Posture of the head, shoulders and thoracic spine in comfortable erect standing

Common clinical beliefs about the relationship between postural characteristics and pain are based on mainly anecdotal evidence. This study examined the reliability of physical characteristics of the head, shoulders and thoracic spine and identified relationships among them. Measurements were made from photographs of subjects in comfortable erect standing. A forward head position was related to the curvature of the upper thoracic spine, and a forward position of the shoulders to the tilt of the head in the sagittal plane and to upper cervical extension. The magnitude of the relationships, however, was of questionable clinical significance. No relationship was found between a forward head position and forward shoulders, nor between a forward head position and upper cervical spine extension.