Exploring the relationship between neck flexion and neck problems in occupational populations: a systematic review of the literature

• Published in: Ergonomics 2022-04, Vol.65 (4), p.587-603
• Main Authors: Norasi, Hamid, Tetteh, Emmanuel, Sarker, Pramiti, Mirka, Gary A., Hallbeck, M. Susan
• Format: Article
• Language: English
• Subjects: cervical spine; Correlation analysis; Evaluation; Exposure; Literature reviews; Longitudinal studies; Neck; neck musculoskeletal disorders; neck pain; Neck postural exposure; Posture; Risk analysis; Risk factors; Systematic review
• ISSN: 0014-0139; 1366-5847
• DOI: 10.1080/00140139.2021.1976847

A systematic review was conducted to evaluate the relationship between occupational neck flexion angles and neck problems. The synthesised findings were used to answer three research questions: (1) Is there a positive/negative relationship between neck flexion and neck problems? (2) What is the appropriate angular threshold for neck flexion as a risk factor for neck problems? (3) What are the gaps in our current knowledge? A review of 21 papers revealed (1) a consistent positive correlation between neck flexion and neck problems, and (2) a neck flexion angle of 20° as the most evidence-based (not necessarily the best) cut-off angle separating high- and low-risk neck flexion postures. Future research should focus on the (1) continuous collection of three-dimensional neck postures through longitudinal studies to quantify cumulative exposures of neck postures, and (2) development of standard descriptions of 'neck problems' and 'neck flexion' to facilitate the development of a dose-response relationship. Practitioner summary: Practitioners depend on thresholds for evaluating neck postural exposure using work assessment tools; however, the scientific basis for this is unclear. This systematic review investigated the angular threshold for neck flexion and found 20° of neck flexion with the greatest evidence-based support as the threshold for high-risk neck postural exposure.