According to a systematic review and meta-analysis, the craniovertebral angle varies for age, gender, and pain vs pain-free subjects, and is linked negatively with neck pain measures. In order to evaluate the relationship between posture and neck pain critically, this review sought to ascertain if sagittal head and neck position varies in neck pain and pain-free people. A total of 26 articles out of 3796 identified during the initial search in EMBASE, CINAHL, PubMed, and Google Scholar were included on the basis of eligibility requirements.

To determine relationships between studies, to evaluate postural correlation with neck pain measures [Visual Analogue Scale (VAS), Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Northwick Park Neck Pain Questionnaire (NPQ)] and for age- and gender-wise variation, the mean pooled difference and effect sizes were calculated. With the aid of the Newcastle-Ottawa Quality Assessment Scale, bias risk was evaluated.

The significant mean pooled difference for the cranial-vertebral angle was -2.93 (95% CI: -4.95 to -0.91). A non-significant mean pooled difference of 1.15 (95% CI -1.16 to 3.46) and -0.26 (95% CI 1.89 to 1.36), respectively, was found for sagittal head angle and forward head posture. The cranial-vertebral angle difference was determined to be 2.36° and 2.57°, respectively, depending on age and gender.

The effect size was reported to be significant for the correlation between intensity of pain and cranial-vertebral angle [VAS: −0.31 (95% CI −0.46 to −0.16); NPRS: −0.44 (95% CI −0.61 to −0.26)], and between disability and cranial-vertebral angle [NPQ: −0.47 (95% CI −0.61 to −0.320); NDI: −0.18 (95% CI −0.31 to −0.05); ]. Additional research is needed on other substitute metrics, including sagittal head angle, cranial and cervical angles, and forward head posture.