Normal craniovertebral angle range in asymptomatic Black South African females : a pilot study

Abstract

Introduction: Forward head posture (FHP) has become more prevalent in modern times and is described as carrying the head anterior to the centre of the shoulder. As the head moves forward, the centre of gravity shifts. To compensate for this shift, the upper body shifts backward to maintain balance, which eventually leads to fatigue and subsequent myofascial pain when this position is maintained for prolonged periods of time. The craniovertebral angle (CVA) measures the degree of FHP and is formed between a horizontal line passing through C7 of the cervical spine and a line extending from the tragus of the ear to C7 spinous process. Previous studies have concluded that a smaller CVA indicates FHP. Global studies have reported possible associations between FHP and postural related musculoskeletal complaints and chronic pain especially in Black females in South Africa. Studies have also reported various therapies that would increase CVA, thus correcting or improving FHP to manage or prevent the negative impacts associated with FHP. Normal cervical spine radiographic parameters may differ in males and females, and among the various South African ethnic groups, suggesting that normal CVA ranges may also differ among the sexes and various ethnic groups. A generally accepted normal CVA range to accurately measure and quantify FHP warrants the need to determine a standardised and normalised range for CVA for Black females in South Africa, so as to a set reference point for clinical practice and research. Aim: The aim of this study was to determine a normalised range for CVA among Black South African females to be utilised for further studies and clinical practice. Method: This was a pilot study that used a quantitative, non-experimental, observational design. Black South African females between the ages of 18 and 45 years were recruited through advertisements placed in and around the Durban University of Technology and greater Durban area and via word of mouth. A total of 51 participants were recruited. Symptomatic participants and participants who presented with FHP on visual assessment were excluded from the study. Markers were placed at the tragus of the ear and at C7 spinous process. Lateral photographs were taken with a digital camera of the participants in seated and standing positions. The Posture Pro Software Analysis was used to measure CVA from the photographs obtained. The data captured were sent to a statistician for statistical analysis. Results: The mean CVA while seated was 41.88 degrees, with a standard deviation of 5.23; and the mean CVA while standing was 37.15 degrees, with a standard deviation of 4.30. The paired t-test result showed a significant difference between CVA in seated and standing position (p < 0.001). Furthermore, the correlation between BMI and CVA seated and standing had a significant weak positive correlation of 0.320 (p<0.05) and 0.391 (p<0.01) respectively. Conclusion: The results indicated that CVA differs significantly between the seated and standing position and that CVA in the seated position was more increased when compared to the standing position.