Frequency of Musculoskeletal pain and its Association with Forward Head Posture among Architecture Students in Lahore: A cross-sectional Study.
Talha Ahmed 1
, Sidra Syed 2
, Ahmed Jahanzab 3
, Alisha Akram 4
, Maheera Khalid 5
, Sana Saeed 6
1,4-6 Physiotherapist, University Institute of Physical Therapy (UIPT, University of Lahore, Lahore, Pakistan
2 Assistant Professor, University Institute of Physical Therapy (UIPT), University of Lahore, Lahore, Pakistan
3 Physiotherapist, Hameed Latif Hospital, Lahore, Pakistan
A
B S T R A C T:
Background: Forward head posture
has become very common in our society. Pain in the cervical and its surrounding
areas results from the protrusion of the neck, which is related to increased
spinal flexions due to overworking and their work environment.
Objective: To find
the frequency of musculoskeletal pain and its association with forward head
posture among architecture students in Lahore.
Methodology: It was
cross-sectional study. The data was collected from architecture students due to
forward head posture in Lahore from February 2022 to July 2022. 199
participants from 2nd to 5th year who had both acute or
chronic musculoskeletal pain but no systemic disease was selected. Students between
the age of 18-25 with more than 5 working hours were included. Non-probability
convenient sampling technique was used. Standardized Nordic Questionnaire,
Visual Analog Scale and ruler measurement method was used for data collection.
The Statistical Package of Social Sciences (SPSS 20.0) was used to analyze the
data.
Results: Out
of 199 students 168 with a prevalence of 84.4% were having musculoskeletal pain
due to forward head posture. In which neck pain had the prevalence of 70.9%,
shoulder 54.8%, upper back 52.8% and lower back 65.8%. The p-value (chi-square)
was 0.000 < 0.05 showing that there is a significant association between
forward head posture and musculoskeletal pain.
Conclusion:
There was a high prevalence and association of musculoskeletal pain due to
forward head posture among architecture students due to the nature of their
work in which they assume a forward head posture for many hours and still
remain in that posture even when not working causing pain in the neck,
shoulder, upper back and lower back.
Keywords: Forward head posture, Cervical pain, Musculoskeletal Pain, Atlanto-Occipital
Joint, Nordic Pain scale, Visual Analogue Scale.
INTRODUCTION:
Forward head posture is a phrase used to
describe a condition in which pain can be felt in a variety of places, ranging
from the upper back to the neck and shoulders.(1)
The upper cervical vertebrae protrude forward while the face turns upward when
significant extension between the atlanto-occipital and upper cervical joints
occurs as a response to the postural abnormality of forward head posture.(2)
Due to an imbalance in muscle work caused by a change in the curvature of the
neck bone, resulting in rounded shoulder posture. Rounded shoulder posture is
classified as when there is protraction at the acromion joint in front of the
line of gravity, protraction and downward rotation at the shoulders and
increased internal rotation at the shoulder.(3)
Additionally, this aberrant state causes musculoskeletal abnormalities like
decreased upward scapular rotation, scapular lateral and outward shifting, all
of which can make it challenging to maintain an upright sitting posture.(4)
It also shifts the body's center of gravity anteriorly, causing mechanical
changes in postural control of upper trunk and multiple joint causing
abnormalities.(5) Cervical
discomfort, increased kyphosis and pain in the upper limbs have all been
demonstrated to be common musculoskeletal issues.(6)
Muscle and emotional issues can create poor posture, which can lead to
structural or positional abnormalities if the person remains in the incorrect
position for a long time.(7) If
such aberrant alteration in the joints and muscles of the cervical region
persists, it may lead to limited cervical mobility and impaired muscular
function, with early studies suggesting that deep cervical flexors play a
crucial role in maintaining and aligning the cervical spine in cases of forward
head posture.(8)
The body maintains its ideal functional position while at rest by maintaining
its center of gravity over its base of support, minimizing mechanical stress at
the shoulder, elbow, and wrist joints.(9)
On the other hand, using a laptop
encourages postural misalignment, including forward flexion of the neck and
head, which results in biomechanical reactions that can lead to a deviation in
the normal curve of the neck and spine, resulting in, among other things, facet
joint syndrome, degenerative disc disease, and headaches.(10)
To reduce the demand of muscle activity
and the stress placed on the cervical tissues, it's crucial to have proper head
and neck posture, as neck pain has long been related with forward head posture,
which is described as the forward head movement on the cervical spine, which
has been correlated with increased stress on the posterior cervical parts, a
change in the length tension relationship in the cervical muscles, an increase
in muscular activity, a restriction in neck movement, and a loss of cervical proprioception.(11)
Human posture can be affected by a variety
of factors, including genetics, physical structure deficiencies, postural
habits, and work.(6) Academic
focus, computer use, non-neutral body posture, and the use of drafting boards
and tables have all been identified as risk factors for developing
musculoskeletal pain due to forward head posture.(10)
These factors can be prevented by using specific measure like using an
ergonomic chair in which there must be aesthetic aspects on one hand, in an
ergonomic chair design, and on the other hand, there must be features
associated to comfort and relaxation.(12)
In the first two years of their
architectural studies, students complete their university projects using a
variety of tools, such as drafting boards, tables, laptops, and desktop
computers. However, in the last two years, they rely entirely on computers to
complete their projects, frequently working for extended periods of 10 to 12
hours without breaks or other forms of physical activity.(13)
Patients with musculoskeletal pain can
anticipate a positive prognosis if they show motivation and carefully adhere to
physical therapist treatment guidelines, while people with postural pain
typically seek relief through manual therapy techniques like manipulation,
mobilization, and traction, which, when combined with advised exercises and
targeted stretches targeting the relevant muscles for back stabilization,
contribute to the successful treatment.(14) Some
other methods, such as postural bracing, have shown to improve trunk support,
leading to better control of the head and neck and the restoration of normal
arm and hand functions; these neck braces are frequently used as effective
interventions for the treatment of forward head posture. Notable examples of
these neck braces include the universal cervical collar and the Aspen Vista
collapsible neck brace.(15)
Scapular posture stability, upper trapezius and serratus anterior muscular
activity management, and muscle re-education are some of the treatments for
dealing with forward head posture, while exercising the neck and shoulder
muscles is another approach to improve forward head posture.(16)
Myofascial release can also be used to
reduce musculoskeletal pain in which 2–3 minutes of shallow stroke massage on
the back region to the neck and shoulders Then, focusing locally on the painful
area, perform myofascial release method with pressure appropriate for the
patient's pain tolerance.(17)
An important issue that has to be looked
into is the prevalence of musculoskeletal pain brought on by forward head
posture among Lahore architecture students. Long periods of desk work and
drawing might result in bad posture and musculoskeletal problems. This study
intends to analyze the relationship between forward head posture and
musculoskeletal discomfort in order to estimate the severity of the issue and
pinpoint potential risk factors. Knowing how these two factors interact would
help promote the general wellbeing and academic success of Lahore's
architecture students by increasing awareness of the issue and informing
preventive efforts.
METHODOLOGY:
A
cross-sectional research study was conducted about musculoskeletal pains among
architecture students due to forward head posture in Lahore (The University of
Lahore, National College of Arts, and Lahore College for Women University) from
February 2022 to July 2022 with a total of 199 participants which was
calculated by the bio-statistician using formulae n= [DEFF*Np(1-p)] / [d²/Z ²
1-α/2* (N-1) +p*(1-p)] (2). The estimated population proportion is taken
as 0.247, the absolute precision is 0.06, and the confidence interval is 95%.
Non-probability convenience sampling technique was used for the selection of
the sample. The data was collected by using Nordic Musculoskeletal
Questionnaire (NMQ), Visual Analogue Scale (VAS), and ruler measurement method
used to determine whether the participant had any forward head posture. The
participants stood against a wall and a ruler was used to measure the distance
between the occiput and the wall this was used to determine whether students
had forward head posture or not. For data analysis, SPSS 20.0 was used. The
categorical data were presented in the form of frequency and percentages, and
the association is presented in the form of chi-square where p-value <0.05
is considered significant. Students of both genders from second, third, fourth,
and fifth years who had more than 5 working hours which either acute or chronic
musculoskeletal pain and were between the age of 18-25 were included while any
students who previously had any spinal injury, fracture or neurological disorders
were excluded.(13)
Ethical
Approval was taken from The University of Lahore Ref no: REC-UOL-/22-08/2022
RESULTS:
The
result of this study showed the descriptive statistics of pain in last 12
months of different body regions.
An association was seen between forward head posture
and VAS scale with p-value of 0.000.
Table
I
Description of gender
|
Gender |
Frequency (%) |
|
Male |
77
(38.7%) |
|
Female |
122
(61.3%) |
Table II: Descriptive
statistics of pain and forward head posture using NMQ
|
|
|
Forward head posture (Yes) Frequency (%) |
|
Neck pain |
Yes |
132 (78.5%) |
|
No |
36 (21.4%) |
|
|
Shoulder pain |
Yes |
101 (60.1%) |
|
No |
67 (39.8%) |
|
|
Elbow pain |
Yes |
40 (23.8%) |
|
No |
128 (76.1%) |
|
|
Wrist pain |
Yes |
82 (48.8%) |
|
No |
86 (51.1%) |
|
|
Upper back pain |
Yes |
88 (52.3%) |
|
No |
80 (47.6%) |
|
|
Lower back pain |
Yes |
111 (66.1%) |
|
No |
57 (33.9%) |
|
|
Hips/thighs |
Yes |
41 (24.4%) |
|
No |
127 (75.6%) |
|
|
Knees pain |
Yes |
27 (16.1%) |
|
No |
141 (83.9%) |
|
|
Ankle pain |
Yes |
27 (16.1%) |
|
No |
141 (83.9%) |
This table describes the frequency of patients
having pain in different regions
Table
III
Association between forward head posture and VAS
|
|
Visual Analogue
Scale (VAS) |
Total |
p- value (Chi-square) |
||||
|
|
1-3 mild pain |
4-6 moderate pain |
7-10 severe pain |
||||
|
Forward head posture
|
Yes |
34 |
91 |
43 |
168(84.4%) |
0.000 |
|
|
No |
10 |
3 |
18 |
31(15.6%) |
|||
|
Total |
44 |
94 |
61 |
199(100%) |
|||
DISCUSSION:
An
investigation of the prevalence of musculoskeletal pain linked to forward head
posture in this population was done with the help of architecture students from
the National College of Arts, University of Lahore, and Lahore College for
Women University. The results showed a significant prevalence of
musculoskeletal pain (84.4%) that was linked to the nature of their study,
which involved continuous usage of drafting boards and laptops, which resulted
in the adoption of a forward head posture. With a prevalence of 70.9%, the
cervical region was discovered to be the most impacted. certain findings are in
line with Kuorinka's research, which highlighted the importance of certain body
parts and inspired the creation of the Standardized Nordic questionnaire.(13)
The
p-value for the current study's findings of 0.000 suggested a statistically
significant link between forward head posture and musculoskeletal pain. These
results are in line with earlier study that found that using a computer or
mobile device increases the probability of adopting a forward head posture by
63.96%.(18)
Notably, the present study found a higher incidence rate, suggesting that
architecture students are more susceptible to forward head posture as a result
of their daily job routine. Long periods of forward head posture while using
computers and drafting boards might lead to muscular imbalances in the neck
area. In particular, some neck muscles shorten and tighten, whilst others
elongate and weaken. As a result, these structural changes in the neck cause
musculoskeletal discomfort to occur often in the cervical area, along with
related symptoms such neck stiffness, cervicogenic headaches, and cervicogenic
dizziness. Additionally, the neighboring structures are also impacted by the strain
placed on the spine as a result of these biomechanical alterations, which
results in discomfort felt in the shoulder, upper back, and lower back areas.(11)
CONCLUSION:
The
study discovered that more than half of the students had musculoskeletal pain
due to forward head posture in the neck, shoulder, upper back and lower back.
So, there is an association between pain in these regions and forward head
posture. There were few participants who had musculoskeletal pain in elbow,
wrist, hip, knee and ankle but there was no forward head posture which led to
believe that there was no direct link between the pain in elbow, wrist, hip,
knee and ankle and forward head posture. Discomfort in these extremities could
be due to over exertion or some other factor.
LIMITATIONS:
The
data was only taken from three universities (The University of Lahore, National
College of Arts, and Lahore College for Women University); therefore, the
results cannot be applied to the whole population. The pain was only associated
with forward head posture other factors were not considered. Due to the
cross-sectional nature of the study only prevalence and its association were
analyzed.
REFERENCES:
1. Naz
A, Bashir MS, Noor R. Prevalance of forward head posture among university
students. Rawal Med J. 2018;43(2):260-2.
2. Raykar R, Tajne K, Palekar TJWJoPR.
Effect of forward head posture on static and dynamic balance.
2018;7(9):797-808.
3. Kim E-K, Kim JSJJopts. Correlation
between rounded shoulder posture, neck disability indices, and degree of
forward head posture. 2016;28(10):2929-32.
4. Kwon JW, Son SM, Lee NKJJopts. Changes
in upper-extremity muscle activities due to head position in subjects with a
forward head posture and rounded shoulders. 2015;27(6):1739-42.
5. Lee J-HJJopts. Effects of forward head
posture on static and dynamic balance control. 2016;28(1):274-7.
6. Malepe M, Goon D, Anyanwu F, Amusa L.
The relationship between postural deviations and body mass index among
university students. Biomedical Research. 2015;26(3):437-42.
7. Van Der Beek AJ, Dennerlein JT,
Huysmans MA, Mathiassen SE, Burdorf A, Van Mechelen W, et al. A research
framework for the development and implementation of interventions preventing
work-related musculoskeletal disorders. Scandinavian Journal of Work, Environment
& Health. 2017:526-39.
8. Kang DY. Deep cervical flexor training
with a pressure biofeedback unit is an effective method for maintaining neck
mobility and muscular endurance in college students with forward head posture.
Journal of physical therapy science. 2015;27(10):3207-10.
9. Schlussel AT, Maykel JAJCic, surgery r.
Ergonomics and musculoskeletal health of the surgeon. 2019;32(06):424-34.
10. Osama M, Ali S, Malik RJ. Posture related
musculoskeletal discomfort and its association with computer use among
university students. J Pak Med Assoc. 2018;68(4):639-41.
11. Ghamkhar L, Kahlaee AHJBJoPT. Is forward
head posture relevant to cervical muscles performance and neck pain? A
case–control study. 2019;23(4):346-54.
12. Al-Hinai N, Al-Kindi M, Shamsuzzoha
AJIJoME, Research R. An ergonomic student chair design and engineering for
classroom environment. 2018;7(5):534-43.
13. Ilyas T, Umer B, Taufiq F. Frequency of
Musculoskeletal Disorders and their Related Causative Factors Among Female
Architecture Students in Lahore: JRCRS. 2018; 6 (1): 38-42. Journal Riphah
College of Rehabilitation Sciences. 2018;6(1):38-42.
14. Southerst D, Yu H, Randhawa K, Côté P,
D’Angelo K, Shearer HM, et al. The effectiveness of manual therapy for the
management of musculoskeletal disorders of the upper and lower extremities: a
systematic review by the Ontario Protocol for Traffic Injury Management
(OPTIMa) Collaboration. Chiropractic & manual therapies. 2015;23(1):1-17.
15. Kuo Y-R, Fang J-J, Wu C-T, Lin R-M, Su
P-F, Lin C-LJESJ. Analysis of a customized cervical collar to improve neck
posture during smartphone usage: a comparative study in healthy subjects.
2019;28(8):1793-803.
16. Im B, Kim Y, Chung Y, Hwang SJJopts.
Effects of scapular stabilization exercise on neck posture and muscle
activation in individuals with neck pain and forward head posture.
2015;28(3):951-5.
17. El-Gendy MH, Lasheen YR, Rezkalla WKJPQ.
Multimodal approach of electrotherapy versus myofascial release in patients
with chronic mechanical neck pain: A randomized controlled trial. 2019;27(4):6.
18. Ramalingam V, Subramaniam AJSICS.
Prevalence and associated risk factors of forward head posture among university
students. 2019;10(7):775.
