Forward Head Posture. Laura Hegle. August 13, Mt Shasta, Ca. Davis, Ca

Transcription

1 Forward Head Posture Laura Hegle August 13, Mt Shasta, Ca Davis, Ca

2 Abstract For every inch that your head protrudes forward from its proper alignment, it increases the weight of the head on the neck by 10 pounds! Compensatory posture caused by the extra leverage eventually leads to a kyphosis. What causes forward head posture? Before starting to work with a client with this posture it is imperative to do an in depth evaluation. Typically, too much time spent at a computer, driving, reading, extended use of cellphones and lack of developed back muscle strength leads to this posture. However, there are instances that forward head posture can be related to a spinal injury. Body alignment of a client that presents with forward head posture will have rounded shoulders and the head will protrude forward in relation to the shoulder joint. Tingling and numbness in the arms and hands is possible along with a burning pain between the shoulder blades and a kyphotic posture. There is usually an anterior pelvic tilt because the body has to compensate for the top half of the body which causes tight hip flexor muscles and hip extensors. While working with a client who has this postural deviation it is of extreme value to teach proper alignment and body awareness in order to restore the body s natural balance. 2

3 Table of Contents Abstract page 2 Anatomical Description pages 4 & 5 Case Study page 6 Conditioning Program pages 7-9 Conclusion page 9 Bibliography pages 10 & 11 3

4 Anatomical Description The prime muscles that are responsible for posture are known as erector spinea. The erector spinea consits of three columns of muscles: iliocostalis, longissimus and spinalis. This muscle group runs from the base of the skull to the pelvis. The erector spinea assists in forward flexion however prolonged time in that position will lengthen and weaken this muscle group leading to a kyphotic posture. The erector spinea in extension provides proper posture and postion of the neck. 4

5 The muscles of the upper extremities are responsible for the movements of the shoulder and upper limb. When forward head posture is present the pectoral muscles, levator scapulae and anterior deltoid are shortened and tight. At the same time the rhomboids, serratus anterior, trapezius, posterior deltoid, infraspinatus and teres minor are lengthened and weak. This causes muscle imbalance, rounding of shoulders and a kyphotic posture along with kyphosis the rib cage becomes compressed and respiration is impaired. 5

6 Case Study Andrew is 53 years old. He is a handyman and spends his days doing various jobs in which he is leaning forward and looking down. Andrew s job leaves little time for stretching or exercising. He has never done Pilates. At 14 the client was in a car accident from that time forward he has had neck pain, tightness in the neck muscles and the beginning of rounded shoulders. Andrew was referred to Pilates by his Neurological Surgeon prior to surgery. The physician wanted him to strengthen his back muscles in order to help correct his forward head posture, work on deltoid strength and abdominal engagement. Forward flexion is contraindicated at this time as he has retrolisthesis of C3 on C4 with a broadbased disc bulge. From these medical issues Andrew has numbness in both hands with diminished strength in his right hand, balance problems, weakness in right and left deltoids, nocturnal muscle spasms in both legs and slightly impaired gait. Andrew was in physical therapy for eight weeks prior to starting Pilates with no measurable gains. The following program was designed to help Andrew become aware of his posture, work on balance, take time to breath, concentrate on each movement, practice controlled movement, find his center, achieve efficiency of movement through flow and precision culminating in harmony, the ten principals of BASI Pilates. 6

7 Assessment Standing in best posture, forward flexion is contraindicated for client at this time Assessing how Andrew stands in his normal daily activities. Looking at the alignment of the joints and bony landmarks as well as how he uses his musculature to fight gravity. Warm Up-Mat Pelvic Curl, Supine Spine Twist, Leg lift, Leg Circles. Forward flexion is contraindicated for client at this time Waking up core muscle groups with limited spinal articulation. Working on intercostal breathing. Goal is to use BASI Pilates SIM approach. Foot Work on Reformer 3.5 Springs Abdominals on Reformer Parallel Heels & Toes, V position Toes, Open V Heels, Open V Toes, Calf Raises, Prances, Single Leg Heel and Single Leg Toes Hundred Prep without lifting head as forward flexion is contraindicated at this time Muscle Focus- Hamstrings & Quadriceps. Working legs with pelvic stability, learning to initiate movement from hamstrings and quads in cocontraction, develop hip extensor strength and trunk stability. Work full range of motion in ankle and foot. Muscle Focus- Abdominals. We took this time to focus on intercostal breathing while contracting the transverse abdominals. Also focusing on shoulder extensor control. Hip Work on Cadillac Basic leg springs-frog, Circles down & up, Walking, Bicycle Forward & Reverse Muscle Focus- Adductors & Hamstrings. Pelvic lumbar stabilization, hip adductor strength and hip extensor strength. 7

8 Spinal Articulation Reformer Added at Session 11 Bottom lift Muscle Focus- Abdominals and Hamstrings. Working spinal articulation and hip extensor control. I placed a towel under client s neck as a tactile reminder to not use neck muscles when articulating up and down. Stretches-Reformer Standing Lunge Muscle Focus- Hip Flexors and Hamstrings. Working to elongate hip flexors and hamstrings, develop back extension and enhance pelvic lumbar stability. Full Body Integration on Reformer Arm Work- Ped a Pull Leg Work- Magic Circle Added at Session 11 Scooter Arms Standing Series- Extension, Adduction, Circles Up, Circles Down, Triceps Sitting Series- Ankles, Below Knees, Above Knees Muscle Focus- Abdominals. Maintain scapular and pelvic lumbar stabilization. Working to control/strengthen hip extensor and knee extensor. Consistent C curve position during movement. Muscle Focus-Latissimus dorsi and Triceps. Goal to work below shoulder height keeping shoulders down by engaging scapulae while working shoulder extensor, shoulder adductor and elbow extensor strength. The Ped A Pull gives tactile postural reinforcement. Muscle Focus-Hip adductors. Goal to sit in ideal posture, working toward proper alignment with trunk stabilization and even pressure in both feet. Lateral Flexion/ Rotation on Ladder Barrel Side Over Prep Muscle Focus- Abdominals with Oblique emphasis. Working trunk lateral flexors to stretch and strengthen while maintaining neutral pelvis. 8

9 Back Extension on Mat Back Extension Muscle focus- Back extensors. Goal to engage abdominals while lifting from upper back, visualizing the posture the client is working to achieve. Assessment Roll down is contraindicated at this time. Client laid on a foam roller with arms in a T position with light weights Goal to open his shoulder and pectoral muscles while stretching. Conclusion Good posture can be successfully acquired only when the entire mechanism of the body is under perfect control. (Pilates 2003,2005,2010. Page 32) Andrew has become aware that using his back extensors, externally rotating his shoulders and opening the tight pectoral muscles will help him avoid the rounding of his shoulders. Focus on the breath allowed Andrew to relax into neutral spine and with a few cues he found he could co-contract his transverse abdominals and back extensors, the power house, to give him the firm foundation he needed to stand tall. In proper alignment Andrew found that he did not need to compensate with his hips, hamstrings and feet to fight gravity. Andrew is very precise, taking time to concentrate on the muscle groups that are being recruited in each exercise to obtain the benefit of each movement. The deepened mind body connection found in Pilates work allowed Andrew to gain proprioception which he can take with him into recovery from his surgery. 9

10 Bibliography Book Isacowitz, Rael. Pilates, Second Edition, Champaign, Il.; Human Kinetics, Copyright 2014, 2006 Isacowitz, Rael, and Karen Clippinger. Pilates Anatomy, Champaign, Il.; Human Kinetics Copyright 2011 Breland, Mariska. Pilates for MS Third Edition, Copyright 2013 Isacowitz, Rael. Study Guide, Comprehensive Course. Costa Mesa, California: Body Arts and Science International, Copyright Isacowitz, Rael. Mat, Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Copyright Isacowitz, Rael. Reformer, Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Copyright Isacowitz, Rael. Cadillac, Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Copyright Isacowitz, Rael. Auxiliary, Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Copyright Pilates, Joseph and William John Miller. Pilates Return to Life Through Contrology. Miami, FL. Pilates Method Alliance (Original Copyright 1945 by Joseph Pilates) Copyright 2003, 2005,

11 Websites Axial Muscles of the Head, Neck and Back: Anatomy and Physiology, philzchatz.com Forward Head Posture and the 42 pound head, erikdalton.com,