Forward head posture

Dear friends,

I am doing an assignment on "Forward head posture" as a part of cerficate in manual therapy course. Any valuable information regarding the above topic is greatly appreciated.

alterations in the length of the muscles and connective tissues of the head and neck, which may result from poor alignment, precipitate many of the clinical symptoms associated with mandible position and temporomandibular joint dysfunction.22 Head and neck position may influence the tension in the area muscles, which in turn may affect the biomechanics and function of the mandible.16 It has been established that forward head position and the alignment of the upper quarter contribute to TMD.17,18 Forward head posture is often associated with changes in proximal musculoskeletal structures comprising of the cervical erector spinae, upper trapezi, levator scapulae, and anterior vertebral neck flexors and associated joints.17,19 Muscles and soft tissue imbalances may affect the alignment and biomechanics of the upper quadrant structure causing hyperextension of the upper cervical spine, flattening of the lower cervical spine, elevation and forward protraction of the shoulders, and excessive thoracic kyphosis.17 Forward head and cervical hyperlordosis cause the tempromandibular joint to become malaligned affecting occulsion.20,21 These postural changes affect mandibular position, condyle position and masticatory musculature activity, thus, contributing to craniomandibular dysfunction.

Hello,

First its important to know what Forward head posture is.

For every inch your head moves "forwards", the head "gains" 10 pounds in weight, as far as the muscles in your upper back and neck are concerned, as they have to work harder to keep the head (chin) from dropping forwards onto your chest. This forces the muscles that raise the chin to remain in constant contraction, putting pressure on the 3 Suboccipital nerves. This can cause headaches at the base of the skull, and even mimic sinus headaches!

An anterior positioning of the cervical spine is caracteristic of forward head posture. Forward head posture may may make it more difficult to perform exercises with the bar in front of head or neck. Evaluate neck position at night since elevating head too high with additional pillows may act as a continuous neck stretch throughout the evening exacerbating the forward head posture.

The head should sit directly over the shoulders. The head weighs about the same as a bowling ball, so holding it forward, or out of alignment puts strain on the neck and upper back muscles and spinal tissues. When spinal tissues are under a significant load for a long period of time they begin to deform and remodel structurally and can become permanent. Forward head posture also has been shown to decrease the curvature in the neck leading to disc compression, damage and arthritis. This is why forward head posture takes a long time to correct. Some of the symptoms associated with forward head posture are fatigue, headaches, pain, carpals tunnel, TMJ and even fibromyalgia, just to name a few. Forward head posture has been linked to many neck and upper back conditions.

Also have a look at www.causeof.org/posture_fhp.htm

I hope that it was of some help.

Cheers.

Hai Ramleo,

Thank u very much for ur reply. That was a valuable input. Need further information on treatment of FHP.

Cheers

Hi,
Treatment for Forward Head Posture
The chiropractic approach to Forward Head Posture is to relieve muscle and ligament tension by restoring the proper C-shaped curve of the neck. Because forward head posture occurs slowly over time, techniques involving sustained loading (application of sustained pressure in a specific direction) are often coupled with chiropractic adjustments and muscle rehabilitation. Enhancing the flexibility of the muscles of the front of the neck is also an effective strategy often overlooked by other practitioners.

Here's somethingelse i found on the net:

In head forward position the chin moves upward to keep the eyes horizontal, resulting in muscle tension in the neck and back of the head. Head forward position shifts the center of gravity of the body and creates various postural deformities:

● By jaming shoulders it drifts upper body backward and tilts the hips forward.
● In hunched position body becomes rigid and range of motion decreases.
● Tight chest and neck muscles impedes deep breathing.
● Rigid neck muscles limits neck movements which results in the reduction of endorphins, the
body’s pain controlling chemicals.
● Abnormal positioning of the lower jaw tightens facial muscles and triggers TMJ problems.

Treatment
Treatment of forward head position and slouched shoulders mainly includes physical therapy, postural training and muscle strengthening exercises. Ergogenik® is a resistance stretching device designed specifically for rdeveloping/strengthening neck, shoulders and upper back muscles. It holds the body in a perfect balanced posture, restores normal head position and corrects slouched shoulders.

I'll get somemore in future.

Cheers.

Treating forward head posture (FHP) is not rocket science, it's just hard work. I find people tend to be either floppy or rigid in their postural fault. In your floppy patients they have good ROM but have dreadful postural sense so general postural awareness is required and effort++ required to maintain a posture they can attain immediately. I find Clinical Pilates and use of a lumbar roll great for these patients.

In your other patient type, rigidity in the upper thoracic and cervico-thoracic junction (CTJ) is to blame, usually due to obstruction by a posterior disc derangement or adaptive shortening over many years of never having good posture. In this situation you will often note a dowagers hump deformity of ther CTJ. Treatment requires lots and lots and lots of retraction exercises (opposite of FHP). A combination of active/patient generated retraction with clinician overpressure at the CTJ/Upper Tx in sitting followed by or alternating with retraction/extension in lying +/- with manual traction (see McKenzie Cx/tx text for details) works well. This is just in the clinic though, this will be useless if they don't do their own retraction exercises as often and every hour or two for as long as it takes.

I will almost always tape my patients into adequate thoracic extension for at least 24 hours in both rigid and floppy patients. Patients just don't realise most of the time that they have forward head posture and they give in to thoracic flexion. They need a constant reminder (a good kick up the behind basically) to sort themselves out.

Correction of FHP is more about what the patient does to themselves than what you do to them....

Angel

[alophysio]

I agree with Angel, the patient has to do most of the work.

However, i would be wary of too much T/S extension. I have taken to using a digital camera on my patients to show them what their "ideal" posture (according to them) is like and then giving them ***thoracic kyphosis*** to show them what it does - a lot of my FHP patients are actually in T/S lordosis or flat backed.

The tape for T/S extension might be a good cue for them to do the exercises because as Angel said, floppy patients (excessive kyphosis) is also bad.

I think a lot people grow up with the shoulders back idea of good posture but never do it (being children and teenagers has something to do with it!). Then they get older and start to care so they try to correct it and over-correct into excessive extension.

I have had one patient who went too far into flexion - but i hadn't seen her for something like 2 years and she had no probs during that time after nearly constant back and neck pain for years! The body is a crazy thing...

BTW, i also use a digital camera because i think even our own perceptions of what is good posture can be skewed - have you ever been on a physio course where *no-one* was sore or had bad posture? HAHAHAHAHA :lol

[arkesh_physio]

hi
shoulder bracing exs,chin tucking & postural advice are most important for FHP.

[monak84]

does chin tucking really help??

Hai,

Chin tucks really helps in treatment of neck pain. As you know they are used to retrain the deep cervical neck flexors. These muscles support the spine and keep it from buckling under the weight of the head. Just like Tr-Ab training in low back pain, deep cervical flexors (longus colli and capitis) have to be retrained in neck dysfunction cases

Venkat