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Forward Head Posture and Upper Cross Syndrome In Teenagers

Brittany Beltram

February 15, 2018

Comprehensive Global

Dubai, U.A.E

2017-18

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Abstract

Overview of F.H.P and Upper cross syndrome

Condition, statistics, research

Forward Head Posture is when the head is in a position that is anterior of its neutral.

This can be due to sitting, posture, injury or bad habits. Upper Cross Syndrome is

characterized by an internal rotation of the shoulders and a roundness in the upper

back. Today’s generation is tech driven with regard to education and entertainment.

Children and teens are leading a more sedentary life whether is familial environmental

factors or social obligations and expectations. Teens are experiencing fixation of fascia

and additional tightness in their musculature because of factors outside of normal

growth stages. It is primarily due to less activity and movement. Schools are often

cutting recess short in an effort to reduce playground bullying while not providing

more opportunities for movement inside the classroom. Teenagers are participating in

less organized sports while online gaming participation is skyrocketing. These trends

are only exacerbating the postural imbalances of the 21st century teen.

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Table of contents

Overview

Anatomical description and detail of Forward head Posture and Upper Cross

Syndrome

Case Study

Comprehensive Program Using BASI Block system

Conclusion

Bibliography

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Anatomical description and detail of Forward head Posture and Upper Cross Syndrome

Forward head posture (FHP) is most often described as excessive anterior

positioning of the head in relation to a vertical reference line, involving increased

cervical spine lordosis (head forward, middle cervical spine extended, lower cervical

spine flexed) and rounded shoulders with thoracic kyphosis. Forward Head posture is a

muscle imbalance that is comprised of long, weakened deep cervical flexors and

extensors, trapezius muscles and rhomboids. It also means that the sub occipital

muscles are shortened, along with an imbalance in the sternocleidomastoid and

scalenes.

As a compensatory action for the postural deformity of FHP, severe extension

arises between the upper cervical joint and atlanto-occipital joint, and the upper

cervical vertebrae relatively protrude forward while the face directs upwards. Change in

the curvature of the neck bone causes upper-crossed syndrome due to an imbalance in

muscular pattern, which subsequently leads to rounded shoulder posture (RSP).

Rounded shoulder is a protrusion of the acromion of the shoulder joint relative to the

centerline of gravity of the body, causing stooped posture along with elevation,

protraction, and downward rotation of the scapula, and an increased angle between the

lower neck bone and upper spine. (www.ncbi.nlm.nih.gov/pmc/articles/PMC5088155/)

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The atlanto-occipital joint (articulation between the atlas and the occipital bone) it

consists of a pair of condyloid joints. The atlanto-occipital joint is a synovial joint. The

movements permitted in this joint are:

• (a) flexion and extension around the mediolateral axis, which give rise to the

ordinary forward and backward nodding of the head.

• (b) slight lateral motion, lateroflexion, to one or other side around the

anteroposterior axis.

Flexion is produced mainly by the action of the longi capitis and recti capitis anteriores;

extension by the recti capitis posteriores major and minor, the obliquus capitis superior,

the semispinalis capitis, splenius capitis, sternocleidomastoideus, and upper fibers of

the trapezius. en.wikipedia.org/wiki/Atlanto-occipital_joint. A deviation from the natural

Cervical curve occurs with the repetitive motion of looking down. This happens at the

apex of C4/C5. The brain wants the eyes to be level and not looking down so

hyperextension occurs in an effort to bring the gaze forward.

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www.spineuniverse.com/conditions/kyphosis/kyphosis-description-diagnosis

Upper-Crossed Syndrome (UCS) is also referred to as proximal or shoulder girdle

crossed syndrome. In UCS, tightness of the upper trapezius and levator scapula on the

dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the

deep cervical flexors ventrally crosses with weakness of the middle and lower trapezius.

This pattern of imbalance creates joint dysfunction, particularly at the atlanto-occipital

joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment.

Janda noted that these focal areas of stress within the spine correspond to transitional

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zones in which neighboring vertebrae change in morphology. Specific postural changes

are seen in UCS, including forward head posture, increased cervical lordosis and

thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and

winging of the scapulae. These postural changes decrease glenohumeral stability as the

glenoid fossa becomes more vertical due to serratus anterior weakness leading to

abduction, rotation, and winging of the scapulae. This loss of stability requires the

levator scapula and upper trapezius to increase activation to maintain glenohumeral

centration (Janda 1988) (www.muscleimbalancesyndromes.com/janda-

syndromes/upper-crossed-syndrome/).

Upper Cross posture creates an excessive arch in the neck from tight sub occipital

muscles. Shoulder blades spread and rolling inward as thumbs point to the hips rather

than forward. As the head moves forward it has less ability to rotate. For each inch

forward it doubles the weight and applies additional force to the cervical thoracic

junction.

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Case Study

Rémi is a 17 year old homeschool student and musician. At the age of 10, he was

diagnosed with Complex Partial Seizures. Due to a rigorous schooling program, he

spends six to eight hours at a desk. He stands at 5’11 and has long legs and torso. His

size has him often slouching at his desk while working on tasks. He is also a musician

and plays guitar, drums and bass. All of these musical disciplines favor an Upper Cross

Syndrome Posture. While playing guitar he is continuously, intermittently looking down

at the fret board. As a result of the Forward Head Posture he has become an open

mouth breather at night, while he is sleeping. It is known that when you stop nose

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breathing and your mouth is open, you suffer from deficiencies in O2 (oxygen), CO2

(carbon dioxide), and NO (nitric oxide) in body cells due to hyperventilation. This can

lead to over excited nerve cells and sleep deprivation. Rémi’s main trigger for seizures

is sleep deprivation.

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Comprehensive Program Using the BASI Block System

Initial Assessment -

When viewing client in the saggital plane the deviations along the plumbline are

prominent in the cervical spine. The ear is forward of the plumbline and

the shoulders are rolled forward, creating mild thoracic kyphosis.

Warm Up-

Will initially begin with Fundamental Warm Up Series and progress to

Comprehensive Warm Up on Cadillac.

Fundamental Warm Up- Mat *begin with Roll Downs

Pelvic Tilt, Pelvic Curl, Chest Lift, Chest Lift with Rotation, Supine Spine Twist.

Warm Up progression-Cadillac

Pelvic Tilt, Roll Up with Roll Up Bar, Mini Roll Ups, Mini Roll Up Oblique, Roll Up

Top Loaded

Foot Work- Wunda Chair

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Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf

Raises, Single Leg Heel, Single Leg Toes. (hand positioning provides

opportunity to stretch Pectoralis muscles)

Ab Work- Step Barrel

Chest Lift, Reach, with progression to Overhead Stretch, Teaser

Prep

*options for- Standing Pike and Reverse Pike on Wunda or Tilt and Teaser Prep

on reformer as client progresses.

Hip Work- Cadillac

Supine Leg Series: Frog, Circles Down Up, Walking, Bicycle

Spinal Articulation- (after 10 sessions)

Cadillac: Monkey, Tower Prep, Wunda Chair: Pelvic Curl

Stretches- Initial sessions will utilize stretch series in an effort to increase RoM

options:

Pole Series: Shoulder Stretch, Overhead Stretch, Side Stretch, Spine Twist

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Ladder Barrel- Shoulder Stretch 1, Glute, Adductor or Shoulder Stretch 2,

Hamstrings, Hip Flexors

option to progress to- Wunda Chair: Side Stretch, Reformer:

Standing Lunge

Full Body Integration- Reformer

Scooter Up Stretch 1, Elephant

* option to progress to include- Down Stretch

Arm Work- Initial work well focus on RoM and rehabilitative weight

progressions

Initial sessions-

Magic Circle: Arms Bent, Straight, Overhead, Single Arm Side Press

or

Cadillac: Shoulder Adduction Single Arm and Double, Sitting Side Prep

Wunda Chair: Shrugs

or

Reformer: Supine Arms Series- Extension, Adduction, Up and Down Circles,

Triceps

*option to progress to following options-

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Cadillac: add Sitting Side

Wunda Chair: add Tricep Press Sit, Tricep Prone

or

Reformer: Arms Kneeling Series (weighted initially at Y to HY) Chest Expansion,

Up Circles, Down Circles, Triceps, Biceps

or

Arm Sitting Series- Chest Expansion, Biceps, Rhomboids, Hug a Tree, Salute

Leg Work- Wunda Chair

Leg Press Standing, Hamstring Curl

* option to progress to include Hip Opener on Wunda Chair or

Reformer: Single Leg Skating

Lateral Flexion/ Rotation- Step Barrel, Ladder Barrel, Reformer

Step Barrel: Side Lift, Ladder Barrel: Side Over Prep, Reformer: Mermaid.

* two of the three with one option as Mermaid once Scapular Stabilization is

acquired. Option to progress to Step Barrel: Corkscrew as part of two

exercise option

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Back Extension- Step Barrel/Ladder Barrel/Wunda/Reformer/Cadillac

* Rest Pose between exercises

Step Barrel: Swan Prep, Ladder Barrel: Swan Prep, Wunda: Swan Basic,

Reformer:Breaststroke Prep

*progressions to Step Barrel: Swan, Ladder Barrel: Swan, Wunda: Swan on

Floor, Back Extension Single Arm, Reformer: Pulling Straps 1, Pulling

Straps 2, Cadillac: Prone 1.

two to three of above options depending on time with interchangeable

progression options when more thoracic opening is achieved and client

mobility in Upper Cross Syndrome is evident in updated

plumbline evaluations.

Cool Down: Roll Downs

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Conclusion

Pilates is designed to improve general body flexibility by focusing on strengthening the

‘core complex’, posture and coordination of breathing with movement. Posture

imbalances are addressed by creating body awareness and increasing proprioception.

The stretching and dynamics of the movements in the BASI system, in different planes,

with varying ranges of movement and weighted in various ways with apparatus, are

sequenced to facilitate opening- increasing RoM, and strengthening of the body.

A program that will work to mitigate symptoms of Forward Head Posture and

Upper Cross Syndrome has the potential to help restore not only his current postural

imbalances but also better breathing practices.

Good breathing mechanics along with core strengthening and stabilization will

aid him in conquering postural abnormalities that are present in the activities that he

enjoys and also the ones that he is required to do. This will provide him with a better

opportunity to maintain optimum health moving forward.

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Bibliography

Journal of Physical Therapy Science

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088155/

Groven, Mark ND:Upper Cross Syndrome Postural Health by naturopathic.org

Isacowitz, Rael: Pilates Second Addition

Isacowitz, Rael, Study Guide: Global Comprehensive Course, Costa Mesa, California:

Body Arts and Sciences International, 2013

Isacowitz, Rael, Clippenger, Karen: Pilates Anatomy, 2011

Websites

www.ncbi.nlm.nih.gov/pmc/articles/PMC5088155/

en.wikipedia.org/wiki/Atlanto-occipital_joint

www.muscleimbalancesyndromes.com/janda-syndromes/upper-crossed-syndrome

www.spineuniverse.com/conditions/