Issue link: https://www.massageandbodyworkdigital.com/i/1402696
54 m a s s a g e & b o d y wo r k s e p te m b e r/o c to b e r 2 0 2 1 FORWARD HEAD POSTURE Forward head posture (FHP) is the name given to a sagittal-plane postural distortion pattern in which, as the name implies, the head is held forward. This usually involves excessive flexion of the neck at the cervical spinal joints, as well as excessive forward translation and extension of the head at the atlanto-occipital joint. The net result is the center of weight of the head is anterior to the trunk. Whenever a body part is not centered on the body part below, there is an imbalance such that the body part should fall with gravity. In the case of FHP, the head and neck should fall into flexion due to the force of gravity (until the chin hits the chest). To prevent this, an equal force of extension must be occurring to counterbalance gravity's flexion force. This extension force is usually created by contraction of the cervicocranial extensor musculature in the back of the neck (Image 1). Muscles such as the upper trapezius, splenius capitis and cervicis, semispinalis capitis, and others will have to isometrically contract to oppose gravity (Images 2A–2B, page 56–57). So, whenever the person is sitting or standing, which is probably between 16–18 hours a day, cervicocranial neck extensor musculature must isometrically work every second of every minute of every one of these hours, every day of every year of every decade. This use/overuse/misuse/abuse of the extensor musculature of the neck will likely result in neck pain. The mechanical effects of FHP are not limited to the posterior extensor musculature. The chronic posture of holding the head forward will result in adaptive shortening of the flexor musculature of the cervical spine in the front of the neck, and chronically tight posterior and anterior musculature would then result in decreased range of motion. And, if the anteriorly located scalenes lock short, then the possibility of anterior scalene syndrome (a version of thoracic outlet syndrome) arises. Tight scalenes might pull the first rib up, approximating it toward the clavicle, and thereby decreasing the costoclavicular space and predisposing the person toward costoclavicular syndrome (another version of thoracic outlet syndrome). The adaptive shortening of the anterior hyoid musculature, with its pull on the mandible, might even precipitate temporomandibular joint (TMJ) syndrome. Chronically tight cervical extensor musculature also predisposes the person to tension headaches, cervical spine osteoarthrosis, and disc pathology. None of these effects must follow, but the likelihood of these biomechanical sequelae increases with FHP. Now, will a person with FHP necessarily experience pain and/or dysfunction? No. The human body has the ability to deal with a great deal of structural asymmetry without necessarily spilling over into patterns of pain and dysfunction. Further, it would make sense from a mechanical point of view that this repetitive physical stress would take many years before tissues are overloaded to the point that pain and dysfunction would occur. THE RELATIONSHIP BETWEEN FHP AND PAIN Now let's turn our attention to the relationship between FHP and pain. In a previous Massage & Bodywork article, I addressed the advent of what I term negative ideologies, examining the ideology that certain muscles cannot be stretched ("Muscles That Can't Be Stretched?," May/June 2020, page 58). I would like to address here another somewhat new negative ideology. This new ideology states that FHP, and indeed most all postural distortion patterns, do not cause pain. Forward head posture and the counterbalancing contraction of neck musculature. 1