Cervical Posture, Pain, and Pathology: Developmental, Evolutionary and Occupational Perspective

The cervical spine is the most mobile component of the spinal column. Its curvature (lordosis) supports the head above the shoulders, maintaining head position, gaze, and visual field. However, there is considerable variability in the cervical spine curvature of different individuals, generating several unresolved questions: What is a normal cervical curvature? How is cervical posture associated with cervical spine pain and pathology? How is erect posture and a modern lifestyle associated with cervical pain and pathology? Based on the current literature, we found that many factors influence the extent of cervical lordosis and its internal architecture such as age, sex, and the morphology of adjacent anatomical regions-the thorax, the head, the lumbar spine, and the pelvis. We also found that cervical posture and alignment are correlated with cervical pathology and health-related quality of life. In the adult population, individuals with lordotic cervical spines (a Cobb angle (C0-C7) of ~40° ± 10 and Sagittal Vertical Axis (SVA) C2-C7 <40 mm) have less pathology and a better quality of life, while individuals with a straight/kyphotic/S-shape cervical spine (a small Cobb angle and SVA C2-C7 >40 mm) have greater cervical pathology, pain, and a lower quality of life. It is clear today that certain workers in various professions suffer more from neck pain. Neck pain appears generally in those who sit for long periods of time, i.e., mostly office workers. Forward head posture and sustained sitting are typical risk factors for neck pain. The prolonged static trunk and neck postures together with excessive work of the stabilizing muscles, can cause neck pain. Cervical spine pathology has been observed in apes, extinct hominins, and prehistoric societies. Yet the evolution of cervical posture in hominins and its interaction, or lack of it, with neck pain and dysfunction is far from being resolved. Future studies should explore the prevalence and nature of cervical pathology in extinct and extant hominoids and in pre- and post-agricultural societies. Further investigations should also explore the interaction between cervical posture, pathology, and lifestyle in modern humans, and the efficacy of treatment methods for alleviating neck pain and pathology by improving posture.