FORWARD HEAD POSTURE
 
   
Forward Head Posture Page

This section was compiled by Frank M. Painter, D.C.
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If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.

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What is Forward Head Posture?
 
   






Thanks to ATonalBalance.Com and Erik Dalton, Ph.D. for the use of these pictures!

In the poster on the left, the first sketch (top-left) represents “perfect” head posture. A line dropped from the center of the external auditory meatus (EAM) would land directly in the center of the shoulder (the tip of the acromion process). The graphic on the right demonstrates the progression of forward head posture (occasionally referred to as “anterior head translation”).

According to Kapandji (Physiology of the Joints, Volume III), for every inch your head moves forwards, it gains 10 pounds in weight, as far as the muscles in your upper back and neck are concerned, because they have to work that much harder to keep the head (chin) from dropping onto your chest.   This also forces the suboccipital muscles (they raise the chin) to remain in constant contraction, putting pressure on the 3 Suboccipital nerves.   This nerve compression may cause headaches at the base of the skull. Pressure on the suboccipital nerves can also mimic sinus (frontal) headaches.

Rene Cailliet M.D., famous medical author and former director of the department of physical medicine and rehabilitation at the University of Southern California states:

Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis, which blocks the action of the hyoid muscles, especially the inferior hyoid responsible for helping lift the first rib during inhalation.”

Persistent forward head posture (a.k.a “hyperkyphotic posture”) puts compressive loads upon the upper thoracic vertebra, and is also associated with the development of Upper Thoracic Hump, which can devolve into Dowager Hump when the vertebra develop compression fractures (anterior wedging).   A recent study found this hyperkyphotic posture was associated with a 1.44 greater rate of mortality.

It's not uncommon to observe 2" of anterior head placement in new patients.   Would you be surprised that your neck and shoulders hurt if you had a 20-pound watermelon hanging around your neck?   That's what forward head posture can do to you.   Left uncorrected, FHP will continue to decline.   Chiropractic can be very corrective, especially in the hands of a chiropractic rehabilitationist.   Our specialty is in reversing the joint fixations (what we refer to as “subluxations”) and in re-invigorating the muscles that normally retract the head.




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Forward Head Posture Articles
 
   

The Chiropractic And Spinal Allignment and Cervical Curve Page
This page reviews how loss of function in the spine, and the loss of structural integrity (hypolordosis) can lead to degenerative changes and the neurological abnormalities associated with the Vertebral Subluxation Complex.


Posture and Your Health
Our thanks to TonalBalance.Com for access to this interesting (and perhaps controversial) Adobe Acrobat document!


Effect of Backpack Load Carriage on Cervical Posture
in Primary Schoolchildren

Work. 2012 (Jan 1);   41 (1):   99—108

Subjects demonstrated immediate and statistically significant changes in craniovertebral angle (CVA), indicating increased forward head positions upon donning the backpacks containing 15% and 20% body weight. Following the walking of 6 minutes, the CVA demonstrated further statistically significant changes for all backpack loads indicating increased forward head postures. For the 15 & 20% of body weight conditions, more than 50% of the subjects reported discomfort after walking, with the neck as the primary location of reported pain.


The Efficacy of Forward Head Correction on Nerve Root Function
and Pain in Cervical Spondylotic Radiculopathy: A Randomized Trial

Clin Rehabil. 2011 (Sep 21) [Epub ahead of print]

Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.


Musculoskeletal Dysfunction and Pain in Adults with Asthma
J Asthma. 2011 (Feb);   48 (1):   105—110

This cross-sectional and controlled study enrolled 30 patients with mild (n = 17) and severe (n = 13) persistent asthma. Fifteen non-asthmatic volunteers were also assessed. Postural alignment and muscle shortening were evaluated by head and shoulder positions, chest wall mobility, and posterior (trunk and lower limb) muscle flexibility. In comparison with non-asthmatic subjects, patients with mild or severe persistent asthma held their head and shoulders more forward and had lower chest wall expansion, decreased shoulder internal rotation, and decreased thoracic spine flexibility. Chronic lower thoracic, cervical, and shoulder pain was significantly increased in patients with mild or severe asthma compared with non-asthmatic subjects.


Influence of Forward Head Posture on Scapular Upward Rotators
During Isometric Shoulder Flexion

J Bodyw Mov Ther. 2010 (Oct);   14 (4):   367—374

Significantly increased EMG activity in the upper trapezius and lower trapezius and significantly decreased EMG activity in the serratus anterior were found during loaded isometric shoulder flexion with FHP. Thus, FHP may contribute to work-related neck and shoulder pain during loaded shoulder flexion while sitting. These results suggest that maintaining NHP is advantageous in reducing sustained upper and lower trapezius activity and enhancing serratus anterior activity as compared with FHP during loaded shoulder flexion.


Head and Shoulder Alignment Among Patients with
Unilateral Vestibular Hypofunction

Rev Bras Fisioter. 2010 (Aug);   14 (4):   330—336

This was a cross-sectional study. Thirty individuals with unilateral vestibular hypofunction (UVH) and 30 with normal vestibular function and without complaints of dizziness underwent CB in the anterior, right and left and posterior views, in an upright standing position. Alcimage™ 2.0 was used to evaluate three angles in order to verify the anterior deviation and inclination of the head, and the alignment of the shoulders. The patients with UVH had greater forward (55.44 ± 16.33) and lateral (2.03 ± 1.37) head deviation angles than did the normal individuals (34.34 ± 4.60 and 1.34 ± 1.05 respectively), with a statistically significant difference (p<0.001).


Managing Forward Head Posture in the Elderly
The American Chiropractor 2010 (Jul);   32 (7)

I recently got some great questions from a doctor in south Florida who frequently encounters aging patients with large forward head translations, yet have pronounced, sometimes even hyperlordotic, cervical curves. We've all observed this posture, common among elderly patients, but many doctors aren't aware it needs to be managed differently than the typical case of FHP associated with cervical hypolordosis.


Recurrent Neck Pain and Headaches in Preadolescents Associated
with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional
Observational Study With 131 Students

J Manipulative Physiol Ther 2009 (Oct);   32 (8):   625—634

Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence.


Increased Forward Head Posture and Restricted Cervical Range
of Motion in Patients with Carpal Tunnel Syndrome

Journal of Orthopaedic & Sports Physical Therapy 2009 (Sep);   39 (9):   658—664

Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion. However, a cause-and-effect relationship cannot be inferred from this study.


Respiratory Dysfunction in Chronic Neck Pain Patients.
A Pilot Study

Cephalalgia 2009 (Jul);   29 (7):   701—710

According to the results, chronic neck patients presented with a statistically significant decreased maximal voluntary ventilation (P = 0.042) and respiratory muscle strength (Pimax and Pemax), (P = 0.001 and P = 0.002, respectively). Furthermore, the current study demonstrated a strong association between an increased forward head posture and decreased respiratory muscle strength in neck patients. The connection of neck pain and respiratory function could be an important consideration in relation to patient assessment, rehabilitation and consumption of pharmacological agents.


The Relationship Between Head Posture and Severity and Disability
of Patients With Neck Pain

Manual Therapy 2008 (May);   13 (2):   148—154

The CV angle in subjects with neck pain is significantly smaller than that in normal subjects. There is moderate negative correlation between CV angle and neck disability. Patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability.


Myofascial Trigger Points, Neck Mobility, and Forward Head
Posture in Episodic Tension-Type Headache

Headache 2007 (May);   47 (5):   662—672

Active TrPs in the upper trapezius, sternocleidomastoid, and temporalis muscles were more common in ETTH (Episodic Tension-Type Headache) subjects than in healthy controls, although TrP activity was not related to any clinical variable concerning the intensity and the temporal profile of headache. ETTH patients showed greater FHP and lesser neck mobility than healthy controls, although both disorders were not correlated with headache parameters.


Hyperkyphotic Posture and Risk of Future Osteoporotic Fractures:
The Rancho Bernardo Study

J Bone Miner Res 2006 (Mar);   21 (3):   419—423

In logistic regression analyses, older women with hyperkyphotic posture had a 1.7-fold increased risk of having a future fracture independent of age, prior fracture, and spine or hip BMD (bone mineral density). There was a significant trend of increasing fracture risk with increasing kyphosis of the spine. Whereas hyperkyphosis may often result from vertebral fractures, our study findings suggest that hyperkyphotic posture itself may be an important risk factor for future fractures, independent of low BMD or fracture history.


Trigger Points in the Suboccipital Muscles and Forward Head Posture
in Tension-Type Headache

Headache: The Journal of Head and Face Pain 2006 (Mar);   46 (3):   454—460

Twenty chronic tension-type headache (CTTH) subjects and 20 matched controls without headache participated. Trigger points (TrPs) were identified by eliciting referred pain with palpation, and increased referred pain with muscle contraction. Side-view pictures of each subject were taken in sitting and standing positions, in order to assess forward head posture (FHP) by measuring the craniovertebral angle. Suboccipital active TrPs and FHP were associated with CTTH. CCTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs. The degree of FHP correlated positively with headache duration, headache frequency, and the presence of suboccipital active TrPs.


Hyperkyphotic Posture and Poor Physical Functional Ability in Older
Community-dwelling Men and Women: The Rancho Bernardo Study

J Gerontol A Biol Sci Med Sci 2005 (May);   60 (5):   633—637

Physical functional decline is often the determining factor that leads to loss of independence in older persons. Identifying risk factors for physical disability may lead to interventions that may prevent or delay the onset of functional decline. Our study objective was to determine the association between hyperkyphotic posture (Forward Head Posture) and physical functional limitations. In multiply adjusted comparisons, there was a graded stepwise increase in difficulty in bending, walking and climbing, measured grip strength, and ability to rise from a chair (with increased kyphosis of the spine).


Hyperkyphotic Posture Predicts Mortality in Older Community-dwelling
Men and Women: A Prospective Study

J Am Geriatr Soc 2004 (Oct);   52 (10):   1662—1667

To determine the association between hyperkyphotic posture and rate of mortality, the authors tracked 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit. Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates. This study found that persons with hyperkyphotic posture had a 1.44 greater rate of mortality.


Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache
J Manipulative Physiol Ther 2004 (Jul);   27 (6):   414—420

The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache. NOTE: There are more articles on this topic in the Rehabilitation Diplomate Information Page.


A Study on the Prevalence of and Risk Factors for Neck Pain Among
University Academic Staff in Hong Kong

J Occup Rehabil 2002 (Jun);   12 (2):   77–91

Among those with neck pain during computer processing, 60.3% had a forward head posture. However, a low correlation between psychosocial factors and neck pain was demonstrated (r = 0.343). Academic staff in tertiary institutions could be considered as a high-risk group of job-related neck pain.


Forward Head Posture is the Cause of 'Straight Spine Syndrome'
in Many Professionals

Indian J Occupat and Environmental Med 2000 (Jul);   4 (3):   122—124

Our results show that forward head posture is the commonest defect found in variety of professionals. This leads to SSS, an early functional stage, and can lead to serious compression of cervical nerve roots. Education programmes on right posture, ergonomics, regular corrective exercises may prevent SSS.


Forward Head Posture
Dynamic Chiropractic – April 3, 2000,

Forward head posture is a clinical entity that has been identified by multiple authors as a significant factor in a variety of musculoskeletal pain syndromes. [2-7] Although some reports are essentially anecdotal, [2-4] several reports use sophisticated statistical analyses and healthy ontrols versus painful subjects to establish forward head posture as a real clinical entity with significant musculoskeletal consequences. [5-7]


The Associations Between Adolescent Head-on-neck Posture, Backpack Weight, and Anthropometric Features
Spine 1999 (Nov 1);   24 (21):   2262–2267

A significant change in craniovertebral angle was found at every year level, when comparing standing posture with no backpack with posture when carrying a backpack. The change was greatest for the youngest students. There are more articles like this in the Backpack Page


Forward Head / Forward Shoulders
Dynamic Chiropractic ~ August 23, 1999

Probably one of the most common postural distortions we see is the forward head, forward shoulders posture. This distortion often appears in teenagers and progresses to old age. Porterfield and DeRosa1 have provided some important information regarding this problem. They state1 that while lengthening or weakness of the scapular retractors is often blamed, a major cause is weakness and lengthening of the abdominal muscles, allowing the chest to descend and shifting the weight of the upper trunk anteriorly. This causes the chest to descend with the scapula shifting forward around the rib cage, pressing the clavicle to the first rib. In this position, the humerus internally rotates and the head and neck are brought forward.


Neck Posture a Key to Pain Relief
Seattle Fibromyalgia International Team Conference ~ 2-13-1997

Head and neck posture may be a major factor in the pain experienced by many fibromyalgia (FMS) and chronic fatigue and immune dysfunction syndrome(CFIDS) patients. Case studies presented last week showed that successful treatment of neck and jaw pain made significant improvements in FMS and CFIDS patients. Herbert P. Gordon, D.D.S., Ph.D., P.S., attributed a major portion of head, neck, jaw, and shoulder pain to the posture of the sufferer. Dr. Gordon, an assistant professor of oral medicine at the University of Washington, Seattle, presented his theories and techniques for pain relief to the conference, which was attended by 200 FMS and CFIDS survivors.


The Relationship Between Forward Head Posture
and Temporomandibular Disorders

J Orofac Pain 1995 (Spring);   9 (2):   161—167

This study investigated the relationship between forward head posture and temporomandibular disorder symptoms. Thirty-three temporomandibular disorder patients with predominant complaints of masticatory muscle pain were compared with an age- and gender-matched control group. In other words, when evaluating the ear position with respect to the seventh cervical vertebra, the head was positioned more forward in the group with temporomandibular disorders than in the control group (P < .05).


Cervical Headache: An Investigation of Natural Head Posture
and Upper Cervical Flexor Muscle Performance

Cephalalgia 1993 (Aug);   13 (4):   272—284

In this study, 60 female subjects, aged between 25 and 40 years, were divided into two equal groups on the basis of absence or presence of headache. A passive accessory intervertebral mobility (PAIVM) examination was performed to confirm an upper cervical articular cause of the subjects' headache and a questionnaire was used to establish a profile of the headache population. Measurements of cranio-cervical posture and isometric strength and endurance of the upper cervical flexor muscles were compared between the two groups of subjects. The headache group was found to be significantly different from the non-headache group in respect to forward head posture (FHP) (t = -5.98, p < 0.00005), less isometric strength (t = 3.43, p < 0.001) and less endurance (t = 8.71, p < 0.0005) of the upper cervical flexors.


Incidence of Common Postural Abnormalities in the Cervical, Shoulder, and Thoracic Regions and their Association with Pain in Two Age Groups of Healthy Subjects
Phys Ther 1992 (Jun);   72 (6):   425–431

Subjects with kyphosis and rounded shoulders had an increased incidence of interscapular pain, and those with a forward-head posture had an increased incidence of cervical, interscapular, and headache pain.



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