Cervical Headache: An Investigation of Natural Head Posture and Upper Cervical Flexor Muscle Performance
In this study, 60 female subjects, aged between 25 and 40 years, were divided into two equal groups on the basis of absence or presence of headache. A passive accessory intervertebral mobility (PAIVM) examination was performed to confirm an upper cervical articular cause of the subjects’ headache and a questionnaire was used to establish a profile of the headache population. Measurements of cranio-cervical posture and isometric strength and endurance of the upper cervical flexor muscles were compared between the two groups of subjects. The headache group was found to be significantly different from the non-headache group in respect to forward head posture (FHP) (t = -5.98, p < 0.00005), less isometric strength (t = 3.43, p < 0.001) and less endurance (t = 8.71, p < 0.0005) of the upper cervical flexors.
This study investigated the relationship between forward head posture and temporomandibular disorder symptoms. Thirty-three temporomandibular disorder patients with predominant complaints of masticatory muscle pain were compared with an age- and gender-matched control group. In other words, when evaluating the ear position with respect to the seventh cervical vertebra, the head was positioned more forward in the group with temporomandibular disorders than in the control group (P < .05).
Probably one of the most common postural distortions we see is the forward head, forward shoulders posture. This distortion often appears in teenagers and progresses to old age. Porterfield and DeRosa1 have provided some important information regarding this problem. They state1 that while lengthening or weakness of the scapular retractors is often blamed, a major cause is weakness and lengthening of the abdominal muscles, allowing the chest to descend and shifting the weight of the upper trunk anteriorly. This causes the chest to descend with the scapula shifting forward around the rib cage, pressing the clavicle to the first rib. In this position, the humerus internally rotates and the head and neck are brought forward.
The Associations Between Adolescent Head-on-neck Posture, Backpack Weight, and Anthropometric Features
The results support a differential postural response per gender and per level of spinal development but also suggest that the craniovertebral angle may not be the most sensitive measure of head-on-neck postural change for adolescents.
The forward head posture is an abnormality of posture routinely observed in subjects with a wide variety of musculoskeletal complaints. Both medical and chiropractic researchers have devised reliable methods to assess the posture and skeletal alignment of the spine and skull of patients with such abnormalities. Methods which have been shown to reduce the magnitude of the forward head posture are readily available to doctors of chiropractic. For those interested in these methods, we would suggest investigating both the McKenzie protocols of neck retraction exercise15 and extension traction protocols.
Our results show that forward head posture is the commonest defect found in variety of professionals. This leads to SSS, an early functional stage, and can lead to serious compression of cervical nerve roots. Education programmes on right posture, ergonomics, regular corrective exercises may prevent SSS.
A Study on the Prevalence of and Risk Factors for Neck Pain Among University Academic Staff in Hong Kong
Among those with neck pain during computer processing, 60.3% had a forward head posture. However, a low correlation between psychosocial factors and neck pain was demonstrated (r = 0.343). Academic staff in tertiary institutions could be considered as a high-risk group of job-related neck pain.
Studies in this report have shown the relevance of treating cervicogenic and other headaches with spinal manipulation. Further study is needed on the relationship of postural patterns, such as muscle imbalance, to headache symptoms and other ailments. This case study was an attempt to offer a rehabilitation exercise approach as an adjunct to spinal manipulation in the treatment of cervicogenic headache. Doctors Janda, Christiansen, Murphy, Liebensen, and Harrison have researched the use of corrective exercise to treat muscular imbalance. [5, 8-11, 14] This patient was relieved from chronic headaches through the combination of chiropractic adjustments, interferential therapy, trigger point massage, exercise, and alteration of activities of daily living. The care this patient received is an example of a low-tech rehabilitation treatment protocol. The example this case presents is intended to help the reader understand Janda’s  principle of upper crossed syndrome and to review literature related to muscular imbalance and cervicogenic headache.
Hyperkyphotic Posture Predicts Mortality in Older Community-dwelling Men and Women: A Prospective Study
To determine the association between hyperkyphotic posture and rate of mortality, the authors tracked 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit. Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates. This study found that persons with hyperkyphotic posture had a 1.44 greater rate of mortality.
Hyperkyphotic Posture and Poor Physical Functional Ability in Older Community-dwelling Men and Women: The Rancho Bernardo Study
Physical functional decline is often the determining factor that leads to loss of independence in older persons. Identifying risk factors for physical disability may lead to interventions that may prevent or delay the onset of functional decline. Our study objective was to determine the association between hyperkyphotic posture (Forward Head Posture) and physical functional limitations. In multiply adjusted comparisons, there was a graded stepwise increase in difficulty in bending, walking and climbing, measured grip strength, and ability to rise from a chair (with increased kyphosis of the spine).
Visual and vestibular input, as well as joint and soft tissue mechanoreceptors, are major players in the regulation of static upright posture. Each of these input sources detects and responds to specific types of postural stimulus and perturbations, and each region has specific pathways by which it communicates with other postural reflexes, as well as higher central nervous system structures. This review of the postural reflex structures and mechanisms adds to the growing body of posture rehabilitation literature relating specifically to chiropractic treatment.
Suboccipital active TrPs and FHP were associated with CTTH. CCTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs. The degree of FHP correlated positively with headache duration, headache frequency, and the presence of suboccipital active TrPs.
Whereas hyperkyphosis may often result from vertebral fractures, our study findings suggest that hyperkyphotic posture itself may be an important risk factor for future fractures, independent of low BMD or fracture history.
Myofascial Trigger Points, Neck Mobility, and Forward Head Posture in Episodic Tension-Type Headache
Active TrPs in the upper trapezius, sternocleidomastoid, and temporalis muscles were more common in ETTH subjects than in healthy controls, although TrP activity was not related to any clinical variable concerning the intensity and the temporal profile of headache. ETTH patients showed greater FHP and lesser neck mobility than healthy controls, although both disorders were not correlated with headache parameters.
The CV angle in subjects with neck pain is significantly smaller than that in normal subjects. There is moderate negative correlation between CV angle and neck disability. Patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability.
According to the results, chronic neck patients presented with a statistically significant decreased maximal voluntary ventilation (P = 0.042) and respiratory muscle strength (Pimax and Pemax), (P = 0.001 and P = 0.002, respectively). Furthermore, the current study demonstrated a strong association between an increased forward head posture and decreased respiratory muscle strength in neck patients. The connection of neck pain and respiratory function could be an important consideration in relation to patient assessment, rehabilitation and consumption of pharmacological agents.
Increased Forward Head Posture and Restricted Cervical Range of Motion in Patients with Carpal Tunnel Syndrome
Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion. However, a cause-and-effect relationship cannot be inferred from this study. Future research should investigate if FHP and restricted cervical range of motion is a consequence or a causative factor of CTS and related symptoms (eg, pain).
Recurrent Neck Pain and Headaches in Preadolescents Associated with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional Observational Study With 131 Students
Forty percent of the preadolescents in this study had recurring neck pain and/or headache which was initiated or exacerbated by prolonged static activities. Among those students with neck pain and/or headache, there was an even sex distribution in those clearly preadolescent and an increase in neck pain and/or headache prevalence as students transitioned into adolescence as well as a sex shift with female preponderance. There was a discrepancy between parental report and child self-report in regards to the occurrence of head trauma and the prevalence of neck pain and/or headache. One parameter, CJD, was found significantly more often among those preadolescents complaining of neck pain and/or headache as compared to those who were symptom free.
Patients with UVH had greater forward and lateral head deviations. Forward head deviation increased with age, duration of clinical symptoms and greater self-perception of the intensity of dizziness. Forward head deviation was also greater among patients who reported having had falls.
Significantly increased EMG activity in the upper trapezius and lower trapezius and significantly decreased EMG activity in the serratus anterior were found during loaded isometric shoulder flexion with FHP. Thus, FHP may contribute to work-related neck and shoulder pain during loaded shoulder flexion while sitting. These results suggest that maintaining NHP is advantageous in reducing sustained upper and lower trapezius activity and enhancing serratus anterior activity as compared with FHP during loaded shoulder flexion.
Adults with persistent asthma have musculoskeletal dysfunction and chronic pain that is independent of the severity of their disease but that might be related to their age at the onset of disease symptoms.
The Efficacy of Forward Head Correction on Nerve Root Function and Pain in Cervical Spondylotic Radiculopathy: A Randomized Trial
Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.
Backpack loads carried by schoolchildren should be limited to 10% body weight due to increased forward head positions and subjective complaints at 15% and 20% body weight loads.
The Effect of Adding Forward Head Posture Corrective Exercises in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Study
The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.