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By Ashley Pena, DPT Student

Although “forward head posture” (FHP) has long been regarded as a problem leading to pain and disability, with increased time spent on smartphones in recent years, it is becoming a very common source of pain. In a study performed by Kim et. al. which studied the effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults using EMG analysis, it was found that prolonged smartphone use resulted in increased upper trapezius and cervical erector spinae fatigue.

As a result of FHP, compensatory motions occur such as severe extension of the upper cervical spine. Often seen in conjunction with FHP, rounded shoulder posture (RSP) occurs when the acromion protrudes anterior to the shoulder joint. Scapular elevation, protraction, and downward rotation are also seen. Several studies have found that this combination of FHP and RSP promote an imbalance in muscle strength and length leading to Janda’s Upper Crossed Syndrome:

  • Weakness of the deep neck flexors, middle and lower trapezius, and serratus anterior
  • Stiffness of the pecs, upper trapezius, levator scapulae, SCM and suboccipitals.

Together, these impairments can lead to dysfunctions at the OA joint, C4/C5 segment,  CT junction, or GH joint resulting in neck and/or shoulder pain and increased disability.

❗️Forward Head Posture❗️leads to compensatory motions such as severe extension of the upper cervical spine. 👓👓👓 Often seen in conjunction with FHP, Rounded Shoulder Posture which includes; Scapular protraction, elevation & downward rotation. 📚📚📚 Several studies have found that this combination of FHP and RSP promote an imbalance in muscle strength and length leading to Janda’s Upper Crossed Syndrome: 🔘Weakness of the deep neck flexors, middle and lower trapezius, and serratus anterior. 🔘Stiffness of the pecs, upper trapezius, levator scapulae, SCM and suboccipitals. 🎥🎥🎥 This video focuses on decreasing the signal to the tightened muscles so that training of the weakened muscles can be more effective. 📹Tips📹 1️⃣Pec Stretch-Step forward and across your midline for an increased stretch, if you feel pain in the shoulder joint stop 🛑 2️⃣Upper Trap & Levator- Use something to pin down the scap, make sure your 🤚pull on the head is upward not 🚫down. 3️⃣T-Spine Mobilization- Use 2 Tennis 🎾s with your spine between the 🎾s. Perform 3 reps of shoulder elevation then move the 🎾s up a segment. Same goes for the foam roller. 4️⃣Suboccipital Mobility- place the 🎾s just below the scull💀 and tilt your chin to your chest. Perform reps or holds. @ashpena3r

A post shared by Chris Butler, MPT, CSCS (@cbutlersportspt) on

Stay tuned to @cbutlersportspt on Instagram for a forthcoming exercise series to combat this poor posture and it’s resulting impairments.

Blog Post written by Ashley Pena, DPT Student from Cal State Northridge. Ashley is currently in her final clinical rotation with me at Catz PTI.

References:

  1. Kim E-K, Kim JS. Correlation between rounded shoulder posture, neck disability indices, and degree of forward head posture. Journal of Physical Therapy Science. 2016;28(10):2929-2932. doi:10.1589/jpts.28.2929.
  2. Kim S-Y, Koo S-J. Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. Journal of Physical Therapy Science. 2016;28(6):1669-1672. doi:10.1589/jpts.28.1669.
  3. Kwon JW, Son SM, Lee NK. Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. Journal of Physical Therapy Science. 2015;27(6):1739-1742. doi:10.1589/jpts.27.1739.
  4. Upper Crossed Syndrome. Muscle Imbalance Syndromes RSS. http://www.muscleimbalancesyndromes.com/janda-syndromes/upper-crossed-syndrome/. Accessed June 13, 2017.