Document Type : Original Articles


1 Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences

2 Shahid Beheshti University of Medical Sciences


 Background: Forward head posture (FHP) is recognized as a common postural disorder of modern societies. Increase in anterior cervical convexity and anterior displacement of the line of gravity of head in individuals with FHP is assumed to result in altered moment arms and muscle activity on cervical spine. Measurement of muscle thickness seems to be an appropriate index for muscle activity. This study was aimed to compare cervical extensor muscle thickness in individuals with normal head posture with those suffering from FHP.Methods: Twenty volunteers with FHP and 20 matched controls (11 females and 9 males in each group) participated in this cross-sectional study. The thickness of cervical extensor muscles including multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis and upper trapezius were measured using ultrasonography at the level of forth cervical vertebrae at rest.Results: No significant differences of thickness of cervical extensor muscles were observed between the two groups (p<0.05) at of rest.Conclusion: The results of this study showed that the thickness of cervical extensor muscles at the level of forth cervical vertebrae in individuals with FHP did not change in comparison with normal head posture at rest. Further studies are recommended to evaluate extensor muscles at other levels of cervical spine.


  1. Nam SH, Son SM, Kwon JW, Lee NK. The intra-and inter-rater reliabilities of the forward head posture assessment of normal healthy subjects. Journal of physical therapy science. 2013;25(6):737.
  2. Kang J-H, Park R-Y, Lee S-J, Kim J-Y, Yoon S-R, Jung K-I. The effect of the forward head posture on postural balance in long time computer based worker. Annals of rehabilitation medicine. 2012;36(1):98-104.
  3. Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons. Archives of physical medicine and rehabilitation. 2009;90(4):669-74.
  4. Lau KT, Cheung KY, Chan MH, Lo KY, Chiu TTW. Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Manual therapy. 2010;15(5):457-62.
  5. Levangie PK, Norkin CC. Joint structure and function: a comprehensive analysis: FA Davis; 2011.
  6. McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. Journal of manipulative and physiological therapeutics. 2005;28(3):187-93.
  7. Silva AG, Johnson MI. Does forward head posture affect postural control in human healthy volunteers? Gait & posture. 2013;38(2):352-3.
  8. Weon J-H, Oh J-S, Cynn H-S, Kim Y-W, Kwon O-Y, Yi C-H. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork and movement therapies. 2010;14(4):367-74.
  9. Lee W-Y, Okeson JP, Lindroth J. The relationship between forward head posture and temporomandibular disorders. Journal of orofacial pain. 1994;9(2):161-7.
  10. Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Applied ergonomics. 2002;33(1):75-84.
  11. Fernandez‐de‐las‐Peñas C, Alonso‐Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger Points in the Suboccipital Muscles and Forward Head Posture in Tension‐Type Headache. Headache: The Journal of Head and Face Pain. 2006;46(3):454-60.
  12. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: testing and function with posture and pain. 2005.
  13. Edmondston SJ, Sharp M, Symes A, Alhabib N, Allison GT. Changes in mechanical load and extensor muscle activity in the cervico-thoracic spine induced by sitting posture modification. Ergonomics. 2011;54(2):179-86.
  14. Peolsson A, Marstein E, McNamara T, Nolan D, Sjaaberg E, Peolsson M, et al. Does posture of the cervical spine influence dorsal neck muscle activity when lifting? Manual therapy. 2014;19(1):32-6.
  15. Rezasoltani A, Nasiri R, Faizei A, Zaafari G, Mirshahvelayati A, Bakhshidarabad L. The variation of the strength of neck extensor muscles and semispinalis capitis muscle size with head and neck position. Journal of bodywork and movement therapies. 2013;17(2):200-3.
  16. Rezasoltani A, Ali-Reza A, Khosro KK, Abbass R. Preliminary study of neck muscle size and strength measurements in females with chronic non-specific neck pain and healthy control subjects. Manual therapy. 2010;15(4):400-3.
  17. Lee J-P, Tseng W-YI, Shau Y-W, Wang C-L, Wang H-K, Wang S-F. Measurement of segmental cervical multifidus contraction by ultrasonography in asymptomatic adults. Manual therapy. 2007;12(3):286-94.
  18. Kristjansson E. Reliability of ultrasonography for the cervical multifidus muscle in asymptomatic and symptomatic subjects. Manual therapy. 2004;9(2):83-8.
  19. Salahzadeh Z, Maroufi N, Ahmadi A, Behtash H, Razmjoo A, Gohari M, et al. Assessment of forward head posture in females: observational and photogrammetry methods. Journal of back and musculoskeletal rehabilitation. 2013;27(2):131-9.
  20. Falla D, Jull G, Russell T, Vicenzino B, Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Physical Therapy. 2007;87(4):408-17.
  21. Fernandez-De-Las-Peñas C, Albert-Sanchis JC, Buil M, Benitez JC, Alburquerque-Sendin F. Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls. Journal of Orthopaedic and Sports Physical Therapy. 2008;38(4):175.
  22. Amiri Arimi S, Rezasoltani A, Sakhaei SY, Khalkhali M, Rahnama L. Symmetry of cervical multifidus muscle in females with chronic non-specific neck pain and healthy by ultrasonography. Modern Rehabilitation. 2013;7(1):13-20.
  23. Motialla T, Moslemi Haghighi F, Ghanbari A, Amir Moezi S, Saadat Z, , et al. The correlation between forward head posture and trigger points in trapezius muscle in subjects with chronic neck pain. Journal of Research in Rehabilitation Sciences. 2013;1(1):989-97.
  24. Caneiro JP, O'Sullivan P, Burnett A, Barach A, O'Neil D, Tveit O, et al. The influence of different sitting postures on head/neck posture and muscle activity. Manual Therapy. 2010;15(1):54-60.