Ann Rehabil Med.  2014 Dec;38(6):821-826. 10.5535/arm.2014.38.6.821.

Radiologic Assessment of Forward Head Posture and Its Relation to Myofascial Pain Syndrome

  • 1Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea.
  • 2Department of Nanobiomedical Science & WCU Research Center, Dankook University, Cheonan, Korea.
  • 3Institute of Tissue Regeneration Engineering, Dankook University, Cheonan, Korea.


To assess head posture using cervical spine X-rays to find out whether forward head posture is related to myofascial pain syndrome (MPS) in neck and shoulder.
Eighty-eight participants who were diagnosed with MPS in neck and shoulder were evaluated in this study. Four parameters (distance among head, cervical spines, and shoulder, and cervical angle) were measured from lateral view of cervical spine X-ray. The location and number of trigger points in the neck and shoulder and symptom duration were evaluated for each patient.
Both horizontal distances between C1 vertebral body and C7 spinous process and between the earhole and C7 vertebral body were negatively correlated with cervical angle reflecting cervical lordosis (p<0.05). Younger patients had significantly (p<0.05) less cervical angle with more forward head posture. There was no relationship between MPS (presence, location, and number of trigger points) and radiologic assessments (distance parameters and the cervical angle).
Forward head posture and reduced cervical lordosis were seen more in younger patients with spontaneous neck pain. However, these abnormalities did not correlate with the location or the number of MPS. Further studies are needed to delineate the mechanism of neck pain in patients with forward head posture.


Cervical vertebrae; Lordosis; Neck pain; Myofascial pain syndromes; Trigger points
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