Issue link: https://www.massageandbodyworkdigital.com/i/1402696
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 55 I always try to be careful with my verbiage. I do not believe that FHP must cause pain, or that it must cause dysfunction. In fact, I believe function is much more important than structure, including good and bad postures. Clinically, I often counsel my patients that a small degree of scoliosis, or pronated feet, or FHP for that matter, are rarely important to their quality of life. But biomechanics, and therefore these pathomechanics, do matter. The presence of any structural condition— any asymmetry of hard or soft tissues—must, by definition, place physical stress forces into the body. The only question is whether they will accumulate to reach a threshold tipping point that impacts the person's life with pain and/or dysfunction. When a person presents with a small postural distortion pattern, I do not alarm them about all the horrible things that must inevitably befall them with the condition. I do not try to scare or convince them that they need long treatment programs because of the postural distortion pattern they have. Instead, I reassure them their condition is mild and need not impact their life. But . . . I do explain to them that if they do not take the healthful steps to improve their health, their condition might progress to the point that it will cause pain and/or dysfunction. Again, biomechanics do matter. They must matter. Structure must inevitably affect function, at least in most cases. Like dominoes falling, if a condition like FHP is allowed to progress, the person will most likely experience some type of pain or dysfunction. And when it finally surfaces, it will likely be much harder to treat, and the prognosis for improvement will be diminished. NEW STUDY My motivation for writing this article is the release of a 2019 research study 1 that examines the correlation between FHP and neck pain. I feel this study, and its interpretation, are the perfect example of what is so wonderful and at the same time so frustrating to me about evidence-based research and its place in the clinical world of manual and movement therapy. Advocates who believe there is no correlation between postural distortion and pain have used this study to advance their ideology. So, let's explore this study. A review of previously done studies (a metastudy) concluded that there is no correlation between the presence of FHP and neck pain. Hmm . . . this seems to back up the new negative ideology that there is no correlation between posture and pain. Isn't research wonderful? FHP with Dysfunction But No Pain I have posited that the counterbalancing extension force to prevent the head and neck from falling into flexion is created by isometric contraction of the cervicocranial extensor musculature in the back of the neck. However, that is not necessarily true. And I discovered this with an octogenarian patient who presented to me with the most pronounced FHP that I had ever seen, stemming largely from an incredibly hyperkyphotic thoracic spine (see Upper-Crossed Syndrome, page 58). I fully expected upon palpation examination to find that the muscles in the back of the neck would be extremely tight. But they weren't. In fact, they were extremely loose. And he had zero neck pain. Why? I found out during joint mobilization examination that my client's cervical spinal joints were effectively locked with no range of motion. I did not have the benefit of an X-ray or any other radiographic imaging to view, but I would venture to say that his body had probably taken the load off his neck musculature by having increased fibrosis of his posterior cervical fascial tissues, including the facet joint capsules, and perhaps osteoarthritic bony fusion throughout his cervical spine. With the adhesions and fusing of these "passive" tissues, his "active" musculature was relieved of all work and responsibility to maintain the otherwise imbalanced posture of his head. Certainly, this individual would be an example of a person with FHP (indeed, even severe FHP) who had no pain at all, but, with all ranges of motion lost, did have quite severe dysfunction.