Forward head posture: addressing the neck versus mid-back
Being part of a sitting culture makes forward head posture with associated neck pain is almost inevitable, given the amount of hours we spend in front of a computer, on transportation, or while watching TV. We look at two different approaches towards improving forward head posture and neck pain .
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.
Tech neck: hands-on treatment, supervised exercise, or exercise on your own?
Learn which treatment methods work best when dealing with neck pain. Our chosen study highlights the power of combined supervised therapeutic exercise and hands-on manual therapy.
As COVID-19 pushes more people to work from home, we’re seeing much more cases of neck pain due to incorrect ergonomic setup and associated postural faults. While research continues to support conservative treatment methods, much debate still lies in what game plan per se yields the most positive outcomes for this population.
The study:
A randomized controlled trial of 60 participants who reported neck pain and presented with “forward head posture rounded shoulders posture” sought the effects of hands-on manual therapy (MT), stability exercises (SE) and home exercise programs (HEP), over a six-week period.
Group 1: Received MT and performed SE (3 times a week, supervised)
Group 2: Performed SE (3 times a week, supervised)
Group 3: Performed HEP (control group)
Data would be collected pre-, post-, and 1-month after intervention.
The results:
Statistically significant changes (p<0.05) were noted for the following:
Group 1 had significantly improved pain levels post-intervention and even better reports at the 1-month follow-up.
Groups 1 and 2 demonstrated significantly improved Progressive Iso-inertial Lifting Evaluation (PILE) scores (aka capacity to lift heavy things) post-intervention compared to pre-intervention.
Groups 1 and 2 also demonstrated significantly improved “forward head posture rounded shoulders posture”, measured by favorable shoulder and head angles post-intervention, compared to pre-intervention.
Group 3 participants had no significant change in symptoms, function or postural alignment throughout the study.
What this means:
People with non-specific, generalized neck pain may benefit from a combination of hands-on manual therapy and a supervised stability exercise program, as the study shows it can improve pain levels, function and postural alignment. Another important observation is that Group 3, which only partook in an unsupervised home exercise program, showed no significant improvement in symptoms. In other words, exercise can be otherwise useless if not performed correctly.
See the vid below for examples of tech neck neutralizing exercises.
REFERENCES:
Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC Musculoskelet Disord. 2019;20(1):86. Published 2019 Feb 18. doi:10.1186/s12891-019-2438-y