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Title: Normal craniovertebral angle range in asymptomatic Black South African females : a pilot study
Authors: Antony, Reenu 
Keywords: Craniovertebral angle;Forward head posture;Observational assessment
Issue Date: 29-Sep-2022
Introduction: Forward head posture (FHP) has become more prevalent in modern
times and is described as carrying the head anterior to the centre of the shoulder. As
the head moves forward, the centre of gravity shifts. To compensate for this shift, the
upper body shifts backward to maintain balance, which eventually leads to fatigue and
subsequent myofascial pain when this position is maintained for prolonged periods of
time. The craniovertebral angle (CVA) measures the degree of FHP and is formed
between a horizontal line passing through C7 of the cervical spine and a line extending
from the tragus of the ear to C7 spinous process. Previous studies have concluded that
a smaller CVA indicates FHP. Global studies have reported possible associations
between FHP and postural related musculoskeletal complaints and chronic pain
especially in Black females in South Africa. Studies have also reported various
therapies that would increase CVA, thus correcting or improving FHP to manage or
prevent the negative impacts associated with FHP. Normal cervical spine radiographic
parameters may differ in males and females, and among the various South African
ethnic groups, suggesting that normal CVA ranges may also differ among the sexes
and various ethnic groups. A generally accepted normal CVA range to accurately
measure and quantify FHP warrants the need to determine a standardised and
normalised range for CVA for Black females in South Africa, so as to a set reference
point for clinical practice and research.
Aim: The aim of this study was to determine a normalised range for CVA among Black
South African females to be utilised for further studies and clinical practice.
Method: This was a pilot study that used a quantitative, non-experimental,
observational design. Black South African females between the ages of 18 and 45
years were recruited through advertisements placed in and around the Durban
University of Technology and greater Durban area and via word of mouth. A total of 51
participants were recruited. Symptomatic participants and participants who presented
with FHP on visual assessment were excluded from the study. Markers were placed at
the tragus of the ear and at C7 spinous process. Lateral photographs were taken with
a digital camera of the participants in seated and standing positions. The Posture Pro
Software Analysis was used to measure CVA from the photographs obtained. The data
captured were sent to a statistician for statistical analysis.
Results: The mean CVA while seated was 41.88 degrees, with a standard deviation of
5.23; and the mean CVA while standing was 37.15 degrees, with a standard deviation
of 4.30. The paired t-test result showed a significant difference between CVA in seated
and standing position (p < 0.001). Furthermore, the correlation between BMI and CVA
seated and standing had a significant weak positive correlation of 0.320 (p<0.05) and
0.391 (p<0.01) respectively.
Conclusion: The results indicated that CVA differs significantly between the seated
and standing position and that CVA in the seated position was more increased when
compared to the standing position.
Dissertation submitted in partial compliance with the requirements for the
Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2022.
Appears in Collections:Theses and dissertations (Health Sciences)

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