The increasing use of smartphones and computers has led to poor posture habits among frequent users.
Forward Head Posture (FHP) is a common issue associated with poor neck alignment, often occurring alongside Upper Crossed Syndrome. This condition is characterized by an overextension of the upper cervical vertebrae and a forward shift of these vertebrae.
Additionally, Thoracic Kyphosis can develop due to rounded shoulders and a hunched upper back. This posture can cause the muscles at the back of the neck to become painfully shortened and may compress the cervical vertebrae, which are crucial for supporting the head and safeguarding the spinal cord.
The heightened pressure on neck joints and the added muscle tension from Forward Head Posture (FHP) often lead to various issues. Common problems associated with FHP include:
- Headaches
- Neck pain
- Muscle tightness in the neck and shoulders
- Mid-back discomfort
- Chest pain
- Pain, tingling, and numbness in the arms and hands
Forward Head Posture – Effects on Health:
Assessing Forward Head Posture (FHP) is crucial for accurate diagnosis and effective rehabilitation.
- FHP leads to increased compressive forces on the cervical spine tissues, especially affecting the facet joints and ligaments. Research indicates that FHP is associated with various symptoms, including neck pain, headaches, temporomandibular joint discomfort, and other musculoskeletal issues.
- FHP can also impair respiratory function by weakening the muscles responsible for breathing. Additionally, it can negatively affect static balance.
- Forward head and rounded shoulder postures can contribute to shoulder pain and dysfunction due to changes in scapular movement and muscle activity, resulting in added stress on the shoulder.
- In the posterior cervical region, FHP causes stretching and weakening of the Semispinalis cervicis muscle, while the Semispinalis capitis muscle becomes overactive and shortened. Conversely, the Longus cervicis and Longus capitis muscles at the front are affected by shortening and lengthening.
- Recent evidence suggests that there may not be a direct link between FHP and neck pain, but individuals with neck pain often exhibit reduced range of motion and slower neck movement.
Epidemiology/ Etiology:
Neck pain is quite common, affecting up to 86.8% of the general population.
Several risk factors are associated with Forward Head Posture (FHP), including being female, older age, former smoking habits, high job demands, and limited social or work support.
The causes of FHP can be attributed to:
- Workplace Posture: Prolonged periods of leaning the head forward or backward, slouching, or using poor posture while seated at a computer or screen.
- Gravity Effects: Slouching and inadequate ergonomic alignment.
- Other Postural Issues: Poor pelvic and lumbar spine alignment.
- Sleeping Conditions: Using a pillow that elevates the head too much.
- Sustained Poor Posture: Maintaining poor posture over extended periods.
- Muscle Weakness: Insufficient development of back muscles
Clinical Findings:
Forward Head Posture (FHP) can lead to a range of issues and complications, including:
- Muscle Ischemia, Pain, and Fatigue: Prolonged FHP can cause reduced blood flow to muscles, resulting in pain and fatigue.
- Reduced Cervical Spine Range of Motion: Limited movement in the neck is commonly observed with FHP.
- Disc Degeneration and Osteophyte Formation:
- Early wear and tear on spinal discs and the development of bone spurs.
- Temporomandibular Joint Pain: Pain and inflammation in the jaw joint.
- Tension Headaches: Increased muscle tension leading to headaches.
- Increased Dorsal Kyphosis: A worsening of upper back curvature, which may result in a decrease in overall height.
- Reduced Vital Capacity and Arm Mobility: Decreased lung capacity and restricted movement of the shoulders and arms.
- Potential Nucleus Pulposus Protrusion and Nerve Compression: Risks of disc herniation and nerve impingement.
- Muscle Mobility Impairments: Limited mobility in various muscles, including:
- Anterior Thorax Muscles: Intercostals
- Upper Extremity Muscles Originating on the Thorax: Pectoralis major and minor, Latissimus dorsi, Serratus anterior
- Cervical Spine and Head Muscles Attaching to the Scapula and Upper Thorax: Levator scapulae, Sternocleidomastoid, Scalene, Upper Trapezius
- Suboccipital Region Muscles: Rectus capitis posterior major and minor, Obliquus capitis inferior and superior
- Impaired Muscle Performance: Weakness in the lower cervical and upper thoracic erector spinae, scapular retractor muscles (Rhomboids, middle Trapezius), anterior throat muscles (suprahyoid and infrahyoid muscles), and capital flexors (Rectus capitis anterior and lateralis, superior oblique, Longus colli, Longus capitis).
- Increased Tension in Mastication Muscles: Elevated tension in the jaw muscles, including the Pterygoid, Masseter, and Temporalis, in individuals with temporomandibular joint symptoms.
Physiotherapy Management:
- Pain Management Advice
To alleviate pain, consider these strategies:
- Pain Relief Techniques: Use methods such as applying heat or cold packs, practicing relaxation techniques, or engaging in gentle stretching exercises.
- Over-the-Counter Medications: Non-prescription pain relievers like ibuprofen or acetaminophen can be effective for managing mild to moderate pain.
- Professional Help: Consult with a healthcare provider for personalized treatment options, including physical therapy or prescription medications.
- Postural Alignment, Balance, and Gait
- Cervical Retraction: This involves gently moving your head backward to align the cervical spine properly. It can help relieve neck pain and improve overall posture.
- Scapular Retraction: Pull your shoulder blades together and down, which can enhance upper back posture and alleviate shoulder discomfort.
- Balance Training: Engage in exercises designed to improve balance if you experience dysfunction. This can include activities like standing on one leg, using balance boards, or practicing Tai Chi.
Implementing these techniques can help manage pain and improve overall physical function.
- Range of Motion, Joint Mobility, and Flexibility
- Cervical Range of Motion Exercises: Perform gentle neck movements, including flexion, extension, and rotation, to maintain and improve cervical spine flexibility.
- Shoulder Range of Motion Exercises: Incorporate shoulder circles, arm lifts, and external rotations to enhance shoulder joint mobility and reduce stiffness.
- Cervical Traction: Use gentle, controlled pulling forces to relieve pressure on cervical vertebrae and improve spinal alignment.
- Thoracic Manual Techniques and Exercises: Apply techniques such as manual stretching and joint mobilizations to improve thoracic spine mobility and reduce stiffness.
- Stretching Exercises: Focus on stretching tight muscles, including the trapezius, scalenes, sternocleidomastoid (SCM), and pectoralis major and minor, to enhance flexibility and relieve muscle tension.
- To Reduce Spasm: Apply techniques such as myofascial release, ischemic compression, and positional release. These methods can help alleviate muscle spasms and tension, including those associated with tension headaches.
- Muscle Strength and Endurance
- Cervical Isometric Strengthening Exercises: Start with isometric exercises, where you contract neck muscles without movement, and gradually progress to isotonic and dynamic exercises that involve actual movement for comprehensive cervical strength.
- Scapular Retraction Exercises: Focus on strengthening the scapular retractors, such as the rhomboids and middle trapezius, through exercises like rows and reverse flys to enhance upper back stability and posture.
- Ergonomic Advice
- Pillow Use: Ensure you use an appropriate number of pillows to maintain proper neck alignment while sleeping, which supports overall spinal health.
- Postural Corrections: Adjust your seating and work environments to promote proper posture, reducing strain and preventing discomfort during daily activities.
About Authors
Dr. Muhammad Mahmood Ahmad is a Spinal as well as an Orthopedic Surgeon with over 14 years of experience currently practicing at Razia Saeed Hospital, Multan.
