally but rather, is assumed to have a positive influence on head and neck posture.

METHODS

Thirty healthy male participants (18-30 years) were photographed while registered in the natural head resting position in each of 4 sitting positions with and without a lumbar roll in situ. Two positions incorporated adjustments to the back rest and 1 to the seat pan of the office chair. The craniovertebral (CV) angle, as a determinant of head and neck posture was measured from the set of digitized photographs obtained for each participant. Comparisons between the CV angle in all postural registrations were made using a mixed model analysis adjusted for multiple comparisons.

RESULTS

Of the positions examined, significant differences in the mean CV angles were found with the backrest of the chair at 100 degrees and at 110 degrees (P < 0.001). With the lumbar roll in situ and the backrest position at 110 degrees , there was a significant increase in the mean CV compared with the angle without the lumbar roll in situ (2.32 degrees , 95% confidence interval: 1.31-3.33; P < 0.001).

CONCLUSION

The degree of angulation of the backrest support of an office chair plus the addition of lumbar roll support are the 2 most important factors to be taken into account when considering seating factors likely to favorably change head and neck postural alignment, at least in asymptomatic subjects.

Influence of forward head posture on scapular upward rotators during isometric shoulder flexion

SUMMARY

We assessed the effects of forward head posture in the sitting position on the activity of the scapular upward rotators during loaded isometric shoulder flexion in the sagittal plane. Healthy volunteers (n = 21; 11 men, 10 women) with no history of pathology participated in the study. Subjects were instructed to perform isometric shoulder flexion with the right upper extremity in both the forward head posture (FHP) and neutral head posture (NHP) while sitting. Surface electromyography (EMG) was recorded from the upper trapezius, lower trapezius, and serratus anterior muscles. Dependent variables were examined by 2 (posture)×3 (muscle) repeated measures analysis of variance. Significantly increased EMG activity in the upper trapezius and lower trapezius and significantly decreased EMG activity in the serratus anterior were found during loaded isometric shoulder flexion with FHP. Thus, FHP may contribute to work-related neck and shoulder pain during loaded shoulder flexion while sitting. These results suggest that maintaining NHP is advantageous in reducing sustained upper and lower trapezius activity and enhancing serratus anterior activity as compared with FHP during loaded shoulder flexion.