Forward head posture – a pain in the neck

1. Forward head posture – a pain in the neck Dr Shwetha S Hegde Consultant, Oral Medicine and Radiology Australian Dental Board Certified Dr Shwetha S Hegde

2. What is forward head posture? • A major postural imbalance • Anterior positioning of the cervical spine • Common occupational hazard Dr Shwetha S Hegde

3. The mechanism.. • Poor posture alters spine position mandible shifts forward the upper and lower teeth misalign skull moves back on the spinal column. • If not addressed, pain and inflammation in the muscles and jaw joints will develop when the mouth opens and closes. • Forward Head Posture (FHP) is a very common postural issue, and it is estimated to occur in between 66% and 90%  of the population. Dr Shwetha S Hegde

4. Role of the mandible in posture • Mandibular posture and head posture are inversely proportional in an antero-posterior (forward-backward) plane. • Shifting the mandible backward causes the head to shift forward, and shifting the head forward causes the mandible to shift backward. Dr Shwetha S Hegde

5. FHP is strongly correlated with backward mandibular posture.  TMJ disorder patients typically have both FHP and backward mandibular posture. Dr Shwetha S Hegde

6. Protective mechanism Dr Shwetha S Hegde

7. Head and jaw posture are both controlled by a hierarchy of neuromuscular reflexes, and airway protection is top priority.   • For every inch the neck goes forward there is an extra 4.5 kg of weight on the neck.  Dr Shwetha S Hegde

8. FHP produces a progressive loss and then a reversal of the normal cervical curve (lordosis) of the neck Dr Shwetha S Hegde

9. Changes occurring in the curvature of the spine over time due to FHP Dr Shwetha S Hegde

10. FHP causes realignment of the curvature of the spine due shifting of the weight of the head. • The weight is distributed unevenly on the intervertebral spine causing compressive strain on the intervertebral disc • This leads to stiffness and arthritic changes in the spine • Since muscles function in groups, muscles determining posture are also affected Dr Shwetha S Hegde

11. Effects on tmJ • Pain in the muscles of mastication and infrahyoid muscles • Pain in the TM joints • Change in occlusion due backward shift of the mandible Dr Shwetha S Hegde

12. THE ROLE OF STRESS • Stress worsens muscle tension by a measurable decrease in muscle circulation • Brings down threshold for jaw muscle pain due to inhibition of endorphin release Dr Shwetha S Hegde

13. THE ROLE OF ATTITUDE • Attitude influences posture and resting muscle tensions in the jaw area just like it does in the rest of the body.  Dr Shwetha S Hegde

14. Signs and symptoms • Chronic neck pain • Headaches • Tingling and numbness in the arms and hands • Improper breathing • Poor neck posture with outward stretching of neck • Chronic fatigue Dr Shwetha S Hegde

15. Treatment goals • Re-establishing a stable balanced resting posture for the head and the mandible. • Has mechanical and psychological components. • Mechanical component- paying attention to posture while standing, sitting sleeping etc •  The psychological component involves the way your mental state affects the resting postures of your muscles and thereby also the stance you use for weight bearing.   Dr Shwetha S Hegde

16. Treatment: • EXERCISE • STRETCHING • PASSIVE PHYSICAL SUPPORT Dr Shwetha S Hegde

17. Short term treatment: • Anti inflammatory drugs • Ultrasound • TENS • Cortisone injections • Use of neck brace Dr Shwetha S Hegde

18. exercise • Neck exercises because the neck muscles are the primary determinants of head posture. • Resistance exercises to strengthen neck muscles Dr Shwetha S Hegde

19. Stretching: • Yoga, Tai Chi, and swimming are popular exercises which provide both stretching and strengthening.  • Another way to combine strengthening with stretching is to pull oneself upward using overhead bars. Dr Shwetha S Hegde

20. Passive physical support: • Ergonomically perfect chair • A simple foam rubber mattress or a relatively hard mattress is preferable • Passive support using a pillow under the neck Dr Shwetha S Hegde

21. Do's and don'ts… • Make sure your computer monitor is ergonomically set up. • top third of your screen is at eye-level. • distance from your monitor to your eyes to should be 18 to 24 inches • Never carry heavy bags, backpacks or purses Dr Shwetha S Hegde

22. Get up and walk around every half an hour that you work at a desk, work in front of a computer or watch television. • Buy a supportive neck pillow, if you often wake up with a sore neck. Dr Shwetha S Hegde

23. Who are the potential patients? • People in the software field • Surgeons • Dentists • Factory/high precision workers • People with a desk job • People with sedentary lifestyle-prolonged TV watching Dr Shwetha S Hegde

24. Role of a oral medicine and radiology specialist.. • Create awareness among the target population • Counsel them to develop better posture and eliminate parafunctional habits • Treat the symptoms Dr Shwetha S Hegde

25. Thank You Dr Shwetha S Hegde