Friday, November 18, 2016

Correcting the Forward Head Fault

As I'm sure you've heard millions of times before, modern technology isn't doing our bodies any favors. Spending hours a day texting or hunching over a laptop is physically morphing out bodies. We're altering our fascia, compressing our spines, and stretching our muscles in ways that contradict our biology. Our traps are tight, and we're riddled with back pain.

Does your posture resemble that of the guy on the right or on the left?
The farther forward your head gravitates, the more weight your cervical spine (neck) has to support: in a "neutral position," the neck only bears about 12 pounds of load, but if your head juts forward only 2 inches in front of your center of mass, your spine now has to support ~32 pounds of load. When the spine has to work harder, so too, do the muscles that buttress (haha) the neck. If you've ever experienced neck pain, then I would wager that your posture needs improvement.

The "ideal" posture involves the joints to be centered from the top of the head, all of the way down to the lateral malleolus of the ankles. Notice how neither the rib cage nor the chin shift too far in front of the pelvis–these are both common compensatory patterns.

Ultimately, when it comes to addressing this dysfunction, I have a three-pronged approach:
  1. Correct postural awareness. Cueing and awareness can go a long way. Forward head posture goes hand-in-hand with rounding of the upper back (kyphosis). Once you show a client where their center of mass is, they have a better understanding of proper alignment, and they're better able to recreate that position on their own.
  2. Instil proper breathing mechanics. Chest breathing with an incomplete exhale will only aggravate any postural deviations. Full breaths initiating at the diaphragm with minimal chest expansion will promote optimal bodily function and positioning. Your breath influences every other muscular sequence in your body, and should be the priority of any corrective exercise program.
  3. Strengthen the core and the neck flexors. The neck is an extension of the core, and, as such, if you display forward head posture, then we need to look there for answers. Similarly, I often find the neck flexors (sternocleidomastoids) to be weak or lack muscular endurance in these individuals.
Try this test: lay on your back, and pick up your head about 2-3 inches off of the ground. Hold your head up for 30 seconds. If you feel tightness in your neck, or your muscles start to twitch within that time, you need to build up the muscular endurance of your neck flexors. If you failed that test, then you definitely need some work.

Here's a good place to start:
  1. Neck flexion
  2. Cobra pose
  3. Neck retraction against the wall
  4. Neck nods
  5. Bench neck bridge* (Note: This exercise should be used with caution, as there is the potential to strain your neck extensors. Start with holds of only 5-10 seconds for two sets. Gradually increase the lime you hold this movement.)
I would recommend performing two of these exercises at least two or three times per week. When it comes to improving posture, you have to be consistent and deliberate with your corrective exercises. If you stay on top of your drills, but continue to slouch at your desk, then there's little value to your postural training.

Another thing I've noticed is that the neck is often one of the first places people look to for help. Let's say they're struggling on their last pull-up. What do we see? The neck cranks into hyperextension to inch the chin over the bar. If you're grinding out that final biceps curl, you again see the neck shift forward to the rescue. These patterns are important to be mindful of during your training sessions. Don't use the neck to cheat your reps!

Once you treat your neck alignment, you'll notice that the rest of your spine will assume a better position, and you may even notice fewer incidences of back/neck pain and headaches.

Performing these exercises regularly, along with practicing proper sitting and standing positions will have a lasting impact on how you carry yourself. 

Works Cited:

  1. Falla, D., G. Jull, T. Russell, B. Vicenzino, and P. Hodges. "Effect of Neck Exercise on Sitting Posture in Patients With Chronic Neck Pain." Physical Therapy 87.4 (2007): 408-17. Web.
  2. Watson, Dean H., and Patricia H. Trott. "Cervical Headache: An Investigation of Natural Head Posture and Upper Cervical Flexor Muscle Performance." Cephalalgia 13.4 (1993): 272-84. Web.
  3. Zito, G., G. Jull, and I. Story. "Clinical Tests of Musculoskeletal Dysfunction in the Diagnosis of Cervicogenic Headache." Manual Therapy 11.2 (2006): 118-29. Web.