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Forward Head Posture

Online Course: The Effect…

Introduction

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. It often co-exists
with Upper Crossed Syndrome

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] This 4 minutes video is a brief
summary of FHP

Corrective Exercise for F…

[3]

Forward Head Posture -

Affects on Health

FHP evaluation is clinically important for

diagnosis and rehabilitation treatment.

FHP increases compressive loading on

tissues in the cervical spine,
particularly the facet joints and
ligaments.
Studies have reported that symptoms
including neck pain, headache,
temporomandibular pain, and
musculoskeletal disorders are related
to FHP
FHP greatly influences respiratory
function by weakening the respiratory
muscles[1].
FHP can have a negative impact on
static balance.[4]
Forward head and round-shoulder
postures (FHRSP) can result in
shoulder pain and dysfunction
because of altered scapular kinematics
and muscle activity and consequently,
placing increased stress on the
shoulder.[5][6]
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.[6]
There is newly evidance that there is
no relation between FHP and neck
pain, additionally individual with
neck pain had lower ROM and slower
neck movement.[7]

Epidemiology/ Etiology

The overall prevalence of neck pain in the

general population is high, reaching 86.8%.
[8]

Risk factors associated with forward head

posture include female gender, older age,
being an ex-smoker, high job demands, and
low social or work support.[8]

Etiologies include:

Occupational posture: forward or

backward leaning of head for long
durations, slouched or relaxed sitting,
faulty sitting posture while using
computer or screen.
Effect of gravity: slouching, poor
ergonomic alignment.
Other faulty postures like pelvic and
lumber spine posture.
Sleeping with head elevated too high.
Poor posture maintained for long
durations.
Lack of development of back muscle
strength.

Clinical Findings

Include

Muscle ischemia, pain and fatigue

Decreased range of motion of cervical

spine[9]
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

Mobility impairment in the muscles of

the anterior thorax (intercostal
muscles), muscles of the upper
extremity [10]originating on the
thorax (Pectoralis major et minor,
Latissimus dorsi, Serratus anterior),
muscles of the cervical spine and head
that attached to the scapula and upper
thorax (Levator scapulae,
Sternocleidomastoid, Scalene, upper
Trapezius), and muscles of the
suboccipital region (Rectus capitis
posterior major and minor, Obliquus
capitis inferior and superior).
Impaired muscle performance due to
stretched and weak lower cervical and
upper thoracic erector spinae and
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).
With temporomandibular joint
symptoms, the muscles of mastication
may have increased tension
(Pterygoid, Masseter, temporalis
muscles).[11][12]

Assessment

Assessment of FHP is important to assess

the impact of the therapeutic interventions.

Clinical assessment of FHP is done

through observation of the position of
the head relative to the reference
anatomical landmarks.
Radiographic techniques can be used
to measure postural angles, but it is
not always practical.
The craniovertebral angle is one of the
most reliable methods and common
angles for evaluating the FHP. It
examines head status relative to the
seventh cervical vertebrae (C7). [13]

Physiotherapy
Management

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[14]
1. Cervical Range of Motion
Exercises
2. Shoulder Range of Motion
Exercises
3. Cervical Traction
4. Thoracic Manual Techniques and
exercises
5. 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 headache)

Muscle Strength and

Endurance
1. Cervical isometric
strengthening
exercises (initial phase)
progressing to isotonic and
dynamic strengthening
exercises.
2. Strengthening exercises for
scapular retractors (Rhomboids,
middle Trapezius).[15]

strength neck ex

Ergonomic Advice
correct number of pillows used
postural corrections

scapular strength ex

srength ex

Outcome Measures

Occiput to Wall

VAS

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| edit source]
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source]
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circulation,
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body forward It is major,
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kyphosis hasslightly also been and associated
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Flat back posture-posterior In this type tilt of of scapula
posture,and there
by Vulsfons
increased and Minerbi:[5] Bajaj et al.[10]
is forwardelevation[1] head, extension In theofpresence the cervical of
compared
cervical 14 patients
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spine, extension of forward
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lumbar lordosis andoesophagus
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control
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significantly
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the control group. There was also
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increased
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and extension of vertebral
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there hyoid is atbone, least which 10° of spinal also
involved.[11]
influences the Alarynx[1]
case-control It also study causes by changes
angulation on the posterior-anterior
Albuquerque-García
in the vocalassociated tract, with et al.[12]
associated compared alterations 18
radiograph with vertebral
female
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rotation[17]. This is a 3and in the
dimensional structures
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that produce The authors
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is flexion of of-
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the increased
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muscles.
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head found
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theofvocal OA group
tract Final willhadnot
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more
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optimal trigger points
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Remarks[edit | edit source] ItStomatognathic is important to
associated
System[edit with| edit a higher
source] pain
Thedynamicintensity
stomatognathic and
make sure clients have good and
lower
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et al.[13]
maxilla
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