Forward Head Posture (What Is It and Does It Matter?) | Chesterfield Chiropractor

The Posture of the Future

The irony of reading about computer posture while on your computer!

There is no doubt that technology has slowly consumed our everyday lives.  We spend hours everyday on our smart devices looking at the internet, checking social media, answering emails, etc.  Many of us also work jobs consisting of prolonged computer use.  These activities are thought to lead to issues such as neck pain and/or headaches.  Do the postures conveyed in "Text/Tech Neck" really cause long term problems or are we overreacting?

In my opinion, the answer is a little bit of both.  To use sitting as an example:

Sitting at a computer is not BAD.  Heck, sitting in general is not BAD.  The hysteria on social media that "sitting is the new smoking" creates a perception that any and all sitting is not ideal.  This is a little misleading, obviously.  Really, any activity that we do repetitively and for long duration can POTENTIALLY lead to issues.  What may cause an issue in one person may not affect another.

With that being said, let's highlight one of the common postural traits that are associated with technology usage, the forward head posture.

What Causes A Forward Head Posture?

Forward head posture, or anterior head carriage, is a term that describes when the head sits too far forward on the shoulders.  It is incredibly common and I would wager that every single one of us has it to a certain extent.  Is it something to worry about?  Well, it depends.  As stated above, any one posture is not inherently bad.  However, prolonged and repetitive postures can be.  This postural tendency seems to be common in those with chronic neck pain and headaches.  In fact, we find that postural dysfunctions can be one of the 3 biggest contributors to tension headaches.  

One thing to keep in mind is that many people have a forward head posture and have no symptoms.  In fact, many studies have concluded that there is no correlation with posture and pain.  I certainly look at the mechanical factors of posture but I tend to draw conclusions on the overall big picture.

An Issue of "Stacking"

The image shows Justin Bieber's forward head posture.

An evaluation of head posture involves assessing the position, curvature, and adaptations of the muscles and joints.  In theory, the further that the head translates forward, the more compensation is needed within these joints and muscles.  When you factor in the weight of the head, and gravity, the natural position of our face would be in a downward direction (when the head is pulled forward).  So in order to adapt, we crank the upper cervical vertebrae into extension.  This creates a secondary "rounding" or flexion of the lower part of the neck/upper back.  

Essentially, the upper part of the neck is "compressed" while the lower part is "hunched".  It is for this reason why the majority of cervical disc problems and degeneration occur at the levels C5/C6/C7.  So when you consider the potential long term changes, prevalence of forward head positions and the distribution of forces, it seems wise to have a strategy to reverse these positions from time to time.

It's All About the Chin Tuck

I will often have a patient demonstrate how they would go about reversing their postural position.  At first attempt, they will often just pull their head straight backwards (retraction).  This causes a "jamming" effect at the mid to lower part of the neck.  It is often uncomfortable and can exacerbate any symptomatic discs or joints.  We need to incorporate more flexion, or better stated, chin tuck.  

The images below demonstrate some common computer postures (image one and two) and a correction strategy using the chin tuck (third image).

Demonstrates a typical computer head posture where the head moves forward with compensation in the neck.

My natural computer posture.  My head sits forward as do my shoulders (red arrows). The dotted lines indicate face position relative to parallel.  Nothing wrong with this position.  However, prolonged and repetitive sitting like this MAY result in unfavorable adaptations.

Common head posture adaptation where the head moves backwards but the lack of chin tuck creates compression in the neck.

Here we see an attempt to sit up straighter with the head translated backwards (blue arrows). This is often what patients do to "correct" their posture. Due to a lack of chin tuck, there is compression in the upper part of the neck (red arrows).

Ideal sitting posture with the torso upright and the head in neutral

This is an ideal scenario where the head is stacked, the chin is tucked, and the face is parallel (blue arrows). I try to assume this position with prolonged computer use or driving.  When I don't, I often have neck issues.  Again, not everyone will have these issues so every case is different.

Exercises for Forward Head Posture

Shows the deep neck flexor muscles.

The deep neck flexors (pictured) are the unsung heroes of trying to initiate the chin tuck.  Unfortunately, they are often underutilized when compared to the larger, more superficial muscles in the front of the neck.  In addition, there is compensatory muscle tightening/shortening in the muscles in the back of the neck.  To put it simply; some muscles work too much while other muscles don't work enough.  I'm sure every workplace has this problem with employees!  The overworked muscles eventually start to cause problems.  It is important to minimize the activity of these muscles when engaging the deep neck flexors.  This is possible by pulling the head back while engaging the chin tuck.

Check out the video below on some of our favorite neck exercises:

In addition, to strengthening the muscles in the neck, it helps to incorporate some range of motion exercises to help with joint tightness.  Remember, a forward head posture often involves increased extension (compression) of the upper vertebrae of the neck as well as increased flexion (rounding) of the lower vertebrae.  Motion is Lotion when it comes to joint function so give these exercises a try:

How Do We Help Forward Head Posture?

We certainly pay attention to head posture.  Especially when neck pain, shoulder pain, and headaches are involved.  However, it is just one component of a thorough assessment.  We never draw specific conclusions to posture and pain but recognize that certain postures MAY lead to adaptations within the muscles and joints.  

We implement joint mobility techniques, like adjustments, to the joint structures that are most restricted.  Myofascial therapy is used for the overactive and "tighter" muscles.  Implementation of a rehab/exercise program is vital to help improve function by addressing muscular weakness, movement impairments, and breathing to name a few.  The purpose of this article is to recognize the biomechanical factors of forward head posture, but also to stress that it does not necessarily mean anything and may not be clinically significant.  If you are struggling with conditions such as neck pain and headaches, and think your posture may be related, give us a call (636-728-8607) to set up a FREE consultation!

tension headache

Top 3 Causes of Tension Headaches

The Headache Dilemma

Just about everybody has experienced a headache of some sort in their lifetime.  Maybe you get them after a long night of drinking.  Or, they pop up during stressful times at work.  Whatever the scenario, headaches are a common problem in our society.  According to WebMD, 80% of Americans suffer from tension headaches from time to time and women are twice as likely to have them.  3% of the population suffers from daily, chronic tension headaches (a number that I believe is under reported).  The key term here is “tension”.  Tension headaches are typically labeled as “cervicogenic”, meaning they generate from the cervical spine.  However, there are many more sinister reasons for pain around the head.  For the sake of this write up, we are excluding things such as head trauma, vascular issues, and migraines.

What Triggers Tension Headaches?

As mentioned above, I believe the reporting of chronic tension headaches is vastly understated.  Basically, people tend to accept them as “normal” and are unaware of their effects.  That is, until they feel relief for the first time!  Based on my training and clinical experience, I have come to find that there are three main triggers for the classic tension based headache.  They consist of upper cross posture, poor breathing patterns, and TMJ/jaw dysfunction.

Posture and Headaches

Poor posture
Janda's Postural Syndromes

The obvious one is poor posture.  Specifically, upper cross posture.  Click here to read about the effects of technology on our posture.  It’s not that poor posture directly causes headaches.  It’s the adaptations of the muscles and joints as a result of prolonged and repetitive poor positioning.  For example, a forward positioned head often leads to excessive rounding, or hyperkyphosis, of the upper back.  This adaptation often results in subsequent muscle tightening as well as locking up of vertebral joint segments.  There is a high likelihood that when I evaluate a patient that works at a computer for a living that I will find trigger points and muscle tightness in various muscles of the upper thoracic spine and cervical spine.

In addition, their upper thoracic and lower cervical joints move like a brick compared to the segments above and below.  For these patients, treatment is centered towards these dysfunctions.  In addition, some sort of rehab program is implemented to offset the over usage of these muscles and joints.  One rule of thumb is that if there is a muscle that is being overworked, there tends to be a muscle, or muscles, that aren’t doing enough hence the implementation of strengthening.

Below are some diagrams by Dr's Travell and Simons outlining the common trigger points in the head and neck as well as their referral patterns.

Pain patterns and trigger points
Travell and Simons Trigger Points of the Head and Neck

An Exercise in Futility?

Individualized treatment and rehab is crucial to success.  However, an attempt to correct work stations and postural habits may be the most important factor.  Simply getting treated or doing a handful of exercises will not overturn years of bad habits. A diligent effort must be made to break these habits which usually involves constant reminder of postures throughout the day.  Typically, the more I show you how much you really struggle, the more likely to facilitate a change.

Posture Reminder
Sit Up Straight!

We recommend that you use some kind of reminder system to keep you in check throughout the day.  This can include stickers to place on things you look at the most, i.e. computer, rear view mirror, or phone.  Or, setting alarms on your cell phone will do the trick.  The point of constantly reminding you is to create awareness.  The more awareness, the more actions can be taken to create better postural habits.

Breathing and Headaches

The second component related to tension based headaches is poor breathing mechanics.  When most people think of the respiratory system, they picture the lungs.  However, we must understand the contribution of certain muscles in assisting the process of getting air in and out of the lungs.  I group the muscles into two categories, primary and accessory.  The primary muscle of respiration is called the diaphragm.  The accessory muscles consist of muscles in the neck (SCM and scalenes), ribs (obliques and intercostals), as well as muscles that affect the spine and scapula (levator scapulae, erectors, upper trapezius, etc).  The accessory muscles are meant to kick in during times that require more assistance such as during exercise.  While at rest, we should primarily use our diaphragm to breathe.  Instead, I find that most people rely on the accessory muscles all of the time.  A concerted effort should be made to remedy this dysfunction.  A quick drill for you to evaluate your breathing is to place one hand on your chest and another on your belly.  As you breathe, your bottom hand should push outwards with minimal movement of the top hand.  You can also place both hands around your neck to feel whether or not the neck muscles are contracting when you breathe.

Diaphragm breathing
"Belly Breathing"
Diaphragm breathing
Accessory muscles of breathing
Accessory Muscles
Neck muscle tension with breathing
Too much tension in accessory muscles

When evaluating one’s ability to use the diaphragm, we typically get one of two types of patients.  The first patient has little issue with breathing correctly; they just need to make it more of a habit.  The second patient, on the other hand, cannot grasp the concept.  These patients tend to need some TLC to help get them going in the right direction AND THEN they need to make it a habit.   I have seen so much success with simply pointing out that proper breathing is in fact a real thing.  A drastic change is seen when a concerted effort is made to decrease the activity of the accessory muscles.  Once diaphragm activity is normalized, an effort can then be made to teach proper core activation which we will discuss at a later time.

Jaw Tension and Headaches

The third reason for tension headaches may be the most prevalent of them all.  Temporomandibular dysfunction, or TMD for short, involves excessive jaw clenching, grinding, and tensing.  One thing that needs to be pointed out is that TMD is different than TMJ.  TMJ refers to the temporomandibular joint.  Humans have two of these joints.  TMD is simply the dysfunction of that joint.  If I had a dollar for every time that a patient stated that they have "TMJ" I would be, well you know!  Anyways, those that grind their teeth at night most likely are aware of it.  Whether a dentist told them, or their significant other has complained about it, it is not news to them.

Lockjaw and headaches

What these people don’t realize is that they most likely hold excessive tension in and around their jaw throughout the day as well.  The real kicker is that people can have TMD without having any issues with grinding their jaw.  They simply hold tension in their jaw like most people hold tension in their traps and neck.  Long standing TMD can result in tension headaches, TMJ degeneration and disc issues, and varying degrees of "lockjaw".  Lockjaw occurs when the muscles of the jaw become spastic, or the disc located within the TMJ becomes "stuck".  Symptoms can involve an inability to open or close the jaw fully.

Trigger points of the head and jaw.
Travell and Simons Trigger Points of the Head and Jaw

When I began to dive into assessing and treating the jaw, I found that TMD often coincides with poor breathing.  Some studies have correlated a relationship of jaw clenching and poor breathing with anxiety and stress.  So the next time your kids are giving you a fit, take a moment to see if your jaw is tightening up and how you are breathing (if you are at all).  Treatment of the jaw and head region, as well a home stretching program, can yield results so enormous that the patient is usually dumbfounded.  Like breathing, correcting the overarching habit is crucial for sustained benefits.

 

Any questions or comments?  Reach out to us via Facebook, Instagram, or our website.  Want to know if we can help your headache issues?  Call and schedule a free consultation to discuss your case and how we can help! (636) 728-8607.

Text Neck

Text Neck – Fad or For Real?

Text neck, or tech neck, is a term that seems to be commonly tossed around nowadays.  So what exactly does it mean?  Put simply, it refers to the poor postures and positions that we put ourselves in when using our electronic devices.  I don’t think anybody will argue with the increasing trend of technology in our society.  However, I find that many people are in denial on whether or not they are guilty of the accusation of text neck and poor posture.


 

An Evolving Trend

As society continues to rely of technology, and technology continues to be at our finger tips, I believe that the ramifications of text neck and poor posture will increase.  Just look around!  Human beings, once thought of as social animals, sit in groups amongst each other staring at their digitized screens in silence.  To make matters worse, text neck and poor posture is not limited to cell phone use.   Computers, tablets, and even driving a car are all perpetuators of poor posture.  The uses of these devices seem to have one thing in common, flexed postures.  Flexed posture involves excessive forward head positioning, slouched shoulders, and a rounded spine (especially the upper back).  These characteristics typically result in a common term in the rehab and fitness world, upper cross syndrome.  The reason this posture is such a problem is not because it looks unappealing, but because of the ramifications it has on the musculoskeletal system.  Our body was designed for a specific reason, movement.  Continued slouching, regardless of cell phone use, ultimately causes restrictions in our spine and adaptive changes within our muscles.   We often find that certain muscles become “tight” or “short” while others become “weak” or “long”.  This is obviously an over simplification but the basic principles are fairly consistent when evaluating people who work jobs based around technology.  Not to mention, these postural characteristics seem to be more prevalent in our younger populations.  All in all, prolonged poor posture when using technology has contributed to us becoming an imbalanced mess resulting in neck pain, low back pain, and headaches.

 

Text Neck

Control by Pawel Kuczynski


 

Good

Good Texting Form

Bad

Bad Texting Posture

So what can you do?

Well, the first step is admitting you have a problem.  Frankly, the majority of us do.  It is the product of our society, and as stated earlier, it’s only getting worse.  Have you seen a teenager not looking at a cell phone lately?  Neither have I.  Without proper efforts to address posture in all ages, we may all look drastically different in our old age.

At Elite Chiropractic and Performance, we will assess you in a comprehensive manner which includes discussing your lifestyle and habits and possibly calling you out on your posture!  Treatment consists of joint manipulation/mobilization and various soft tissue techniques to help remedy the effects of text neck and poor posture.  Functional rehabilitation is implemented to further help balance the body out.  We will design a personalized home exercise program for you to employ while at work or at the gym to help you maintain positive results.  The ultimate goal is to optimize the individual so that they can move well and move often.  So correct your kids, correct yourselves, and most importantly, get checked out!  In the long run, your body will thank you.  It’s the only one you have!

 

---M. Chris Collier, DC