This is the first post of a three-part article about the
implications of the head-forward posture. Part One (today’s post) discusses some
common pain syndromes to which it contributes. Part Two will discuss the
relationship of this imbalance to the shoulder girdle and will look at the sinew channel relationships. These two parts will be useful
for patients and those suffering from the painful conditions described below;
they will also be useful for acupuncturists who want to understand how improving
posture can improve treatment results.
Part Three will explore the relationship of this imbalance to the zangfu (primary organ systems discussed in TCM). This will be largely for the benefit of practitioners of acupuncture, tuina and other modalities used in Traditional Chinese Medicine.
The following are common complaints that involve a
head-forward posture:
Generalized neck pain and shoulder pain caused from muscle overuse: As stated above, for every inch the head moves
forward, it gains an additional 10 pounds of weight in terms of strain on the
posterior neck and upper back muscles. What this means is that the muscles of
the posterior cervical spine are working overtime, day in and day out, and for
a prolonged time. It is just a matter of time before they start to cry out for
some attention and that usually comes in the form of aches and pain. Specifically,
the upper trapezius, levator scapula, and splenius cervicis are frequent muscular
contributors to neck discomfort; they not only produce pain, but reduce range
of motion and can contribute to stiffness, including stiffness which makes it
difficult to turn the neck. Generally, restriction in the upper trapezius
manifests in reduced range of motion and discomfort towards the end of the range
of motion when looking in the opposite direction, while restriction in the
levator scapula often causes pain when looking to the same direction. However,
sometimes all three of these muscles can become spasmed, making it very
difficult to turn the neck in any direction without considerable pain.
And it is not just the muscles which are involved with neck pain from a head-forward posture. The strain in the posterior neck from the additional load signals fibroblasts to produce more extracellular matrix to support this area. Fibroblasts are specialized cells that produce the building blocks of fibrous connective tissue, such as collagen fibers and a sticky, syrupy substance called proteoglycans (a protein-carbohydrate based molecular structure). Prolonged strain (such as years of bracing against the extra weight of having the head forward) stimulates production of this extra material which can be easily felt as dense, ropy, fibrous bands in the upper back and neck region. It is the body’s attempt to add more support to a region that has additional demands placed on it. Local massage, acupuncture, or other treatments applied directly to the painful tissue may temporarily help make this dense, stagnant tissue feel better, but the posture as a whole needs to be addressed if there is to be any hope of long-lasting relief.
Cervical facet joint referral patterns. Image from: Osteoarthritis of the Spine: The Facet Joints, Gellhorn, A.C. et al Nature Reviews Rheumatology 9, April 2013 |
Splenius capitis (close to GB-20) and splenius cervicis (at extrapoint Bailao) TrP referral patterns. Image from Travell and Simons' Myofascial Pain and Dyfunction: A Trigger Point Manual. |
Nerve impingements
and entrapments: Since disc health is affected by head-forward posture, it
can play a role in spinal nerve impingement.
In addition, thoracic outlet syndrome (another type of entrapment of
neural structures) is often seen with a head-forward posture. Both of these can
radiate pain into the upper extremities and be causes of pain in the arms,
elbows, forearms or hands.
Thoracic outlet syndrome involves an entrapment of the
brachial plexus, which is the bundle of nerves that exit from the neck and
travel to the arms. The brachial plexus can be entrapped as it travels between
the anterior and middle scalene muscles (two anterior neck muscles which are
shortened in a forward-head posture), between the clavicle and ribcage, and
between the pectoralis minor muscle and the ribcage. The head-forward posture is
often a contributing factor to all of these, especially as the entire shoulder
girdle is involved (more on this in the next post).
Jaw tension: a head-forward
posture places the mandible (lower jaw bone) in a position which stresses and
tightens the muscles of the jaw. The position of the head places anterior neck
muscles such as the suprahyoids and infrahyoids in an overstretched position.
These muscles attach to the mandible and pull down on the lower jaw bone. The
muscles of mastication (chewing), such as the masseter, reflexively tighten to
hold the jaw close. They then develop trigger points which put pressure on the
temporomandibular joint (TMJ).
Shoulder and other problems: Part 2 of this post will discuss the relationship of the balance of the cervical spine to the shoulder girdle. Because these are so intimately tied to each other, shoulder dysfunction such as supraspinatus tendinopathy, bicipital tenosynovitis, infraspinatus and subscapularis myostrain, and other conditions are often made worse by the strain of a head-forward posture. As we explore the sinew channel relationship described in Chinese medicine, this neck-shoulder girdle relationship will become even more apparent.
For acupuncturists, it is worth reexamining the Urinary Bladder sinew channel and noting that it does bind to the occiput, and, therefore would include the suboccipital muscles. Looking for a head-forward posture and addressing shortened suboccipitals would be a worthwhile strategy, not only when treating local dysfunction, but with any strain pattern affecting the Urinary Bladder sinew channel. Addressing this pattern would help focus the selection of effective points to treat according to the principle of “selecting points above to treat below.”
Shoulder and other problems: Part 2 of this post will discuss the relationship of the balance of the cervical spine to the shoulder girdle. Because these are so intimately tied to each other, shoulder dysfunction such as supraspinatus tendinopathy, bicipital tenosynovitis, infraspinatus and subscapularis myostrain, and other conditions are often made worse by the strain of a head-forward posture. As we explore the sinew channel relationship described in Chinese medicine, this neck-shoulder girdle relationship will become even more apparent.
For acupuncturists, it is worth reexamining the Urinary Bladder sinew channel and noting that it does bind to the occiput, and, therefore would include the suboccipital muscles. Looking for a head-forward posture and addressing shortened suboccipitals would be a worthwhile strategy, not only when treating local dysfunction, but with any strain pattern affecting the Urinary Bladder sinew channel. Addressing this pattern would help focus the selection of effective points to treat according to the principle of “selecting points above to treat below.”
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