The prevalence of neck pain (NP) has been reported to be increasing among adolescents (aged 16-18 years), but how this pain might affect head posture and endurance of the neck muscles in this age group has received little attention.

Published in Manual Therapy, a new research suggests that adolescents with NP have less forward head posture, less neck flexor and extensor endurance, and greater asymmetry in the relationship between neck flexor and neck extensor endurance capacity, indicating NP in these patients should not be dismissed.

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“Understanding NP and associated functional changes at younger ages might help define more appropriate intervention strategies for this age group while simultaneously contributing to the understanding of NP at older ages and raising awareness for the need of early interventions,” wrote the authors. “Furthermore, it is necessary to know whether clinical tests used for adults are able to reliably measure neck muscle function and head posture in adolescents,” they noted.

The study included 70 students who were in grades 10 to 12 at the Secondary School of Estarreja in the 2013/2014 academic year. Of these participants, 35 had NP (25 girls, 10 boys) and 35 (22 girls, 13 boys) had reported never having NP and served as controls. The researchers had screened all students at the school (n = 452) for NP using a self-report questionnaire and excluded any student with disorders, congenital anomalies, or trauma that could affect neck posture or contribute to NP.

All 70 study participants had their forward head posture, neck flexor endurance, and neck extensor endurance measured using accepted clinical tests. The 35 with NP were also asked to describe the intensity, frequency, and duration of their NP and whether it impacted their ability to perform their daily activities.

The clinical tests showed that adolescents with NP had significantly less forward head posture than asymptomatic students (46.62° ± 4.92° vs 44.18°± 3.64°, respectively; P > .05), less neck flexor endurance (24.50s ± 23.03s vs 35.89s ± 21.53s, respectively; P > .05), and less extensor endurance (12.6.64s ± 77.94s vs 168.66s ± 74.77s, respectively; P > .05). When evaluating reliability of the measurements, almost perfect to substantial reliability was observed for all tests in both groups, leading the authors to suggest that the procedures they used might be of value in clinical practice when assessing NP in an adolescent.

The authors reported study several limitations, including the use of clinical tests that have not been validated in adolescents, non-blinding of the assessor performing the clinical tests, and not accounting for students’ sex. They also suggest the students got easily distracted during the tests, which could have impacted the measurements and, therefore, the reliability of their results.

Despite its limitations, the study sheds light on the impact of NP in adolescents and the authors suggest that future studies should examine the functional changes associated with NP at even younger ages. Such research might be especially important now that the use of mobile devices is increasing, including among very young children, particularly because the use of such devices has already been tied to the increasing prevalence of NP among adults.


Oliveira AC, Silva AG. Neck muscle endurance and head posture: a comparison between adolescents with and without neck pain. Man Ther. 2016;22:62-67.