FORWARD HEAD POSTURE: EXERCICES AND STRETCHES

Forward head posture and protacted shoulders are two of the most common postural deviations in people of all ages ¹. This posture constitutes the "upper crossed syndrome" being frequently associated with musculoskeletal pain.

Image 1: upper crossed syndrome

“Upper crossed syndrome" is a decompensation level upper back, shoulder and chest. There are contracted muscles (pectoralis major, trapezius and levator scapulae) and inhibited others (deep neck flexors, rhomboids and serratus major), producing an imbalance and reflected in the position of the upper part of the trunk. This results in a curved posture that intrinsically leads to a weakness in the scapula with the consequent destabilization in the shoulder joint.

Stretching of the upper trapezius, the sternocleidomastoid, the levator scapulae and the strengthening of the deep cervical flexor muscles have been shown to be effective in correcting the forward head position ². While the treatment of the protacted shoulders is based more on the strengthening of the scapular stabilizers and the rotator cuff muscles and pectoralis minor stretch ^2,3.

That is why I propose to you, strength training and stretching for the correction of posture based on the study by Roivo et al. (2016) ⁴. This protocol is intended to restore normal muscle balance between opposing muscle groups (agonists and antagonists) and work the elongation capacity of muscle groups that restrict the range of joint movements to those that oppose, this concept being supported by several studies ^2.5.

How long?

The exercises must be performed 2 non-consecutive days a week for at least 16 weeks. For strength training, we start with light loads (1- 1'5 kg) and 3 sets of 12-15 repetitions, with the rest interval between sets of 30 seconds. In the three stretching exercises, there will be 2 series of 30 seconds of duration ⁶. The total intervention program took an average of 15 minutes to complete, and the order of the exercises can be random.

Strength exercises

Side-lying external rotation

Side lying with arm fully adducted to side and internally rotated with elbow flexed to 90°. Patients then externally rotate the shoulder with the hand moving in an arc away from the body.

Prone horizontal abduction with external rotation

In a prone horizontal abduction position, the patient horizontally abducts the arm with the elbow extended and with external humeral rotation. The participant lifts the hand toward the ceiling keeping head/neck neutral and squeezing both shoulder blades together.

Y-to-I exercise

The patient retracts the scapulae with the arms abducted to 90°. As the patient advances, the shoulders are externally rotated with the elbows flexed to 90°, forming a Y. Then the patient moves into a position of full bilateral elevation with the elbow extension forming an I.

Chin tuck

This exercise targets the deep flexor muscles of the upper cervical region, the longus capitis and longus colli muscles. This is a low-load exercise51 that involves performing and holding inner range positions of craniocervical flexion that specifically activate and train the deep cervical flexor, rather than the superficial flexors muscles. This exercise is done in a supine lying position with the head in contact with the floor.

Video link

Stretches

One-sided unilateral self-stretch exercise Pectorals minor

The participant’s forearm is stabilized by a vertical plane before the trunk is rotated in the opposite direction. Therefore, arm on the involved side is externally rotated and abducted to 90°.

Static sternocleidomastoid stretch

Start in optimal posture and place right arm behind body, depressing the shoulder. Draw abs in. Tuck chin and slowly draw left ear to the left shoulder. Continue by rotating the neck upward toward the ceiling until a slight stretch is felt on the right side. We can use the left hand to apply slight pressure and assist in lateral flexion and rotation. Switch sides and repeat.

Static levator scapulae stretch

Start in optimal posture and place right arm behind body, depressing the shoulder. Draw abs in. Tuck chin and slowly draw left ear to the left shoulder. Continue by rotating the neck downward toward the ceiling until a slight stretch is felt on the right side. We can use the left hand to apply slight pressure and assist in lateral flexion and rotation. Switch sides and repeat.

What results were obtained?

After 16 weeks, significant differences were observed at two postural angles in the intervention group from pretest to posttest, with an increase in the cervical angle (44.4 ° ± 3.5 ° vs 46.8 ° ± 3.9 °) and shoulder angle (45.9 °). ± 4.9 ° vs 49.8 ° ± 6.5 °) after the intervention ⁴. Getting a head position less advanced and a lower shoulder protraction.

A: Cervical angle; B: Shoulder angle

In summary

This study indicates that a specific exercise program, performed twice a week and integrated into physical education classes over a period of 16 weeks, may result in improved posture, with increases in cervical and shoulder angles.

Bibliography

1. Grimmer-Somers K. An investigation of poor cervical resting posturer. Aust Physiother. 1997;43(1):7-16.2. Lynch S, Thigpen C, Mihalik JP, Prentice W, Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010;44(5):376-381.3. McDonnell MK, Sahrmann SA, Van Dillen L. A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report. J Orthop Sports Phys Ther. 2005;35(1):3-15.
4. Ruivo RM, Pezarat-Correia P, Carita AI. Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents. J Manipulative Physiol Ther. 2017 Jan; 40:1-10.5. Lee M-H, Park S-J, Kim J-S. Effects of neck exercise on highschool students’ neck-shoulder posture. J Phys Ther Sci. 2013;25(5):571-574.
6. Page P. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther. 2012;7(1):109-119.

forward head posture fix 

flex posture corrector