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Researchers tell us that for every inch the head moves forward of the shoulders, weight is increased by 10 pounds. Therefore, a 12 pound head held 3 inches forward, forces the cervical extensors (semispinalis, splenii, longissimus, upper traps, etc.) to isometrically restrain 42 pounds against the unrelenting force of gravity. And we wonder why so many clients present with degenerative disc disease, head pain and TMJ.
Forward Head Postures such as the Upper Crossed Syndrome (Fig. 1) results from poor sleeping positions, driving stress, computer neck, whiplash, and improper breathing habits. Pain arises from muscle strain, disc herniations, arthritis, pinched nerves and overstretching of the spinal cord.
A major part of head, neck, jaw and shoulder pain is due to poor posture, tension, trauma, and central nervous system malregulation. These symptoms may manifest as fibromyalgia, myofascial tender points, TMJ, and chronic fatigue syndromes.
The following symptoms typically accompany this Upper Crossed strain pattern:
– Suboccipital pain syndromes
– Mouth breathing (sleep apnea)
– Difficulty swallowing
– Teeth clenching
– Face & neck pain
– Migraine headaches
The extra pressure imposed on the neck from the altered posture flattens the normal curve of the cervical spine resulting in abnormal strain of muscles, ligaments, fascia and bones (Fig 2).
According to the prestigious Spine Journal, 2006; 6:591-694,forward head carriage causes accelerated aging of intervertebral joints resulting in degenerative disc disease (cervical osteoarthritis) and osteoporosis (Fig.3).
The effects of poor posture extend far beyond just looking awkward. In fact, according to the January, 2008 issue of the American Journal of Pain Management, posture and function are related in that poor posture is evident in clients with chronic pain-related conditions including low back pain, neck related headaches, and stress-related illnesses.
Posture affects and modulates every function from breathing to hormonal production. Spinal pain, headache, mood, blood pressure, pulse and lung capacity are among the functions most easily influenced by poor posture. According to the Mayo Clinic Health Letter Vol. 18, #3, March 2000, the effects of long term forward neck posture lead to “myospasm, disc herniations, osteoporosis and pinched nerves.”
When spinal tissues are subjected to prolonged compression, they deform and undergo a remodeling that can become permanent. Correction of Upper Crossed neck posture is key to stopping and reversing decay, degenerative disc disease and pain from headaches, rib dysfunction, TMJ, and Dowager’s Humps… but it takes time and a concerted effort using modalities such as Myoskeletal Alignment (R) (Fig. 4) to repair the damage caused by faulty neck posture.
I have heard from many clients about the back pain, neck and shoulder they are having from the enormous amounts of snow that fell in Norther Arizona. It seems as if many folks still have a lot of work to do to clean up. Use caution. Give yourself plenty of time to do the jobs. Take breaks and drink plenty of water. Wishing you all the best. We’ll see you on the table.
The Foam Roll
The popularity of foam rollers is huge right now. Many people are simply using them for rolling the iliotibial band. I feel foam rollers can be used for so much more than IT Band – Self Myofascial Release (ITB SMR). This handy little tool can be purchased for around $20 in most towns or on line and requires no gym membership.
Lets look at techniques for the pectoral muscles. I recommend these movements for my clients with forward head posture, upper cross syndrome, shoulder, neck and arm pain, and as a preventative measure for all clients.
We will use two forms of ‘muscle energy techniques’ in these movement patterns:
Reciprocal Inhibition~Reciprocal Innervation (RI)
René Descartes (1596-1650) was one of the first to conceive a model of reciprocal innervation (in 1626) as the principle that provides for the control of agonist and antagonist muscles. Reciprocal innervation describes skeletal muscles as existing in antagonistic pairs, with contraction of one muscle producing forces opposite to those generated by contraction of the other. For example, in the human arm, the triceps acts to extend the lower arm outward while the biceps acts to flex the lower arm inward. In order to reach optimum efficiency, contraction of opposing muscles must be inhibited while muscles with the desired action are excited. This reciprocal innervation occurs so that the contraction of a muscle results in the simultaneous relaxation of its corresponding antagonist.
The significance of Descartes’ Law of Reciprocal Innervation has been additionally highlighted by recent research and applications of bioengineering concepts, such as optimal control and quantitative models of the motor impulses sent by the brain to control eye motion.
Post Isometric Relaxation (PIR)
Immediately after isometric contraction, the neuro-muscular apparatus becomes briefly refractory, or unable to respond to further excitation. Thus, stretching a muscle immediately following its isometric contraction may incrementally restore range of motion.
Pectoralis Minor
Action~
R.I. Reach back with left arm, activating posterior shoulder and back muscles. Keep hips forward, limit trunk rotation. Gently push end of roller with right hand while maintaining your left arm reach to provide length to left Pectoralis Minor. Hold 2 seconds, repeat 10 times or go for general improvement.
P.I.R. Using the angle depicted above, push with the right hand to first motion restriction, you should feel a slight stretch. Maintain pressure with the right ‘push’ hand at the beginning phase of the stretch. Gently, 20% effort, push back with the left hand against ‘stretch’. Hold for 6-8 seconds. repeat 3-5 times or again, go for general improvement.
C.R.A.C. If you really want to get fancy, try CRAC, Contract~Relax~Agonist~Contract, alternate between the two above procedures. First reach back with left, stretch by pushing with the right. 2 second hold, then push with the left hand against pressure. 6-8 second hold. Reach back again with left hand, 2 seconds and so on.
Pectoralis Major
By slightly changing the angle of the direction of force, you will manipulate a variety of tissue. For the clavicular head of pectoralis major, reach straight back, attempting to keep the foam roll flat. As you move through a variety of planes of movement, you will likely find where you most need extensibility. Use the techniques and theory listed above to achieve optimal movement.
In looking at the terms reciprocal inhibition, versus reciprocal innervation, we can think about the intimate relationship of opposing muscle groups and movement patterns. When there is a tight facilitated line in the body, there is likely a weak inhibited line as well. Upper and lower crossed syndrome, as coined by Vladamir Janda in the 1980’s, and popularised in the bodywork profession by Erik Dalton, PhD. today, is epidemic in a vast majority of our population. So what? If we stretch the tight line can that help make the weak line stronger?
Structure before function. Function before form. That’s what. Here’s an example of a condition I see in my clinic often. Young adult, middle aged or elder man or woman. Forward head posture and shoulders rolled forward. Pain at the base of neck, upper back and shoulder problems/difficulty reaching over head without mild to moderate pain.
The body simply can not continue to function, with out pain, if the structure is not ‘balanced’. Head on neck, neck on shoulders, shoulders over the ribs, low back balanced on pelvis, pelvis balanced on legs, and so on down to the feet….which is a book in it’s self. I digress.
Back to the shoulders. Earlier we talked about ‘forward head posture‘. Often times when we balance the body, head, neck, shoulders it will realign the way the arm, humerus, sits in the ‘shoulder’, glenoid fossa, allowing for external rotation, and quit clipping the tissue of the rotator cuff under the acromion.
More on that later…..if you are having neck, shoulder, and/or upper back pain give these movements a try, play around with your roller off the floor and be mindful of your posture. Until next time…Stay Tuned…
Filed under body mechanics, neck pain, pain management, shoulder pain
Erik Dalton’s Myoskeletal Alignment Techniques are partly based on the reflexogenic relationship between muscles and joints. By releasing ‘tight’ deep 4th layer muscles, Myoskeletal Therapists help open ‘stuck’, or ‘out’ joint spaces, reducing irritation in the articular receptors, chemo receptors, and nociceptors. Specific joint positions are reached and some type of activator, client movement, is used to release spasm, and the cycle of movement/pain reduction/movement begins.
Occipitoatlantal Alignment
The charts below demonstrate the pain patterns that are produced by cervical facet joint dysfunction.
For more in depth information of facet joint dysfunction, please visit
Forward head posture can have ill effect through out the body, from the upper cervicals, to the plantar fascia.
Here are a few simple movements you can use during the day to assist in pulling the head back.
Strengthen Deep Neck Flexors (Img. 1)
Drape a resistance band over the base of the skull, just above the ears. Find a comfortable place to hold each end of the band. The closer to the body you hold, the more resistance you will feel when preforming elbow extensions.
As seen in image 1 above, perform elbow extensions, slowly. Come slowly back to a start point, ending with elbows flexed. By completing this movement you must contract the deep head/neck flexors, longus capitus and longus coli, in order to keep the head from flopping forward. You may experience an ‘opening up’ of tissue at the cranial base, the occipitoatlantal joint, and a release of tight tissue in the back of the neck. Repeat a few times a day, start with sets of 5, then 8 and so on. Be sure to maintain proper breathing during this movement.
Deep Neck Flexors (Img.2)
Image 2 is the same movement cue without the resistance band, and is easier to do while driving to work, sitting at the computer, or on the dance floor. In the image I use my finger as a guide, not a force pushing on the chin. Simply glide the cranium posterior, keep the eyes looking forward. Many people will have a tendency to look up toward the sky a bit. The point is to open the posterior cervicals and strengthen the anterior, deep head/neck flexors.
These simple techniques can ease neck, shoulder & upper back pain and may help reduce the formation of Dowager’s Hump at the base of the neck/upper back.
Filed under body mechanics, Flagstaff pain relief, Forward Heads, pain management
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