Relationship between Forward Head Posture and Tissue Mechanosensitivity: A Cross-Sectional Study

Abstract

The relationship between forward head posture (FHP) and neck pain is not clear. FHP could possibly increase the mechanosensitivity of cervical tissues, which could lead to the development of pain depending on the adaptation capability of the central nervous system. The purpose of this study was to analyse the influence of FHP in the mechanosensitivity of articular, muscular, and neural tissues related to the cervical spine. The pressure pain threshold was bilaterally measured in different muscles and nerves and the second cervical vertebrae. The cervical spine’s range of movement was also examined. The measurements were obtained from people with (n = 32) and without (n = 64) FHP. The analyses included a 2-by-2 mixed analysis of variance (ANOVA), pairwise comparisons with Bonferroni correction, and point-biserial correlation coefficients. Subjects with FHP showed a less pressure pain threshold (PPT) in all locations except for the upper trapezius and scalenus medius muscles. They also showed less extension and right-rotation range of motion. There was no association between FHP, neck pain, disability, and headache. Nevertheless, more research is needed to evaluate the relationship between FHP, tissue mechanosensitivity, and neck pain.

Interaction between Pain, Disability, Mechanosensitivity and Cranio-Cervical Angle in Subjects with Cervicogenic Headache: A Cross-Sectional Study

“…On the other hand, there was a nonsignificant relationship between the PPT measured at the upper trapezius and splenius capitis muscles, and CCA. These results agree with the ones obtained by Martinez–Merinero et al [ 17 ] and Kocur et al [ 34 ], who did not find an increase in the mechanosensitivity of the upper trapezius and sternocleidomastoid muscles in subjects with FHP. However, Pacheco et al [ 18 ] and Huber et al [ 35 ] found an increase in the mechanosensitivity of the upper trapezius muscle in subjects with FHP.…”

“…It has been observed that FHP produces an increase in mechanical stress in some cranio-cervical structures [ 14 ] The mechanical over-demands have been related to an increase in mechanosensitivity measured with PPT [ 17 ]. In the present study, there was a significant positive relationship between the PPT measured at C2 and CCA, i.e., subjects with a decrease in CCA (increased FHP) had less PPT at C2 (increased tissue mechanosensitivity).…”

“…Furthermore, the increase in the sustained pressure over the articular surfaces of the upper cervical vertebras because of FHP could lead to a peripherical and/or central sensitization, which in turn would increase the neural mechanosensitivity, thus playing an important role in the pathophysiology of CGH [ 6 , 32 ]. Regarding this topic, Martinez–Merinero et al [ 17 ] and Amiri et al [ 33 ] found a decrease in PPT measured over the articular process of C2 in subjects with FHP [ 17 ] and CGH [ 33 ].…”

“…However, Pacheco et al [ 18 ] and Huber et al [ 35 ] found an increase in the mechanosensitivity of the upper trapezius muscle in subjects with FHP. Furthermore, Martinez–Merinero et al [ 17 ] found an increase in the mechanosensitivity of the splenius capitis muscle. In 1992, Bovim [ 36 ] found a decrease in the PPT measured in multiple points in the cranio-cervical region in subjects with CGH when compared to healthy subjects, subjects with migraine and subjects with tension-type headaches; however, they did not measure any point evaluated in the present study [ 36 ].…”

“…It has been suggested that FHP could impose a great mechanical demand in different tissues in the cranio-cervical region, sensitizing them and thus contributing to the appearance and/or perpetuation of pain [ 14 ]. Multiple authors have investigated the relationship between tissue mechanosensitivity, posture alterations and neck pain [ 15 , 16 , 17 , 18 ], with some finding an increase of mechanosensitivity in subjects with FHP [ 17 , 18 ]. Furthermore, Castien et al [ 16 ] have found an association between headache intensity and mechanosensitivity for some tissues of the cranio-cervical region [ 16 ].…”