{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T22:25:20Z","timestamp":1783203920800,"version":"3.54.6"},"reference-count":74,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T00:00:00Z","timestamp":1685145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CBP Nonprofit, Inc. (Eagle, ID, USA)","award":["CBP Nonprofit, Inc. (Eagle, ID, USA)"],"award-info":[{"award-number":["CBP Nonprofit, Inc. (Eagle, ID, USA)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>There is great interest in thoracic kyphosis, as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; however, this has not been completely investigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (&gt;55\u00b0) were compared to eighty matched participants with normal thoracic kyphosis (&lt;55\u00b0). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann\u2019s kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI), and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student\u2019s t-test to compare the means of continuous variables between the two groups. One-way ANOVA was used to compare mean values in the three groups: postural kyphosis, Scheuermann\u2019s kyphosis, and normal kyphosis group. Pearson correlation was used to evaluate the relationship between participant\u2019s thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning accuracy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p &lt; 0.001) with the SK group having greatest disability (p &lt; 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI, and left and right rotation repositioning accuracy. In addition, there was a significant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p &lt; 0.001), but there was no significant difference for SSR latency (p = 0.07). The CVA was significantly greater in the hyper-kyphosis group (p &lt; 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p &lt; 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.<\/jats:p>","DOI":"10.3390\/jcm12113707","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T16:17:33Z","timestamp":1685204253000},"page":"3707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Is Thoracic Kyphosis Relevant to Pain, Autonomic Nervous System Function, Disability, and Cervical Sensorimotor Control in Patients with Chronic Nonspecific Neck Pain?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4859-1490","authenticated-orcid":false,"given":"Ibrahim","family":"Moustafa","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Neuromusculoskeletal Rehabilitation Research Group, RIMHS\u2013Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0712-4490","authenticated-orcid":false,"given":"Tamer","family":"Shousha","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Neuromusculoskeletal Rehabilitation Research Group, RIMHS\u2013Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashokan","family":"Arumugam","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Neuromusculoskeletal Rehabilitation Research Group, RIMHS\u2013Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Sustainable Engineering Asset Management Research Group, RISE-Research Institute of Sciences and Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6671-7106","authenticated-orcid":false,"given":"Deed","family":"Harrison","sequence":"additional","affiliation":[{"name":"CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,27]]},"reference":[{"key":"ref_1","unstructured":"Cohen, S.P. (2015). Mayo Clinic Proceedings, Elsevier."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.jbiomech.2015.10.035","article-title":"Fundamental biomechanics of the spine-What we have learned in the past 25 years and future directions","volume":"49","author":"Oxland","year":"2016","journal-title":"J. Biomech."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"891","DOI":"10.3906\/sag-1605-178","article-title":"An investigation of sagittal thoracic spinal curvature and mobility in subjects with and without chronic neck pain: Cut-off points and pain relationship","volume":"47","author":"Kaya","year":"2017","journal-title":"Turk. J. Med. Sci."},{"key":"ref_4","unstructured":"Bergmann, T.F., and Peterson, D.H. (2011). Chiropractic Technique Principles and Procedures, Elsevier."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2340\/165019771997167174","article-title":"Reduced mobility in the cervico-thoracic motion segment: A risk factor for musculoskeletal neck-shoulder pain: A two-year prospective follow-up study","volume":"29","author":"Norlander","year":"1997","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"183","DOI":"10.2340\/165019771996183192","article-title":"Mobility in the cervico-thoracic motion segment: An indicative factor of musculo-skeletal neckshoulder pain","volume":"28","author":"Norlander","year":"1996","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"55","DOI":"10.3109\/J180v03n02_05","article-title":"Dorsal manipulation in whiplash injury treatment","volume":"3","year":"2004","journal-title":"J. Whiplash Relat. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.math.2013.03.002","article-title":"Normal kinematics of the neck: The interplay between the cervical and thoracic spines","volume":"18","author":"Tsang","year":"2013","journal-title":"Man. Ther."},{"key":"ref_9","first-page":"1235706","article-title":"The prevalence of and factors associated with neck, shoulder, and low-back pains among medical students at university hospitals in central Saudi Arabia","volume":"2017","author":"Garni","year":"2017","journal-title":"Pain Res. Treat."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Alshagga, M.A., Nimer, A.R., Yan, L.P., Ibrahim, I.A., Al-Ghamdi, S.S., and Radman Al-Dubai, S.A. (2013). Prevalence and factors associated with neck, shoulder and low back pains among medical students in a Malaysian medical college. BMC Res. Notes, 6.","DOI":"10.1186\/1756-0500-6-244"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.3233\/BMR-169669","article-title":"Musculoskeletal pain symptoms among allied health professions\u2019 students: Prevalence rates and associated factors","volume":"30","author":"Almhdawi","year":"2017","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1179\/106698104790825284","article-title":"Short-term effects of thoracic manipulation on lower trapezius muscle strength","volume":"12","author":"Cleland","year":"2004","journal-title":"J. Man. Manip. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.math.2012.07.005","article-title":"Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults","volume":"18","author":"Quek","year":"2013","journal-title":"Man. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.math.2010.03.009","article-title":"Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability","volume":"15","author":"Lau","year":"2010","journal-title":"Man. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"849","DOI":"10.31616\/asj.2018.0302","article-title":"Thoracic posture and mobility in mechanical neck pain population: A review of the literature","volume":"13","author":"Joshi","year":"2019","journal-title":"Asian Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.clinbiomech.2015.01.005","article-title":"Sensorimotor function of the cervical spine in healthy volunteers","volume":"30","author":"Artz","year":"2015","journal-title":"Clin. Biomech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.math.2007.06.003","article-title":"Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control","volume":"13","author":"Treleaven","year":"2008","journal-title":"Man. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"364","DOI":"10.2519\/jospt.2009.2834","article-title":"Sensorimotor function and dizziness in neck pain: Implications for assessment and management","volume":"39","author":"Kristjansson","year":"2009","journal-title":"J. Orthop. Sport. Phys. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"908414","DOI":"10.3389\/fpain.2022.908414","article-title":"Proprioceptive disturbance in chronic neck pain: Discriminate validity and reliability of performance of the clinical cervical movement sense test","volume":"3","author":"Jull","year":"2022","journal-title":"Front. Pain. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102273","DOI":"10.1016\/j.msksp.2020.102273","article-title":"Slower reaction and response times and impaired hand-eye coordination in individuals with neck pain","volume":"50","author":"Sittikraipong","year":"2020","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Asiri, F., Reddy, R.S., Tedla, J.S., ALMohiza, M.A., Alshahrani, M.S., Govindappa, S.C., and Sangadala, D.R. (2021). Kinesiophobia and its correlations with pain, proprioception, and functional performance among individuals with chronic neck pain. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0254262"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00221-005-2309-7","article-title":"Responses of muscle spindles in feline dorsal neck muscles to electrical stimulation of the cervical sympathetic nerve","volume":"165","author":"Roatta","year":"2005","journal-title":"Exp. Brain Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1152\/jn.2002.88.4.2000","article-title":"Neck muscle responses to stimulation of monkey superior colliculus. II. Gaze shift initiation and volitional head movements","volume":"88","author":"Corneil","year":"2002","journal-title":"J. Neurophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S0361-9230(98)00094-X","article-title":"Influences of neck afferents on sympathetic and respiratory nerve activity","volume":"47","author":"Bolton","year":"1998","journal-title":"Brain Res. Bull."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/S0161-4754(00)90076-9","article-title":"Reflex effects of subluxation: The autonomic nervous system","volume":"23","author":"Budgell","year":"2000","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1097\/BRS.0b013e31814b1bef","article-title":"The relationship between thoracic hyperkyphosis and the scoliosis research society outcomes instrument","volume":"32","author":"Petcharaporn","year":"2007","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1093\/ije\/24.6.1178","article-title":"Left handedness and risk of thoracic hyperkyphosis in prepubertal schoolchildren","volume":"24","author":"Nissinen","year":"1995","journal-title":"Int. J. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00586-014-3542-1","article-title":"Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions","volume":"24","author":"Ferrer","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/BRS.0000000000001202","article-title":"The health impact of symptomatic adult spinal deformity: Comparison of deformity types to United States population norms and chronic diseases","volume":"41","author":"Bess","year":"2016","journal-title":"Spine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s00198-017-4253-3","article-title":"Kyphosis and incident falls among community-dwelling older adults","volume":"29","author":"Davis","year":"2018","journal-title":"Osteoporos Int."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Van Der Jagt-Willems, H.C., De Groot, M.H., Van Campen, J.P.C.M., Lamoth, C.J.C., and Lems, W.F. (2015). Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: A prospective cohort study. BMC Geriatr., 15.","DOI":"10.1186\/s12877-015-0018-z"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.ijosm.2015.04.002","article-title":"Reassessing the accuracy and reproducibility of Diers formetric measurements in healthy volunteers","volume":"18","author":"Lason","year":"2015","journal-title":"Int. J. Osteopath. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jspd.2015.08.008","article-title":"Multicenter comparison of 3D spinal measurements using surface topography with those from conventional radiography","volume":"4","author":"Knott","year":"2016","journal-title":"Spine Deform."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2130220","DOI":"10.1097\/00024720-200206000-00008","article-title":"Can the thoracic kyphosis be modeled with a simple geometric shape","volume":"15","author":"Harrison","year":"2002","journal-title":"J. Spinal Disord. Technol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1007\/s00586-020-06402-x","article-title":"Meta-analysis of the validity and reliability of rasterstereographic measurements of spinal posture","volume":"29","author":"Krott","year":"2020","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.math.2006.11.002","article-title":"The relationship between head posture and severity and disability of patients with neck pain","volume":"13","author":"Yip","year":"2008","journal-title":"Man Ther."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Van Niekerk, S.M., Louw, Q., Vaughan, C., Grimmer-Somers, K., and Schreve, K. (2008). Photographic measurement of upper-body sitting posture of high school students: A reliability and validity study. BMC Musculoskelet Disord., 9.","DOI":"10.1186\/1471-2474-9-113"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1080\/165019701753236473","article-title":"Reliability and responsiveness of three different pain assessments","volume":"33","author":"Lundeberg","year":"2001","journal-title":"J. Rehabil. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"400","DOI":"10.2519\/jospt.2009.2930","article-title":"Measurement properties of the neck disability index: A systematic review","volume":"39","author":"MacDermid","year":"2009","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1097\/00007632-199704150-00008","article-title":"Ability to reproduce head position after whiplash injury","volume":"22","author":"Loudon","year":"1997","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1080\/16501970306109","article-title":"Dizziness and unsteadiness following whiplash injury: Characteristic features and relationship with cervical joint position error","volume":"35","author":"Treleaven","year":"2003","journal-title":"J. Rehabil. Med."},{"key":"ref_42","first-page":"76","article-title":"Smooth pursuit neck torsion test: A specific test for cervical dizziness","volume":"19","author":"Tjell","year":"1998","journal-title":"Am. J. Otol."},{"key":"ref_43","first-page":"323","article-title":"Examination of balance measures produced by the biodex stability system","volume":"33","author":"Arnold","year":"1998","journal-title":"J. Athl. Train."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1123\/jsr.7.2.95","article-title":"Intertester and intratester reliability of a dynamic balance protocol using the biodex stability system","volume":"7","author":"Schmitz","year":"1998","journal-title":"J. Sport Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/0013-4694(90)90020-K","article-title":"Sympathetic skin response: Normal results in different experimental conditions","volume":"76","author":"Elie","year":"1990","journal-title":"Electroencephalogr. Clin. Neurophysiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/S0003-9993(97)90331-2","article-title":"Local heat effect on sympathetic skin responses after pain of electrical stimulus","volume":"78","author":"On","year":"1997","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_47","first-page":"108","article-title":"Sympathetic skin response: Review of the method and its clinical use","volume":"105","author":"Kucera","year":"2004","journal-title":"Bratisl. Lek Listy."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/s10286-006-0376-x","article-title":"The effect of stimulation technique on sympathetic skin responses in healthy subjects","volume":"16","author":"Chroni","year":"2006","journal-title":"Clin. Auton. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/S0895-4356(99)00071-2","article-title":"Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life","volume":"52","author":"Wyrwich","year":"1999","journal-title":"J. Clin. Epidemiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/00005650-199811000-00008","article-title":"Changes in the SF-36 in 12 months in a clinical sample of disadvantaged older adults","volume":"36","author":"Wolinsky","year":"1998","journal-title":"Med. Care"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/BF01593882","article-title":"Individual-patient monitoring in clinical practice: Are available health status surveys adequate?","volume":"4","author":"McHorney","year":"1995","journal-title":"Qual. Life Res."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-G\u00e1lvez, N., Gea-Garc\u00eda, G.M., and Marcos-Pardo, P.J. (2019). Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0216180"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"490","DOI":"10.31616\/asj.2018.0097","article-title":"The effect of Schroth therapy on thoracic kyphotic curve and quality of life in Scheuermann\u2019s patients: A randomized controlled trial","volume":"13","author":"Bezalel","year":"2019","journal-title":"Asian Spine J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.bjpt.2018.02.005","article-title":"Is the inclinometer a valid measure of thoracic kyphosis? A cross-sectional study","volume":"22","author":"Hunter","year":"2018","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s00776-012-0341-6","article-title":"Associations between neck and shoulder pain (called katakori in Japanese) and sagittal spinal alignment parameters among the general population","volume":"18","author":"Tsunoda","year":"2013","journal-title":"J. Orthop. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","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 - 2: Neck and shoulder kinematics","volume":"10","author":"Szeto","year":"2005","journal-title":"Man. Ther."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"633","DOI":"10.2519\/jospt.2011.3670","article-title":"Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: A systematic review","volume":"41","author":"Cross","year":"2011","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_58","first-page":"295","article-title":"The study of correlation between forward head posture and neck pain in Iranian office workers","volume":"28","author":"Nejati","year":"2015","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.math.2009.07.005","article-title":"Clinical indicators of \u201cnociceptive\u201d, \u201cperipheral neuropathic\u201d and \u201ccentral\u201d mechanisms of musculoskeletal pain. A delphi survey of expert clinicians","volume":"15","author":"Smart","year":"2010","journal-title":"Man Ther."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1067\/mmt.2002.126128","article-title":"Evaluation of axial and flexural stresses in the vertebral body cortex and trabecular bone in lordosis and two sagittal cervical translation configurations with an elliptical shell model","volume":"25","author":"Harrison","year":"2002","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00586-017-5367-1","article-title":"Cervical sagittal balance: A biomechanical perspective can help clinical practice","volume":"27","author":"Patwardhan","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"S161","DOI":"10.1097\/BRS.0b013e3182a7eb9e","article-title":"Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: Analysis of 56 preoperative cases from the AOSpine North America myelopathy study","volume":"38","author":"Smith","year":"2013","journal-title":"Spine"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/j.1468-2982.2005.01042.x","article-title":"Forward head posture and neck mobility in chronic tension-type headache","volume":"26","author":"Cuadrado","year":"2006","journal-title":"Cephalalgia"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1093\/ptj\/pzx040","article-title":"Cervical spine muscle-tendon unit length differences between neutral and forward head postures: Biomechanical study using human cadaveric specimens","volume":"97","author":"Khayatzadeh","year":"2017","journal-title":"Phys. Ther."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.jelekin.2009.12.003","article-title":"Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks","volume":"20","author":"Thigpen","year":"2010","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"876","DOI":"10.2522\/ptj.20150241","article-title":"Evidence of impaired proprioception in chronic, idiopathic neck pain: Systematic review and meta-analysis","volume":"96","author":"Stanton","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1007\/s12178-019-09594-y","article-title":"The relationship between forward head posture and neck pain: A systematic review and meta-analysis","volume":"12","author":"Mahmoud","year":"2019","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_68","first-page":"371","article-title":"Is neck pain related to sagittal head and neck posture? A systematic review and meta-analysis","volume":"57","author":"Rani","year":"2023","journal-title":"Indian J. Orthop."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1080\/08990220.2018.1475352","article-title":"Forward head posture is associated with pressure pain threshold and neck pain duration in university students with subclinical neck pain","volume":"35","author":"Pacheco","year":"2018","journal-title":"Somat. Mot. Res."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"15379","DOI":"10.1038\/s41598-021-94548-z","article-title":"Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: A randomized, placebo-controlled trial","volume":"11","author":"Moustafa","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40101-019-0193-2","article-title":"Pitfalls of Assessment of Autonomic Function by Heart Rate Variability","volume":"38","author":"Hayano","year":"2019","journal-title":"J. Physiol. Anthropol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e6523","DOI":"10.1097\/MD.0000000000006523","article-title":"Sympathetic Skin Response and Heart Rate Variability in Predicting Autonomic Disorders in Patients with Parkinson Disease","volume":"96","author":"Ke","year":"2017","journal-title":"Medicine"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Bernardo-Filho, M. (2021). Therapy Approaches in Neurological Disorders, IntechOpen.","DOI":"10.5772\/intechopen.97534"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Moustafa, I.M., Shousha, T.M., Walton, L.M., Raigangar, V., and Harrison, D.E. (2022). Reduction of thoracic hyper-kyphosis improves short and long term outcomes in patients with chronic nonspecific neck pain: A randomized controlled trial. J. Clin. Med., 11.","DOI":"10.3390\/jcm11206028"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/11\/3707\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:43:26Z","timestamp":1760125406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/11\/3707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,27]]},"references-count":74,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["jcm12113707"],"URL":"https:\/\/doi.org\/10.3390\/jcm12113707","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,27]]}}}