When helping people with neck pain, we tend to always tell them to sit up straight and have good posture.  Posture, Posture, Posture!!!  But what does it mean to sit up straight and does it really help?  Maybe…

A cross-sectional study out of Australia assessed 1,108 seventeen-year-old individuals between 2006 and 2009.  They used photographic posture analysis with the hips and knees standardized.

They measured thoracic flexion, neck flexion, cervicothoracic angle, craniocervical angle (upward tilt), and head displacement (forward head).

Neck ranges

They analyzed the data and created 4 clusters of postures.  These clusters are:

Neck postures

  1. Upright/Normal Posture (28% of subjects) – individuals with slightly limited thoracic and cervical flexion, limited craniocervical upward tilt
  2. Intermediate Posture (24% of subjects) – limited cervical flexion, increased cervicothoracic angle, less neck flexion, forward head, and less craniocervical upward tilt
  3. Slumped Thoracic and Forward Head Posture (16% of subjects) – excessive thoracic and cervical flexion and craniocervical upward tilt
  4. Erect/Flat Thoracic and Forward Head Posture (32% of subjects) – least cervicothoracic angle, forward head, and slight craniocervical upward tilt

They measured the subjects’ Body Mass Index (BMI), frequency of exercise, computer use, sitting time, depression, neck pain and headaches.  Their goal was to see the correlation between these variables and sitting posture.

They did not find a correlation to neck pain and headaches between the postures.  They did find correlations to exercise, depression, sex, and BMI.

  • Category 1 (Upright Posture) was found to exercise significantly more than the other groups
  • Category 3 (Slumped Thoracic and Forward Head Posture) was found to be more significantly correlated to depression than the other groups
  • Categories 1 and 4 (Upright Posture and Erect Thoracic and Forward Head Posture) were found to be more correlated to females than males
  • Categories 3 and 4 (Slumped Thoracic and Forward Head Posture and Erect Thoracic and Forward Head Posture) were more correlated to a high BMI
  • Females tend to have a greater prevalence of neck pain than males with a prevalence of 64%

What does this mean for helping people with neck pain and headaches?

Posture can place abnormal stress on muscles, ligaments, and joints but may be a small factor in neck pain and headaches.  These symptoms may be more correlated to other factors such as mechanism of injury, repetitive use/how the neck moves, stress, psychosocial factors, etc.

What we can take away is that if someone has a Slumped Thoracic and Forward Head Posture they tend to be overweight and suffer from depression.  If we want to improve their sitting posture it can be as easy as having them complete generalized exercise more often throughout the week without having to give specific exercises for posture. (Individuals tend to respond better with less cues.)  It is still important to work on posture but more focus can be placed on movement and functional during evaluations and treatments.

So instead of Posture, Posture, Posture! maybe the saying should be Posture! Exercise! Function!




Richards KV, Beales DJ, Smith AJ, O’Sullivan PB, Straker LM. Neck posture clusters and their association with biopsychosocial factors and neck pain in Australian adolescents. Phys Ther. October 2016; 96(10): 1576-1587.