Forward head posture: addressing the neck versus mid-back
Let’s face it. Work, transportation, and entertainment all require sitting. Our sitting culture is inevitable, and we can only remind ourselves to keep the body moving and changing positions. The so-called “forward head posture” that humans have adapted, especially with more technological advances that allow for less physical demand in the day-to-day life, is a big contributing factor towards neck and/or upper back pain.
The study:
Cho et al conducted a randomized controlled trial consisting of thirty-two participants with forward head posture (FHP), allocated into one of two groups:
Group 1: The cervical group: received cervical manual mobilization (C1-C2 flexion) with follow-up exercise
Group 2: The thoracic group: received thoracic manual mobilization (T1-T2 extension) with follow-up exercise
The treatment period was 4 weeks, with follow-up assessment at 4 and 6 weeks after the initial examination. Outcome measures included craniovertebral angle (CVA), cervical range of motion, numeric pain scale (NPRS), neck disability index (NDI), and global rating of change (GRC)
The results:
The thoracic group demonstrated significant improvement (p<0.05) in CVA, cervical extension, NPRS and NDI at 6-week follow-up when compared to the cervical group.
11/15 participants of thoracic group and 8/16 participants in cervical group showed a GRC score of +4 or higher at the 4-week follow-up.
Limitations of the study included a small sample size, limited long-term follow-up data and lack of specifics on manual therapy techniques used, including duration, frequency, type, etc.
What this means:
While both groups have demonstrated improved outcomes, the group that received upper thoracic extension treatment had better short-term outcomes in terms of CVA in the standing position, cervical extension range of motion, NPRS, NDI and GRC scores. Therefore, it’s important to address mid-back pre-positioning to minimize the amount of work required from the neck muscles that keep the head upright.
See below for examples of exercises to do between work breaks in front of a computer.
REFERENCES:
Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC Musculoskelet Disord. 2017 Dec 12;18(1):525. doi: 10.1186/s12891-017-1889-2. PMID: 29233164; PMCID: PMC5727966.