Association Of Forward Head Posture And Cervical Joint Position Sense In Patients With Or Without Neck Pain– A Systematic Review

Abstract

Background:  Forward head posture (FHP) is prevalent positional deviation seen in lateral view. According to recent studies, subjects who are having FHP also has somatosensory hypofunction and reduced proprioception which are essential afferent signals to maintain posture. There are no systematic reviews studying association of FHP and cervical joint position sense till date, which is important for further understanding and investigations. Considering the impairments associated with reduced cervical joint position sense it is important to know this relationship, and hence the need for this study.

Methods: This study was performed according the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline (PROSPERO ID: CRD42024572197). Literature search was performed on PubMed, Web of Science, Scopus, and Google Scholar.  Additionally, a manual search using the references of included papers was conducted. Observational studies that examined the connection between FHP and cervical joint position sense were among the studies that qualified. The Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies was used to evaluate the quality of the studies.

Results: Seven studies were included for the final analysis after checking inclusion and exclusion criteria and quality assessment. The evidence supported that people with forward head posture have significant reduction in cervical joint position sense in all four directions. Limited evidence supporting association between FHP and cervical joint position sense in subjects with neck pain.

Conclusion: The results of this systematic analysis consistently showed that subjects with FHP had decreased cervical proprioception. However, the evidence base is weakened by heterogeneity and a dearth of high-quality trials. But this study provides evidence for impact of Forward head posture and application of techniques to reduce dysfunction.