Forward Head Posture: Difference between revisions

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== Introduction ==
== Introduction ==
[[File:Chris-benson-yx-iJFybOBQ-unsplash.jpg|right|frameless|400x400px]]
[[File:Chris-benson-yx-iJFybOBQ-unsplash.jpg|right|frameless|400x400px]]
[[Posture]] is the position assumed by the body either with support during muscular inactivity, or by means of the coordinated action of many muscles working (i.e. during muscular activity) to maintain stability or to form an essential basis which is being adapted constantly to the movement which is superimposed upon it.<ref name=":0">Gardiner MD. The Principles of Exercise Therapy. Fourth Edition. Delhi: CBS Publishers & Distributors Pvt. Ltd., 2005. p245-55.
Because of the rising popularity of media devices such as smartphones and computers, frequent users often exhibit incorrect posture.
</ref> In an ideal erect posture, the body segments are aligned so that the torques and stresses are minimised and standing can be made with minimum energy expenditure. Other postural varients include [[Sway Back Posture]] and [[Low Back Pain Related to Hyperlordosis|Hyperlordosis Lumbar spine]]  
 
Forward head posture (FHP) is a poor habitual neck posture
* Defined by hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae.<ref>Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. Effec[https://www.ncbi.nlm.nih.gov/pubmed?cmd=link&linkname=pubmed_pubmed_reviews&uid=30774207&log$=relatedreviews&logdbfrom=pmc t of forward head posture on thoracic shape and respiratory function]. Journal of physical therapy science. 2019;31(1):63-8. Available from:https://www.ncbi.nlm.nih.gov/pubmed?cmd=link&linkname=pubmed_pubmed_reviews&uid=30774207&log$=relatedreviews&logdbfrom=pmc (last accessed 23.4.2020)</ref>
* Thoracic Kyphosis is a complication of the combination of slouched-forward shoulders and rounded upper back.
* Can lead to a painful shortening of the muscles of the back of the neck, as well as compression of the cervical vertebrae—the uppermost portion of the spine that supports the head and protects the spinal cord.
Due to the increased compressive forces through the neck joints and increased muscle tension, pain is the common outcome. Some of the types of problems associated with FHP are:
* [[Headache|Headaches]]
* Neck discomfort
* Muscle tension in the [[Chronic Neck Pain|neck]] and shoulders
* Discomfort in the [[Thoracic Anatomy|mid back]]
* Chest pain
* Pain, pins & needles and numbness in the arms and hands
Many people develop [[Chronic Neck Pain|chronic]] or recurrent problems because they receive treatment for the pain (e.g. [[Pain Medications|pain killers]] or anti-inflammatory medication) but never receive treatment for the underlying cause which is their FHP.<ref>Centralcity Health professionals [https://www.centralcityphysio.com.au/forward-head-posture/ FHP] Available from:https://www.centralcityphysio.com.au/forward-head-posture/ (last accessed 23.4.2020)</ref>


== Forward Head Posture ==
== Forward Head Posture ==
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=== Postural Analysis ===
=== Postural Analysis ===
Observational postural analysis involves locating the body segments in relation to LOG (representative by plumb line). <ref name=":0" />In an anterior or posterior analysis, the LOG should bisect the body into two symmetrical halves. In a lateral analysis, the LOG should passes anterior to the head, vertebral column, or joints of the lower extremities.<ref name=":2">Levangie PK, Norkin CC. Joint Structure and Function. Fifth Edition. USA: F.A. Davis Company. 2011. p501-37
Observational postural analysis involves locating the body segments in relation to LOG (representative by plumb line). <ref name=":0">Gardiner MD. The Principles of Exercise Therapy. Fourth Edition. Delhi: CBS Publishers & Distributors Pvt. Ltd., 2005. p245-55.
</ref>In an anterior or posterior analysis, the LOG should bisect the body into two symmetrical halves. In a lateral analysis, the LOG should passes anterior to the head, vertebral column, or joints of the lower extremities.<ref name=":2">Levangie PK, Norkin CC. Joint Structure and Function. Fifth Edition. USA: F.A. Davis Company. 2011. p501-37
</ref>
</ref>
== Physiotherapy Management ==
== Physiotherapy Management ==

Revision as of 07:50, 23 April 2020

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Introduction[edit | edit source]

Chris-benson-yx-iJFybOBQ-unsplash.jpg

Because of the rising popularity of media devices such as smartphones and computers, frequent users often exhibit incorrect posture.

Forward head posture (FHP) is a poor habitual neck posture

  • Defined by hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae.[1]
  • Thoracic Kyphosis is a complication of the combination of slouched-forward shoulders and rounded upper back.
  • Can lead to a painful shortening of the muscles of the back of the neck, as well as compression of the cervical vertebrae—the uppermost portion of the spine that supports the head and protects the spinal cord.

Due to the increased compressive forces through the neck joints and increased muscle tension, pain is the common outcome. Some of the types of problems associated with FHP are:

  • Headaches
  • Neck discomfort
  • Muscle tension in the neck and shoulders
  • Discomfort in the mid back
  • Chest pain
  • Pain, pins & needles and numbness in the arms and hands

Many people develop chronic or recurrent problems because they receive treatment for the pain (e.g. pain killers or anti-inflammatory medication) but never receive treatment for the underlying cause which is their FHP.[2]

Forward Head Posture[edit | edit source]

A forward head posture (FHP) or poking chin involves increased flexion of lower cervical vertebrae and the upper thoracic regions, increased extensions of upper cervical vertebrae and extension of the occiput on C1. [3] The FHP is considered to co-exist with hyper-extension of the upper cervical spine, flattening of lower cervical spine, rounding of upper back, and elevation and protraction of shoulders. FHP may result in craniofascial pain, headache, neck ache and shoulder pain together with decreased range of cervical motion,muscle stiffness and tenderness.[4]

Souce: www.flicker.com/photos/internetarchievebookimages/14594814847/ Permission: At the time of upload, the image license was automatically confirmed using flicker API. (No known copyright restriction exist)

Biomechanics[edit | edit source]

Head 1.jpg

In FHP, the head shifts anteriorly from the line of gravity, the scapulae may rotate medially, a thoracic kyphosis may develop and overall vertebral height may be shortened. The features are as follows: there is an obliteration of the cervical lordosis and a compensatory tilting back of the head at the Atlanto-occipital joint. In the posterior cervical muscles there is stretching and weakness of Semispinalis cervicis and overaction with ultimate shortening of Semispinalis capitis. The corresponding flexor muscles in front, namely, Longus cervicis and Longus capitis shorten and lengthen respectively.[5]

Source: Flicker Images Author: Internet Archive Book Images Permission: At the time of upload, the image license was automatically confirmed using the Flickr API. (No known copyright restrictions exist)

Causes[edit | edit source]

  • Effect of gravity: slouching, poor ergonomic alignment.
  • Occupational posture: forward or backward leaning of head for long durations, slouched or relaxed sitting, faulty sitting posture while using computer or screen.
  • Result of other faulty posture like pelvic and lumber spine posture.
  • Sleeping with head elevated too high.
  • Texting posture maintained for long durations.
  • Lack of development of back muscle strength.
    Source: Dr. Kenneth Hansraj Author: Dr. Kenneth Hansraj Permission: This work is free and may be used by anyone for any purpose.

Source of Symptoms[edit | edit source]

  • Anterior location of line of gravity (LOG) causes an increase in flexion (forward head), which requires constant isometric muscle contraction to support head which may result in ischaemia and pain.
  • Stretch of suprahyoid muscles pull mandible posteriorly into retrusion which my result in TMJ Anatomy pain and associated fascial tension.
  • Narrowing of the intervertebral foramina in lordotic areas of cervical region, which may impinge on the blood vessels and nerve roots, especially if there are degenerative changes.
  • Abnormal compression on the posterior zygapophyseal joints and posterior portions of the intervertebral discs.
    This file is licensed under the Creative Commons Attribution 3.0 Unported license. You are free: to share – to copy, distribute and transmit the work to remix – to adapt the work Under the following conditions: attribution – You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work).
    Source: Skoivuma Author: Skoivuma
    Stress to Anterior longitudinal ligament in upper cervical spine and Posterior longitudinal ligament in lower cervical spine.

Effects[edit | edit source]

  • Muscle ischaemia, pain and fatigue
  • Decreased range of motion of cervical spine[6]
  • Early disc degeneration and osteophyte formation
  • Temporomandibular joint pain and inflammation
  • Tension Headache
  • Increase in dorsal kyphosis and decrease in height
  • Decrease in vital capacity and range of motion of shoulder and arm
  • Possible protrusion of nucleus pulposus and nerve compression

Potential Muscle Impairments:[edit | edit source]

Postural Analysis[edit | edit source]

Observational postural analysis involves locating the body segments in relation to LOG (representative by plumb line). [8]In an anterior or posterior analysis, the LOG should bisect the body into two symmetrical halves. In a lateral analysis, the LOG should passes anterior to the head, vertebral column, or joints of the lower extremities.[9]

Physiotherapy Management[edit | edit source]

  • To Decrease Pain:
    1. Pain management advice
  • Postural Alignment, Balance and Gait:
    1. Cervical Retraction
    2. Scapular Retraction
    3. Balance Training ( If dysfunction presents)
  • Range of Motion, Joint Mobility and Flexibility[10]
    1. Cervical Range of Motion Exercises
    2. Shoulder Range of Motion Exercises
    3. Cervical Traction
    4. Stretching Exercises of tight structures- Trapezius, Scalenes, SCM, Pectoralis Major and Minor.
  • To reduce spasm
    1. Myofacial release
    2. Ischemic Compression
    3. Positional release technique (to relieve tension headaches)
  • Muscle Strength and Endurance
    1. Cervical isometric strengthening exercises (initial phase) progressing to isotonic and dynamic strengtening exercises.
    2. Strengthening exercises for scapular retractors (Rhomboids, middle Trapezius).[11]
  • Ergonomic Advice
    • Correct the number of pillows used
    • Postural corrections.
Source: Yamavu Author: Yamavu Permission: Universal public domain

References[edit | edit source]

  1. ↑ Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. Effect of forward head posture on thoracic shape and respiratory function. Journal of physical therapy science. 2019;31(1):63-8. Available from:https://www.ncbi.nlm.nih.gov/pubmed?cmd=link&linkname=pubmed_pubmed_reviews&uid=30774207&log$=relatedreviews&logdbfrom=pmc (last accessed 23.4.2020)
  2. ↑ Centralcity Health professionals FHP Available from:https://www.centralcityphysio.com.au/forward-head-posture/ (last accessed 23.4.2020)
  3. ↑ 3.0 3.1 Kisner C, Colby LA. Therapeutic Exercises. Fifth Edition. USA: F.A. Davis Company.2007. p384-404.
  4. ↑ Raine S, Twomey L. Posture of the head, shoulders and thoracic spine in comfortable erect standing. Aust J Physiother. 1994; 40(1):25-32. Accessed 26 February 2019.
  5. ↑ Burt HA, Effects of faulty posture; President's Address. Proc R Soc Med. 1950; 43(3):187–194. Accessed 26 February 2019.
  6. ↑ Kim DH, Kim CJ, Son SM. Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion. Osong public health and research perspectives. 2018 Dec;9(6):309.
  7. ↑ Weon JH, Oh JS, Cynn HS, Kim YW, Kwon OY, Yi CH. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork and movement therapies. 2010 Oct 1;14(4):367-74.
  8. ↑ Gardiner MD. The Principles of Exercise Therapy. Fourth Edition. Delhi: CBS Publishers & Distributors Pvt. Ltd., 2005. p245-55.
  9. ↑ Levangie PK, Norkin CC. Joint Structure and Function. Fifth Edition. USA: F.A. Davis Company. 2011. p501-37
  10. ↑ Szczygieł E, Sieradzki B, Masłoń A, Golec J, Czechowska D, Węglarz K, Szczygieł R, Golec E. Assessing the impact of certain exercises on the spatial head posture. International journal of occupational medicine and environmental health. 2019 Feb 27;32(1):43-51.
  11. ↑ Im B, Kim Y, Chung Y, Hwang S. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. Journal of physical therapy science. 2015;28(3):951-5.
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