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F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 97 A recent study by Kenneth Hansraj, MD, chief of spine surgery at New York Spine Surgery & Rehabilitation Medicine, confirmed what physical medicine and rehabilitation pioneer Rene Cailliet, MD, theorized three decades ago: "The weight seen by the spine dramatically increases when flexing the head forward at varying degrees." 1 Put simply, for every inch the head moves forward from its ideal gravitational center, it feels as if it weighs an additional 10 pounds (Image 1). The concept is the same as holding a 10-pound weight close to the body, then extending the weight straight out in front of you. The weight does not change, but your brain's perception of how heavy the weight feels does change, and so does the amount of effort required by the muscles, ligaments, and fascia responsible for supporting the weight—in this case, the head. With so many people spending hours daily peering down at digital devices, wear and tear on joints and connective tissues slowly whittles away at our uprightness. The good news is today's bodyworkers and corrective exercise therapists are on the front line against this epidemic. The bad news is clients often wait too long to seek help, allowing time for the brain to map their aberrant forward head postures (FHP) as normal (Image 2). Both prevention and correction rely on a basic understanding of the biomechanical nuances associated with texting and prolonged desktop- computer viewing. For a brief overview on two primary FHP patterns, we'll begin with observational assessments of two former clients. MONA'S DESKTOP DISTRESS Mona was referred to me for treatment of chronic (nontraumatic) head, neck, and rotator cuff pain, exacerbated by more than two decades of prolonged computer use in her job. During static assessment, Mona was asked to assume her usual computer posture while I examined her cervical spine. With my left hand bracing her forehead, my right thumb and index finger began gently palpating tissues at the occipitoatlantal (O-A) joint. Right away, Mona whispered, "That's where my headaches begin." Notice in Image 3 (page 98) how Mona's head is forced to cock back (extend) on the atlas to level the eyes. Neurovascular compression, suboccipital spasm, and head pain are not uncommon in those with desktop FHP. However, as we'll detail below, such issues are rare among text-neck clients. Adding insult to injury, observe how Mona's cocked head and jutted chin caused the lower C-spine joints to cram closed, creating an unsightly dowager's hump. Oddly, Mona had never linked her hunched posture with her medically diagnosed rotator-cuff pain. She was surprised when gentle pressure to the left C7 transverse process replicated her shoulder symptoms. When she was asked to slowly forward-bend her neck, Mona's left C7 transverse technique MYOSKELETAL ALIGNMENT TECHNIQUES Text Neck and Desktop Neck Assessing Forward Head Posture By Erik Dalton The brain perceives the head's weight as increasing by 10 pounds for every inch it migrates forward. Image courtesy Erik Dalton. 1 Neuroposturoplasticity remaps an aberrant postural pattern as normal. Image courtesy Erik Dalton. 2 Somatosensory cortex 12 lb. 32 lb. 42 lb. Limbic system Thalamus