The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis

  • Nesreen Fawzy MahmoudEmail author
  • Karima A. Hassan
  • Salwa F. Abdelmajeed
  • Ibraheem M. Moustafa
  • Anabela G. Silva
Hot Topics


Purpose of Review

Forward head posture (FHP) is the most common cervical postural fault in the sagittal plane that is found with different severity levels in almost all populations. Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.

Recent Findings

A total of 15 cross-sectional studies were eligible for inclusion for this systematic review and meta-analysis. Ten studies compared FHP between a group of asymptomatic participants and a group of participants with neck pain and an overall mean difference (MD) of 4.84 (95% CI = 0.14, 9.54), indicating a significant between-group difference, contrary to adolescent (MD = − 1.05; 95% CI = − 4.23, 2.12). Eight studies showed significant negative correlations between FHP and neck pain intensity (r = − 0.55; 95% CI = − 0.69, − 0.36) as well as disability (r = − 0.42; 95% CI = − 0.54, − 0.28) in adults and older adults, while in adolescents, only lifetime prevalence and doctor visits due to neck pain were significant predictors for FHP.


This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.


Systematic review Meta-analysis Neck pain Forward head Posture 


Compliance with Ethical Standards

Conflict of Interest

Nesreen Fawzy, Karima A. Hassan, Salwa F. Abdelmajeed, Ibraheem M Moustafa, and Anabela G. Silva declare that they have no conflict of interest. However, one of them (AGS) is the author of four of the articles referenced here, two of which were included in this systematic review. To avoid conflict of interest, she was blind in the searching and filtering process and she did not contribute to the quality assessment of those two articles.

Human and Animal Rights

All reported studies with human subjects performed by one of the authors (AGS) have been previously published and complied with all applicable ethical standards.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Nesreen Fawzy Mahmoud
    • 1
    Email author
  • Karima A. Hassan
    • 1
  • Salwa F. Abdelmajeed
    • 1
  • Ibraheem M. Moustafa
    • 2
  • Anabela G. Silva
    • 3
  1. 1.Department of Musculoskeletal Disorders & Surgery, Faculty of Physical TherapyCairo UniversityCairoEgypt
  2. 2.Department of Physiotherapy, College of Health SciencesUniversity of SharjahSharjahUAE
  3. 3.School of Health Sciences & CINTESIS.UAUniversity of AveiroAveiroPortugal

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