Forward Head Posture

[happyjoy]

Call me silly, but I did a casual, unscientific, visual survey over the weekend of the general public checking for visual cues for forward head posture. There are A LOT of people out there with this and the attendant symptoms (depending upon the degree of the condition). The incidence had to be about 90% across the board (age, race, and sex).Question: How many of your clients have forward head posture? Do you address it during your sessions (even marginally) regardless of the reason for their being there? Do you mention the assessment (without diagnosing)?

 

[WillieThompson]

Forward Head Posture

I have been using a new tool recently (for myself and my clients), called Dr. Riter's RealEase. I got it on Amazon for 30 bucks. When you lay on it for about 10 minutes, you can feel the benefits of the body's weight relaxing into the cervically correct positioning. The deep neck muscles & even the traps to a degree soften, and the chest is expanded very moderately. I have had clients with chronic neck issues, laying on this thing (and now buying their own) & really being able to 'discover' what it feels like to enjoy a more appropriate head/neck posture. Sometimes if a client is early & my room is ready (but not me, etc), I'll have them lay down supine while they wait for me to get my hotpacks ready, etc, using this thing. I have also used it after some preliminary neck work & then put them on the RealEase while I move from the feet on up toward the head/neck again. Its very gentle & I personally like how it makes me feel too!Gaspen, I know you didn't necessarily ask for solutions like this, but your observations struck a chord with me. Using this has helped me talk to the clients about the effects of this posture in a new way. And, yes, I have always coached them, etc.Jill/sagetherapist

 

[MzConception]

Forward Head Posture

By all, Jill, post away! Thanks for the product info - I'll for it and see if I can get one.

 

[Pompal 09.]

I have seen the RealEase multiple times and always wondered about it.  I might just have to try one out now!Unfortunatly, most office workers fall into this posture for too many hours of a day.  I advise them to take more frequent breaks, even if it is just to stand up, stretch, and look up at the ceiling.I ask them to remain conscience of their posture, but to make sure they don't over correct it.  One thing I learned in school (I believe from an Alexandar Technique teacher) was to stand straight in your usual posture.  Hunch forward (over-exaggerate) and then straighten back up but go past your normal straight posture (over-exaggerate shoulders back) and then find the posture that is straight, but in the middle range of these two exaggerated postures.  They said that is the posture you should concentrate on keeping.

 

[Lucylu]

We have an Alexander Technique teacher in our clinic and I recently exchanged sessions with her. I was surprised how much I learned in those 50 minutes! I will be referring some of my clients to her for a session or two. I often have to remind my TMJ clients that a fingertip to the chin and a little "push back" will go a long way with the forward head thing.BTW - I am a huge culprit of this myself. I drive only 10-15% of the time with my head on the head rest! That's always a big cue for me to sit back and enjoy the ride, not drive with my chin. LOL!  

 

[Live4love]

Forward Head Posture

Just wanted to add this RealEase link, as I was interested and thought others may be too!Dr. Riter’s Real-Ease Neck & Shoulder Relaxer http://egeneralmedical.com/docritsrealn.html

 

[Rissa C]

Forward Head Posture

Yep I've noticed the forward head posture a lot too... stress seems to have a lot to do with it. And yep I'm a culprit too, although 2 rear-end accidents have not helped. Thanks for the tip for the RealEase! When I'm not massaging I'm usually on the computer and get the neck/shoulder tightness.It would be great for clients too...

 

[sunnyD]

Forward Head Posture

I pretty much notice this all the time since school... I'm amazed at how I never saw it before. But, then, 90% makes it "normal".I sometimes feel so self-conscious about my own posture, and have to remind myself that very few people even "see" it. Unless I'm at a yoga studio ;-)Anyway, it's funny because I see ads with models in them and often the first thing I think is "tight back line, head forward".

 

[Link0710]

Don't feel like the lone ranger...  I do the same thing.  I watched tiger woods for an hour on the driving range, and I could have written an encyclopedia of his physical assesment, granted his posture is probably built for what he needs to do, anyhow, yeah  Ill be walkin through the mall or out with my friends, and Im like " wow!  thats some serious lordosis!"  Yeah call me silly as well!  ;D

 

[nefertiti_1018]

Forward Head Posture

I pretty much notice this all the time since school... I'm amazed at how I never saw it before. But, then, 90% makes it "normal".

I know this is an old thread (and perhaps I should not be posting in this forum at all), but I wanted to chime in momentarily with a quick perspective along these exact lines to pass along some modern medicine just coming down the pipes in the past few years. I hope people won't mind hearing what I have to say.

Technically, we all know having a perfect standing alignment is ideal. Yet, as mentioned in above posts, incidence of head forward posture, with a hiked shoulder position, and swayback pelvis or hyperlordosis is extraordinarily common. In addition, the percent of people with this posture, yet no significantly greater than average pathology, is even more remarkable.

In other words, to a degree, head forwards posture is normal and people with it CAN and DO live normal lives, maintaining such postures with tremendous stability from puberty to old age.

To clarify, I do not mean that the spine is meant to operate optimally with the curvatures such a posture leads to. What I do mean is that from modern research, it appears that in otherwise healthy and balanced individuals, such standing postures are more the result of foot structure than muscle balance. That is, for some people, a perfect muscle balance means standing in a head forward, hunched shoulder, swayback/lordosed posture.

The most likely factor leading to such physiology seems to be what is termed forefoot varus. This is a condition where when the ankle/hindfoot is in its straight vertical position, the forefoot is on an incline relative to the ground, such that the big toe is elevated by as much as 3 or 4 cm above the ground.

This picture demonstrates it in a bony sense quite well:
http://moon.ouhsc.edu/dthompso/namics/labs/fftvar.gif

As a result of this foot type (which cannot healthily be corrected with orthotics or even surgical approaches), the feet pronate when bearing weight. As they do so, the legs rotate internally, forcing the pelvis to tilt anteriorly to compensate. Such compensation cascades up the axial and appendicular skeleton. In an individual with forefoot varus, this pronation and its domino effects are what is fundamentally responsible for the posture he/she presents with.

In such cases of forefoot varus, the spine will be capable of relaxing into a proper balance while lying or even sitting following treatment, as described above. However, upon standing, it will immediately or shortly re-curve to accommodate the forefoot deficiency.

Individuals who attempt to counter this natural re-curving and 'force' their spine into compliance with the ideal curvatures (despite their flawed skeletal support) will be met with undue postural strain, leading to issues potentially including: headaches, TMJ, TOS, as well as joint malfunction at the knees, hips, and/or shoulders. As a result, it seems likely that any greater incidence of such dysfunctions among people with varus are more likely the result of their attempts to "stand up straight", following (outdated) postural dogma, than the actual head forward posture they adopt when relaxed.

In a body with varus but otherwise well balanced muscles, pathology should exist at no greater incidence than the general population at young ages. At higher ages, vertebral damage and fusion may occur more readily.

To summarize, convention might have a person believe that all individuals, for optimal health, should stand up perfectly straight. However, we do not come with all the same parts. The new truth is, for optimal health, we should stand in the posture that transmits our weight through our skeletal structure to the ground most efficiently and requires the least muscular input to be maintained. In the case of a patient with significant forefoot varus/pronation, this will be a head forward position.

Caveat: Head forward posture may ALSO be caused by the traditionally expected muscle imbalance involving: excess pec minor, levator scapula, suboccipital, sternocleidomastoid, scalene, and intercostal activity. Patients with such an etiology will be symptomatic in any number of ways, and can be distinguished from healthy varus patients by the tightness of these muscle groups and/or the absence of a significant weight-bearing forefoot pronation. Such patients may or may not remain in a head forward posture after treatment and muscle re-balancing, again depending on their foot type.

The next time a patient comes in with a significantly "abnormal" posture (hiked shoulders, head forward, etc.), if you really want to get into it, tell them to take off their shoes and have a look for pronation at their ankle. If it is present, when not weight bearing, rotate/lift their ankle outwards (supinate) until the ankle is perfectly straight. Observe as the forefoot inclines and the big toe comes upwards. You may be quite surprised to see how significant it can be.