The relationship between forward head posture and neck pain disability in chronic whiplash-associated disorders

Abstract

PURPOSE: To investigate the association between forward head posture (FHP) and neck pain disability in patients with chronic whiplash associated disorders (WAD). METHODS: This study was a secondary analysis based on data from a randomized controlled study. The study involved patients with chronic WAD reporting their disability using the Neck Disability Index (NDI). FHP was measured with a goniometer. Analyses of correlations and logistic regressions were performed controlling for age, gender, duration of symptoms, WAD-grade (the Quebec Task Force on Whiplash-Associated Disorders classification), bodily pain (the Short-Form 36 Health Survey (SF-36) and kinesiophobia, an irrational fear of physical movement and activity (the Tampa Scale of Kinesiophobia (TSK-SV). RESULTS: The inclusion criteria was fulfilled by 113 patients (81 women, 32 men). Mean age 48.1 years. Mean duration of symptoms 9.7 years. There was no significant correlation between FHP and neck pain disability (rs = 0.004, p = 0.968). A logistic regression analysis showed no significance for FHP neither with (p = 0.418) nor without (p = 0.991) control for age, gender, duration of symptoms, WAD-grade, kinesiophobia and bodily pain. In the multiple model kinesiophobia (p = 0.013) and bodily pain (p = < 0.001) were the only significant predictors. Kinesiophobia was also significantly correlated with both neck pain disability (rs = 0.467, p < 0.001) and FHP (rs = 0.202, p = 0.047), thus being a confounder to the possible correlation between these variables. CONCLUSIONS: There is no significant correlation between neck pain disability and FHP for patients with chronic WAD. Results suggest that physiotherapists should increase their focus on kinesiophobia, since it is associated with both FHP and neck pain disability.