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Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study

PainSci » bibliography » Richards et al 2021
Tags: posture, neck, counter-intuitive, biomechanics, etiology, pro, head/neck, spine

One article on PainSci cites Richards 2021: Does Posture Matter?

PainSci commentary on Richards 2021: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Posture, neck pain, and some other variables were assessed in several hundred 17-year-olds, and then again when they were 22. The risk of developing persistent neck pain was higher in those with a conventionally “good” posture, rather than the much-demonized “poor” posture of a slumped thorax and forward head posture.

What a delightfully counter-intuitive result!

“But they were young!” will be a common objection to this (and I have already seen it). But that hot take ignores half the data: the study did not just show that young woman with supposedly poor neck posture had minimal neck pain: it also showed that young women had more pain with allegedly “good,” erect posture. Despite their youth! Young people do get neck pain. And, in this study, the young ‘uns with “better” posture got more.

Importantly, it’s not like there was a huge difference here. The good-posture group wasn’t being destroyed by a plague of neck pain; their risk was only a little greater. If the numbers were flipped and showing a benefit to good posture, every posturologist in the land would be smugly touting it, but I would write it off as meaninglessly trivial.

There also wasn’t any difference in the young men studied.

So the only clinical implication is probably just that our traditional expectations of the importance of posture are just minor and doomed to be confounded by many other factors.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: The purpose of this study was to determine whether sagittal neck sitting posture subgroup membership in late adolescence was a risk factor for persistent neck pain (PNP) in young adults.

METHODS: There were 686 participants enrolled in the Raine Study at the 17- and 22-year follow-ups. At 17 years of age, posture was measured by photographs, and 4 subgroups of sitting neck posture were determined by cluster analysis. Height and weight were measured, and exercise frequency, depression, and PNP were assessed by questionnaire. At 22 years of age, participants answered questions about neck pain and occupation type. Logistic regression examined if neck posture subgroups at 17 years of age were a risk factor for PNP at 22 years of age, taking into account other factors.

RESULTS: Female sex (odds ratio [OR] = 1.75, 95% CI = 1.16-2.65) and PNP at 17 years of age (OR = 3.78, 95% CI = 2.57-5.57) were associated with PNP at 22 years of age. In females, neck posture subgroup at 17 years of age was a risk factor for PNP at 22 years of age. Compared with the upright subgroup, both the slumped thorax/forward head subgroup groups and the intermediate subgroup had decreased odds for PNP at 22 years of age (OR = 0.24, 95% CI = 0.08-0.76; OR = 0.38, 95% CI = 0.15-0.99, respectively). No association was found in males.

CONCLUSION: After taking into account PNP at 17 years, sitting neck posture at 17 was not a risk factor for PNP at 22 years of age in males, whereas in females, more relaxed postures (slumped thorax/forward head and Intermediate postures) were protective of neck pain compared with upright posture.

IMPACT: Females in late adolescence who sat in slumped thorax/forward head or intermediate posture rather than upright sitting posture had a lower risk of PNP as a young adult. The practice of generic public health messages to sit up straight to prevent neck pain needs rethinking.

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