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!

Preventing Low Back Pain

How To Prevent Low Back Pain (4 Things To Consider)

Prevent Low Back Pain by Looking/Treating Elsewhere

Low back pain is one of the most costly health care conditions in the world.  It is my opinion that we, providers, have managed it poorly over the years.  We are in the middle of an opioid crisis and low back issues are one of the many reasons people seek relief.  There is no excuse for prescribing addictive medications for pain that can be helped and eliminated with conservative measures.  However, I believe even the conservative methods are less than optimal because not enough of us try to prevent low back pain.  Simply adjusting someones low back is not going to get the job done.  We need to evaluate the system as a whole. Click Here to read about the Functional Triage approach to evaluating pain and dysfunction.  In this blog post, I will outline 4 key things to consider when trying to prevent low back pain.

Joint by Joint Approach

The body alternates from mobile segments and stable segments

Low Back Pain and Core Function

Have you been banging out 500 sit ups a day for the past 25 years?  Can you do leg raises with 30-pound ankle weights plus a medicine ball in between your legs because of your super shredded “lower abs”?

What if I told you that a six pack does not equate to a strong core

It is super common for me to find that my patients with chronic lower back discomfort tend to over work their ANTERIOR core.  Needlessly crunching yourself into oblivion to sculpt that perfect 6 pack is counterproductive.  Here’s the thing, your core is actually a 3-dimensional container instead of a flat sheet of abs so the way we train it must be varied.

He Is The One (that is the most important core muscle)

The most crucial muscle for the core also happens to be the most crucial muscle with respiration, and we never use it!  I am speaking of the diaphragm of course.  Proper core stability should begin with an inhale to create intra-abdominal pressure.  In addition, the act of breathing should continue throughout the whole movement/exercise.  This may be a shocker to some since they can barely think let alone breathe during a rep in the gym.

Using the diaphragm to create intra abdominal pressure
Prague School of Rehabilitation
Stabilizing the core from the inside-out
Core Stability from the Inside-Out

You've Been Doing It All Wrong

An ideal scenario involves eccentrically activating ALL the quadrants of the core simultaneously rather than concentrically bracing the abs.  In other words, when you inhale with a tad bit of abdominal stiffness, the air/pressure in turn forces the abdominal wall to contract.  Think of it as “inside-out” core stability.  Many people find this concept abnormal.  Hell, the act of correctly breathing with their diaphragm feels abnormal.  However, we all learned it this way many, many years ago.  In fact, we can trace most of what we do movement wise back to when we were babies.  Creating proper intra-abdominal pressure is the foundation of Dynamic Neuromuscular Stabilization (DNS) and is absolutely crucial when trying to prevent low back pain.  Once the foundation is set, proper movement can be “re-trained” by revisiting the primitive positions that we spent our time in as cute little babies.  In this fashion, we are training the core to do what it is supposed to do, which is transfer load/power/force through the body.

Effective Core Exercises to Prevent Low Back Pain

Low Back Pain and Thoracic Spine Stiffness

The thoracic spine, I feel, is supremely underrated when it comes to many conditions and ailments and is usually needing some TLC when trying to prevent low back pain.  Even with a bulky rib cage attached to it, the thoracic spine should be fairly mobile especially compared to the lumbar spine.  With saying that, I need to point out that the lumbar spine is capable of plenty of movement.  However, its relationship to the core is that it helps create “Good Stiffness” in the mid-section with most physical activities.  Or in other words, we want the thoracic spine to move more during movement and the lumbar spine to move less.  Take the golf swing for example.  If you tend to wield your driver like Thor’s hammer, and in doing so, tend to “reverse spine angle” then you are at a much higher risk for low back pain.  On the flip side, if you rotate more through your hips/pelvis and T-spine you will allow the lumbar spine to do its job which is help the core transfer energy.

Thoracic Spine and Rib Cage

Thoracic spine and rib cage
Bulky but Pliable

Muscles of Rib Cage and Their Role in Respiration

Muscles of respiration and their role
Different muscles. Different roles.

Simply telling somebody to move more in the T-spine rather than the L-spine is easier said than done.  It just so happens that our society influences poor thoracic mobility due to the positions we are in most of the day.  When working with patients that need more thoracic spine mobility (most of them), we are using a combination of treatment to physically loosen up the joints and muscles and rehab/corrective exercise to teach the patient how to utilize this newfound motion.

T-Spine Mobility Drills

Try these exercises out to help mobilize the T-spine.

Low Back Pain and Hip Function

The hips, in my opinion, must be evaluated when attempting to prevent low back pain, even if there is no hip pain.  Unlike the thoracic spine where the issue is usually hypomobility, the hips can have a multitude of dysfunctions.  To make matters more complex, both hips in one individual may have different issues!  In a perfect world, the hips move freely throughout their range of motion with proper muscle activity.  Sadly, the world is not perfect.

 

Anterior Hip/Thigh Muscles

Muscles of the front of the hip
A lot going on in there

Posterior Hip/Thigh Muscles

Muscles of the back of the hip
More than just the glutes

Many Ways for the Hips to Fail

Let’s outline a few scenarios:

  1. Desk worker has “tight” hip flexors and “weak” glutes due to sitting all day. I put tight and weak in quotes for a reason (more on that in a sec)
  2. Dancer has trouble stabilizing on one leg and when doing so, you witness their knee collapse and their pelvis hike.
  3. Cross fitter gets a pinching type pain at the deep aspect of their squat.
  4. Soccer mom is super strong with glute bridging and other hip corrective exercises but they don’t seem to know how to utilize that strength with actual human movement.

The Big Picture

I just listed 4 scenarios for hip dysfunction and all of them are different but similar in that the hips are dysfunctional.  In addition, all four of them may also have low back pain.  It’s simply not enough to say, “oh your glutes are weak” or “my hip flexors are tight”.  The single most important thing that I can do for a patient is get them to FEEL proper hip function during actual activities.  In order to do that, there needs to be some critical thinking and evaluation involved.  I need to know the reason WHY you have reduced internal rotation (IR).  Reduced hip IR due to posterior hip tightness is in a different universe than reduced motion due to some type of impingement.  One can be taken care of with self-stretching and exercise while the other needs to be managed clinically.

Hip Mobility Routines

So what does this have to do with how to prevent pain in the low back?  Well, like the thoracic spine, if the hips are not doing their job the low back will do its best to pick up the slack.  Below are two hip circuits with different objectives.  One is to activate the hips (glute medius).  The other is to stretch and mobilize the hips.  I recommend those with pain in the low back to try these exercises.  Some people need strength AND mobility.  Others just need to loosen up!

Low Back Pain and Daily Activities

Factoring in one's daily activities is a must no matter what the condition is.  Knowing what you do on a daily basis should be the foundation for any treatment and rehab plan.  This concept ties everything mentioned above together.  Lets list two scenarios for low back pain:

  1. Desk worker that sits all day and has a chronic, achy, tight low back
  2. Carpenter that is up and down all day has frequent episodes of low back pain a year

Different Problems. Different Solutions.

Both individuals have totally different job requirements and different pain mechanisms.  They probably each have different goals for themselves as well.  Both patients get a thorough work up.  I might find that patient #1 has a stiff thoracic spine and shortened hip flexors.  My goal with treatment and rehab would be to "reverse his posture".  I would treat his back and hips but also build a daily regimen for him to work on while at work.  As long as I can get him moving in the right direction, things will go well.

Low back pain with activity

Patient #2 may be a different story.  It's the same song and dance with these guys.  They "throw" their back out 4 times a year leaving them handicapped for several weeks.  However, when I question them about it they call it "normal" and don't see any issues with that mindset.  I will have to dig a little deeper and figure out what is causing their back to flare up.  It may be a lack of hip hinging when bending down.  It may be a loading strategy (don't lift a 200 lb fridge by yourself doofus).  The point is, we have to think several steps ahead in order to prevent low back pain and injury from recurring.  Sure, treatment of the above issues is warranted but if we don't get a wrangle on the actual MECHANISM of pain then all we are doing is applying band aids to the problem.

Hip Hinge to Prevent Low Back Pain (sometimes)

Here is a simple video on how to teach yourself to properly hinge through your hips.  I'm not saying that you have to always bend over like this.  However, if you are going to pick up something up heavy I would recommend getting your hips involved.

 

Take Action

If you are a little confused by all of this then I have done my job.  The human population needs to have a better understanding for how their body works so that they can have a better grasp on how to handle whatever life throws at it.  The point is that those grueling lacrosse ball/foam roll sessions may not be helping you.  In fact, it could be hurting you.  Getting the same ole treatment over and over again is no better.  Alternatively, if you are used to banging out the same corrective exercise routine with no regard to how those clam shells apply to human function, then you are in REHAB PURGATORY.  It’s a pitiful place to be.  My challenge to you is to expect more from your body as well as those treating/coaching you.  Don't settle for chronic low back pain!  Learn how to not only manage discomfort, but how to prevent low back pain in the first place!

Contact Your Chesterfield Chiropractor

If you are in the St. Louis and Chesterfield area, we would love to help!  Call us or schedule online for a free consultation.  Can't make it to the office but like what I'm saying?  Reach out to us and I can help you find a provider in your area.


 

  • Anatomy pictures courtesy of Netter's Anatomy Flash Cards, 3rd Edition
  • Core pictures courtesy of the Prague School of Rehabilitation and Dynamic Neuromuscular Stabilization
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