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Forward Head Posture

This article was originally published in Positive Health PH Online April Issue 153 December 2008

Viewed with the naked eye, the neck of many vertebrates appears to have an oblique or horizontal orientation. A study from X-rays of the neck region of these animals revealed that this macroscopic observation is misleading: at rest, the general orientation of the neck was shown to be roughly vertical. Lizards and frogs are an exception as their cervical column at rest is held horizontally.

The anatomists who thought that a vertically orientated neck was unique to Man got it wrong. Ironically, in Man, the cervical column shows a rather forward inclination with the largest deviations from the vertical direction. In this regard, Man is closer to rats than to rabbits, guinea pigs and cats.

The human subjects chosen for the study were so-called healthy and normal persons. But average would be a better word than normal since, after a certain age, almost everybody is afflicted by misuse and misshape. It is my opinion that a vertically orientated cervical column represents the ideal in Man. Note that ‘vertical’ does not mean ‘straight’ inasmuch as the cervical column of vertebrates displays a dorsally concave curvature (cervical lordosis). Deep in cats and chickens, it is hardly visible in Man endowed with an ideal shape.

In selecting a vertically orientated cervical column in many vertebrates, evolution has provided them with mechanical advantages in relation to eye and head movement coordination, head posture, balance and stability. A correct head poise provided by a vertically orientated neck is an energy-saving mechanism where little or no muscle work is needed to hold the head. This is a job delegated mainly to ligamentous and capsular tissues, and muscular tone. On the other hand, if the neck were horizontally orientated, the neck muscles would have to be working constantly in order to counteract the effect of gravity. Consider that the head of an average adult weighs between 10 and 12 pounds. According to Rene Cailliet, a head weighing 10 pounds would ‘weigh’ 30 pounds when held 3 inches forward from the centre of gravity. Moreover, the concavity of the neck would be increased which in turn would compress the inter-vertebral discs. F.M. Alexander was right in stressing the importance of a well-poised head – a key factor in a correct use of the Self and the cornerstone of the technique he devised.

Yet, human beings are very prone to adopt a Forward Head Posture (FHP) thus emulating the lizard. This misuse of our head-neck-back relationship causes a departure from our ideal shape with resultant, discomfort, strain, pain, trauma and, ultimately, disability. For example, malocclusion and temporomandibular joint pain are pathologies caused by FHP.

The term Forward Head Posture sounds self-explanatory enough: a posture where the head is held away from the centre of gravity (plumb line) in a forward direction. But the mechanism is not as simple as it seems. To better understand it let me first describe the correct manner of lowering the head. It involves predominantly two articulations – one between the skull and first cervical vertebra and one between the last cervical and first thoracic vertebrae. Bending the head and neck forward and downward in that way preserves the natural curve of the neck.

This is not the case in the FHP where not only the head is protruded forward, as the term indicates, but the curve of the neck is increased and spread downward into the thoracic portion of the spine. To make matter worst, FHP is usually associated with an increased lumbar lordosis (lower back curvature) which also spreads upwards into the thoracic spine. The meeting point of these two forward curves constitutes what is called kyphosis (the posteriorly convex curve of our spine). The more our two lordoses increase, the more our dorsal kyphosis (round back) is apparent. But the latter has not changed, it is rather the hollow curves above and below it which have deepened and moved forward. When Rene Cailliet writes of “a forward head posture incurred from an increased dorsal spinal kyphosis…” I think, standing on the giant shoulders of F. Mezieres, that he is putting the cart before the horses. FHP is caused by an increase of muscular tone deepening the hollow in our neck and upper back and displacing it forward, primarily incurred by misuse of ourselves.

To remedy this mal-posture I use my two favorite indirect approaches: the Mezieres’ method and the Alexander technique. The direct (and rather disappointing) way of dealing with FHP is to stand against a wall, to slide the head back without tilting the head back and to coax the neck back. This movement is known as a translation motion. But, alas, due to our very unreliable sensory appreciation, it is all too easy to get lost in translation. It is best to enlist the help of someone well-versed in the grammar and vocabulary of the body.

P.P. Vidal, W. Graf, and A. Berthoz. The Orientation of the Cervical Vertebral Column in Unrestrained Awake Animals. Experimental. Brain Research. Springer-Verlag 1986
Rene Cailliet. Shoulder Pain. F.A. Davis Company. Philadelphia. 1991.
Rene Cailliet. Neck and Arm Pain. F.A. Davis Company. Philadelphia. 1991

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