The association between forward head posture and non-specific neck pain: A cross-sectional study

Hilla Sarig Bahat, Andrei Levy, Tomer Yona

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Poor posture is traditionally associated with various musculoskeletal disorders. Consequently, educators in the musculoskeletal field have been teaching postural observation as part of the physical assessment. Forward head posture (FHP) is hypothesized to be associated with neck pain; however, evidence in this topic remains inconclusive.

PURPOSE: To investigate the association between FHP and neck pain intensity, disability, and cervical kinematics in individuals with neck pain compared to asymptomatic individuals. A secondary aim of this study was to explore the possible effect of a head-mounted display (HMD) used in a virtual reality (VR) assessment on FHP.

METHODS: The study was conducted with 43 volunteers (20 asymptomatic individuals, 23 individuals with neck pain) aged 19 to 62. FHP was assessed by measuring craniovertebral angle on profile photographs. Secondary outcome measures included pain intensity, the neck disability index (NDI) questionnaire, and neck kinematics using specialized VR software.

RESULTS: There were no significant differences between individuals with neck pain and asymptomatic individuals in FHP (craniovertebral angle = 48.24 °±7.29; 48.90 °±5.89, respectively, p > .05). The neck pain group demonstrated a restricted range of motion and slower neck movements (p < .05). We found no significant correlation between FHP and visual analog scale, NDI, and most neck kinematic measures.

CONCLUSIONS: Our findings cannot support a clinically applicable association between FHP and neck pain. Additionally, individuals with neck pain had a lower range of motion and slower neck movements.

Original languageEnglish
Pages (from-to)1736-1745
Number of pages10
JournalPhysiotherapy Theory and Practice
Issue number8
StatePublished - 3 Aug 2023

Bibliographical note

Publisher Copyright:
© 2022 Taylor & Francis Group, LLC.


  • Cross-Sectional Studies
  • Humans
  • Neck
  • Neck Muscles
  • Neck Pain/diagnosis
  • Posture


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