Assessment of forward head posture in females: observational and photogrammetry methods

J Back Musculoskelet Rehabil. 2014;27(2):131-9. doi: 10.3233/BMR-130426.


Background: There are different methods to assess forward head posture (FHP) but the accuracy and discrimination ability of these methods are not clear.

Objectives: Here, we want to compare three postural angles for FHP assessment and also study the discrimination accuracy of three photogrammetric methods to differentiate groups categorized based on observational method.

Method: All Seventy-eight healthy female participants (23 ± 2.63 years), were classified into three groups: moderate-severe FHP, slight FHP and non FHP based on observational postural assessment rules. Applying three photogrammetric methods - craniovertebral angle, head title angle and head position angle - to measure FHP objectively.

Results: One - way ANOVA test showed a significant difference in three categorized group's craniovertebral angle (P< 0.05, F=83.07). There was no dramatic difference in head tilt angle and head position angle methods in three groups. According to Linear Discriminate Analysis (LDA) results, the canonical discriminant function (Wilks'Lambda) was 0.311 for craniovertebral angle with 79.5% of cross-validated grouped cases correctly classified.

Conclusion: Our results showed that, craniovertebral angle method may discriminate the females with moderate-severe and non FHP more accurate than head position angle and head tilt angle. The photogrammetric method had excellent inter and intra rater reliability to assess the head and cervical posture.

Keywords: Observational assessment; forward head posture; photogrammetry.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Cervical Vertebrae / anatomy & histology
  • Female
  • Head / anatomy & histology*
  • Healthy Volunteers
  • Humans
  • Neck / anatomy & histology*
  • Observer Variation
  • Photogrammetry / methods*
  • Photogrammetry / standards*
  • Photogrammetry / statistics & numerical data
  • Physical Examination / methods
  • Physical Examination / standards
  • Physical Examination / statistics & numerical data
  • Posture*
  • Reference Values
  • Reproducibility of Results
  • Young Adult