{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:36:51Z","timestamp":1785433011644,"version":"3.56.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop and evaluate deep learning models for classifying office workers with and without cervicogenic headache (CH) and\/or neck and shoulder pain (NSP), based on habitual sitting posture images.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicenter, retrospective, observational study analyzed 904 digital images of habitual sitting postures of 531 office workers. Three deep learning models (VGG19, ResNet50, and EfficientNet B5) were trained and evaluated to classify the CH, NSP, and combined CH\u2009+\u2009NSP. Model performance was assessed using 4-fold cross-validation with metrics including area under the curve (AUC), accuracy (ACC), sensitivity (Sen), specificity (Spe), and F1 score. Statistical significance was evaluated using 95% confidence intervals. Class Activation Mapping (CAM) was used to visualize the model focus areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 531 office workers (135 with CH, 365 with NSP, 108 with both conditions and 139 control group), ResNet50 achieved the highest performance for CH classification with an AUC of 0.782 (95% CI: 0.770\u20130.793) and an accuracy of 0.750 (95% CI: 0.731\u20130.768). NSP classification showed more modest results, with ResNet50 achieving an accuracy of 0.677 (95% CI: 0.640\u20130.713). In the combined CH\u2009+\u2009NSP classification, EfficientNet B5 demonstrated the highest AUC of 0.744 (95% CI: 0.647\u20130.841). CAM analysis revealed distinct focus areas for each condition: the cervical region for CH, the lower body for NSP, and broader neck and trunk regions for combined CH\u2009+\u2009NSP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Deep learning models show potential for classifying CH and NSP based on habitual sitting posture images, with varying performances across conditions. The ability of these models to detect subtle postural patterns associated with different musculoskeletal conditions suggests their possible applications for early detection and intervention. However, the complex relationship between static posture and musculoskeletal pain underscores the need for a multimodal assessment approach in clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpain.2025.1614143","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T05:28:00Z","timestamp":1751866080000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Classifying office workers with and without cervicogenic headache or neck and shoulder pain using posture-based deep learning models: a multicenter retrospective study"],"prefix":"10.3389","volume":"6","author":[{"given":"Ui-jae","family":"Hwang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junghun","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oh-yun","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu Seong","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sejung","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e0149320","DOI":"10.1371\/journal.pone.0149320","article-title":"European Sitting championship: prevalence and correlates of self-reported sitting time in the 28 European Union member states","volume":"11","author":"Loyen","year":"2016","journal-title":"PLoS One"},{"key":"B2","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1080\/10803548.2010.11076850","article-title":"The influence of occupational and nonoccupational factors on the prevalence of musculoskeletal complaints in users of portable computers","volume":"16","author":"Mali\u0144ska","year":"2010","journal-title":"Int J Occup Saf Ergon"},{"key":"B3","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.shaw.2015.08.001","article-title":"Internal oblique and transversus abdominis muscle fatigue induced by slumped sitting posture after 1\u2005h of sitting in office workers","volume":"7","author":"Waongenngarm","year":"2016","journal-title":"Saf Health Work"},{"key":"B4","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/00007632-199601010-00015","article-title":"The influence of different sitting positions on cervical and lumbar posture","volume":"21","author":"Black","year":"1996","journal-title":"Spine"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1177\/0333102415596445","article-title":"Physical therapy for headaches","volume":"36","author":"Fern\u00e1ndez-de-Las-Pe\u00f1as","year":"2016","journal-title":"Cephalalgia"},{"key":"B6","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/0268-0033(92)90007-Q","article-title":"Creep response of the lumbar spine to prolonged full flexion","volume":"7","author":"McGill","year":"1992","journal-title":"Clin Biomech (Bristol Avon)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"212","DOI":"10.2522\/ptj.20140073","article-title":"An investigation of cervical spinal posture in cervicogenic headache","volume":"95","author":"Farmer","year":"2015","journal-title":"Phys Ther"},{"key":"B8","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1016\/S1474-4422(09)70209-1","article-title":"Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment","volume":"8","author":"Bogduk","year":"2009","journal-title":"Lancet Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1111\/j.1526-4610.2012.02169.x","article-title":"Head pain referral during examination of the neck in migraine and tension-type headache","volume":"52","author":"Watson","year":"2012","journal-title":"Headache"},{"key":"B10","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/j.jbmt.2023.11.011","article-title":"Differences in musculoskeletal dysfunctions and in postural alterations between chronic migraine and chronic tension type headache: a cross-sectional study","volume":"37","author":"Deodato","year":"2024","journal-title":"J Bodyw Mov Ther"},{"key":"B11","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.msksp.2019.04.007","article-title":"Cervical musculoskeletal impairments in migraine and tension type headache: a systematic review and meta-analysis","volume":"42","author":"Liang","year":"2019","journal-title":"Musculoskelet Sci Pract"},{"key":"B12","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1186\/1471-2474-15-212","article-title":"The spinal posture of computing adolescents in a real-life setting","volume":"15","author":"Brink","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12891-020-03379-y","article-title":"Risk factors for non-specific neck pain in young adults: a systematic review","volume":"21","author":"Jahre","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"B14","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s12891-021-04957-4","article-title":"Neck pain: global epidemiology, trends and risk factors","volume":"23","author":"Kazeminasab","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"B15","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1023\/A:1015008513575","article-title":"A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong","volume":"12","author":"Chiu","year":"2002","journal-title":"J Occup Rehabil"},{"key":"B16","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/BF02110752","article-title":"The effect of head position on scapular orientation and muscle activity during shoulder elevation","volume":"6","author":"Ludewig","year":"1996","journal-title":"J Occup Rehabil"},{"key":"B17","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/S0003-6870(01)00043-6","article-title":"A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers","volume":"33","author":"Szeto","year":"2002","journal-title":"Appl Ergon"},{"key":"B18","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.math.2005.01.005","article-title":"A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work\u20142: neck and shoulder kinematics","volume":"10","author":"Szeto","year":"2005","journal-title":"Man Ther"},{"key":"B19","doi-asserted-by":"publisher","first-page":"408","DOI":"10.2522\/ptj.20060009","article-title":"Effect of neck exercise on sitting posture in patients with chronic neck pain","volume":"87","author":"Falla","year":"2007","journal-title":"Phys Ther"},{"key":"B20","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.media.2017.07.005","article-title":"A survey on deep learning in medical image analysis","volume":"42","author":"Litjens","year":"2017","journal-title":"Med Image Anal"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e1002686","DOI":"10.1371\/journal.pmed.1002686","article-title":"Deep learning for chest radiograph diagnosis: a retrospective comparison of the CheXNeXt algorithm to practicing radiologists","volume":"15","author":"Rajpurkar","year":"2018","journal-title":"PLoS Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1186\/s12889-021-11144-6","article-title":"Factors associated with headache and neck pain among telecommuters\u2014a five days follow-up","volume":"21","author":"Houle","year":"2021","journal-title":"BMC Publ Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1046\/j.1526-4610.1998.3806442.x","article-title":"Cervicogenic headache: diagnostic criteria. The cervicogenic headache international study group","volume":"38","author":"Sjaastad","year":"1998","journal-title":"Headache"},{"key":"B24","article-title":"Very deep convolutional networks for large-scale image recognition","author":"Simonyan","year":""},{"key":"B25","first-page":"770","article-title":"Deep residual learning for image recognition","author":"He","year":"2016"},{"key":"B26","first-page":"6105","article-title":"Efficientnet: rethinking model scaling for convolutional neural networks","author":"Tan","year":"2019"},{"key":"B27","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/j.jbmt.2015.11.015","article-title":"Comparative analysis of head-tilt and forward head position during laptop use between females with postural induced headache and healthy controls","volume":"20","author":"Mingels","year":"2016","journal-title":"J Bodyw Mov Ther"},{"key":"B28","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s00586-006-0269-7","article-title":"Individual and work related risk factors for neck pain among office workers: a cross sectional study","volume":"16","author":"Cagnie","year":"2007","journal-title":"Eur Spine J"},{"key":"B29","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.math.2008.04.004","article-title":"Relationships between prolonged neck\/shoulder pain and sitting spinal posture in male and female adolescents","volume":"14","author":"Straker","year":"2009","journal-title":"Man Ther"},{"key":"B30","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.math.2009.06.002","article-title":"The influence of different sitting postures on head\/neck posture and muscle activity","volume":"15","author":"Caneiro","year":"2010","journal-title":"Man Ther"},{"key":"B31","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.jmpt.2017.07.002","article-title":"Intrarater and inter-rater reliability of active cervical range of motion in patients with nonspecific neck pain measured with technological and common use devices: a systematic review with meta-regression","volume":"40","author":"Rondoni","year":"2017","journal-title":"J Manipulative Physiol Ther"},{"key":"B32","doi-asserted-by":"publisher","first-page":"pzac080","DOI":"10.1093\/ptj\/pzac080","article-title":"Perceptions and experiences of individuals with neck pain: a systematic critical review of qualitative studies with meta-summary and meta-synthesis","volume":"102","author":"Falsiroli Maistrello","year":"2022","journal-title":"Phys Ther"}],"container-title":["Frontiers in Pain Research"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2025.1614143\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T05:28:01Z","timestamp":1751866081000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2025.1614143\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,7]]},"references-count":32,"alternative-id":["10.3389\/fpain.2025.1614143"],"URL":"https:\/\/doi.org\/10.3389\/fpain.2025.1614143","relation":{},"ISSN":["2673-561X"],"issn-type":[{"value":"2673-561X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,7]]},"article-number":"1614143"}}