How is My Posture Related to My Health?
When discussing the topic of posture, many people ask, “How is my posture related to my health?” Chiropractors know that changes in posture represent the result of physical stressors on the body over time, and that poor posture can result in a variety problems, including pain, tension, degenerative conditions, and more. Because the idea of postural health is not as main-stream as, say, dental health, most members of the public are blissfully unaware that changes in their posture have implications in other areas of their health and wellbeing.
Posture is the window through which a chiropractor can see the different ways your body has structurally broken down over your lifetime. Much like the constant pressure of orthodontic braces slowly move teeth over time, the longstanding and repetitive physical stresses we put on our bodies - through work and play activities, through using computer and driving cars, through the furniture we sit and lie on, and through bad posture habits we have like slouching and carrying one sided loads - slowly move our bodies over time. The result is always the same: the spine gets pushed out of alignment, and the body gets stuck that way. As time progresses, the postural imbalances which form (like forward head posture, rounded shoulders and upper back, and increased or reduced curvature in the low back) lead to reduced mobility/flexibility, muscle spasms and imbalances, increased wear and tear on the structures of the spine causing degeneration, and symptoms of pain and discomfort.
Postural health is a relatively new area of research, but it supports what chiropractors have been working to educate the public about for years; poor posture is a sign of biomechanical dysfunction in the spine, and it leads to impaired physical function of the body, increased degeneration of the spine, symptoms of pain. Here are some highlights of the research on posture which are coming from a variety of fields of study:
Posture is the window through which a chiropractor can see the different ways your body has structurally broken down over your lifetime. Much like the constant pressure of orthodontic braces slowly move teeth over time, the longstanding and repetitive physical stresses we put on our bodies - through work and play activities, through using computer and driving cars, through the furniture we sit and lie on, and through bad posture habits we have like slouching and carrying one sided loads - slowly move our bodies over time. The result is always the same: the spine gets pushed out of alignment, and the body gets stuck that way. As time progresses, the postural imbalances which form (like forward head posture, rounded shoulders and upper back, and increased or reduced curvature in the low back) lead to reduced mobility/flexibility, muscle spasms and imbalances, increased wear and tear on the structures of the spine causing degeneration, and symptoms of pain and discomfort.
Postural health is a relatively new area of research, but it supports what chiropractors have been working to educate the public about for years; poor posture is a sign of biomechanical dysfunction in the spine, and it leads to impaired physical function of the body, increased degeneration of the spine, symptoms of pain. Here are some highlights of the research on posture which are coming from a variety of fields of study:
- The prevalence of neck, spinal, shoulder, knee and other musculoskeletal disorders was found higher in factory workers with a poor work posture
- Age-related hyperkyphosis (an increased forward curvature of the upper back) is a common disorder in men and women as they get older
- Children who mouth-breath were found to have postural changes in the neck and decreased respiratory muscle strength compared with nasal-breathers
- A study of a group of 467 school aged children found that 78% had a lumbar hyperlordosis (increased curvature of the low back), and this was associated with weak abdominal muscles and reduced range of motion/flexibility in the low back
- MRI studies have shown that, compared to individuals with a normal lumbar (low back) curve, those with a reduced or increased lumbar curve have more degeneration of the vertebral discs
- A study of chronic nontraumatic neck pain showed that younger participants with neck pain had a more forward head posture in standing than matched pain-free participants
But the effects of postural imbalance don’t end with musculoskeletal complaints. In fact, research is showing that posture is directly related to other measures of health and wellbeing. Here are some examples of how posture is related to health:
- Hyperkyphotic posture (overly-rounded upper back) was found to be associated with an increased rate of mortality, specifically related to death from atherosclerosis in the elderly
- Moderate hyperkyphotic posture (overly-rounded upper back) appears to be an independent risk factor for injurious falls in older men, with the association being less pronounced in older women
- Older persons with hyperkyphotic posture (overly-rounded upper back) are more likely to have difficulties with physical functionality (their ability to bend, move, and perform common physical activities)
- Compared to controls, patients with mild to moderate carpal tunnel syndrome were found to have increased forward head postures
- Postural changes in the neck and upper back are associated with decreased breathing function
As you can see, posture is a measure of health in many ways, and its significance goes beyond the more obvious musculoskeletal complaints of pain and discomfort (though it is of great relevance in these matters). Given this information, you can now understand why posture correction and spinal care are an important part of a holistic natural health and wellness lifestyle.
Summary of The Scientific Research on Posture and Health:
Evaluation of musculoskeletal disorders in sewing machine operators of a shoe manufacturing factory in Iran
J Pak Med Assoc. 2012 Mar;62(3 Suppl 2):S20-5.
Aghili MM, Asilian H, Poursafa P.
Source
Ministry of Health and Medical Education, Tehran. [email protected]
Abstract
INTRODUCTION:
A 15-year research conducted in USA showed that compensation expenses paid to workers for musculoskeletal disorders (MSDs) of back exceeded 128 million Dollars calculated on the basis of 0.97 Dollars per hour of work. In addition, according to the latest studies carried out in relation with disease burdens with risk factors in Iran, DALYs indices for low back pain, knee arthrosis and other musculoskeletal disorders have been reported to be 307772, 291305 and 872633 respectively, which have caused the work related diseases to occupy the second position in the country, after cardiovascular diseases. On the other hand, in accordance with occupational health indices of Iranian health ministry, 37% of all working population had had poor work postures with 15% of all working population had been working with inappropriate working tools in the year 2009.
METHODS:
This was a case study comparing exposed workers with control group using Standard Nordic Questionnair in sewing machine operators of a shoe manufacturing factory in Iran. In this study, the mentioned questionnaires were filled out for the exposed group (25 sewing machine operators with average age of 43.5 years with work records of 16.8 years) and control group (15 employees from administrative department with average age of 39.8 years with work records of 13.4 years) which both were selected through simple random method.
RESULTS:
There were statistically significant differences in age between musculoskeletal disorders of right elbow (p = 0.033), thigh (p = 0.044), both knees (p = 0.019) and ankles (p = 0.039). There were also statistically significant association between gender and musculoskeletal disorders of right elbow (p = 0.028), thigh (p = 0.026) both knees (p = 0.011); right shoulder disorders (p = 0.018) and work records; disorders of both knees (p = 0.031) and number of cigarettes smoked.
CONCLUSIONS:
In general, prevalence of disorders of cervical area, shoulders with hands, vertebral column, back, knees, thigh with feet were higher in exposed group due to poor work posture. Meanwhile, female workers were inflicted more than males. On the other hand, these disorders were seen more with increased work records and age in which, improvement of work postures, training for better execution of tasks and conducting periodic screening tests are being recommended.
_________________________________________________________________________________
The rehabilitation of hyperkyphotic posture in the elderly
Eur J Phys Rehabil Med. 2009 Dec;45(4):583-93.
Kado DM.
Source
Department of Orthopedic Surgery, UCLA Orthopaedic Hospital, Los Angeles, CA 90095, USA. [email protected]
Abstract
The angle of thoracic kyphosis tends to increase with age resulting in hyperkyphosis in some individuals. While the term "kyphotic" is occasionally used to describe someone with accentuated thoracic curvature, hyperkyphosis is preferred since kyphosis itself refers to the normal sagittal angle of thoracic curvature. Epidemiolo-gic studies have demonstrated that age-related hyperkyphosis commonly affects the elderly population with estimates ranging from 20% to 40%. In addition, hyperkyphosis affects a substantial number of older men. Apart from being a cosmetic deformity, older persons who suffer from hyperkyphosis are at increased risk for a variety of adverse health outcomes that include poor physical function, pulmonary compromise, falls, fractures, and even earlier mortality. Most clinicians and patients have assumed that thoracic hyperkyphosis is a result of underlying spinal osteoporosis, but approximately two thirds of those who are most hyperkyphotic don't have vertebral fractures. Over the past few years, there has been increased awareness and focus on potential effective treatments for age-related hyperkyphosis. Of these treatments, exercise based interventions and spinal orthoses are conservative rehabilitation management techniques that have shown promise in potentially improving health outcomes for affected patients. To date, all of these types of trials have been small in scale, and most short in duration. In the future, larger rigorously designed clinical trials will be needed to test and confirm the efficacy and feasibility of the most promising treatments for age-related hyperkyphosis. This invited review will discuss hyperkyphosis in terms of its etiology, clinical associations, and treatment in elderly individuals.
________________________________________________________________________________
Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study
J Am Geriatr Soc. 2004 Oct;52(10):1662-7.
Kado DM, Huang MH, Karlamangla AS, Barrett-Connor E, Greendale GA.
Source
Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California 90095, USA. [email protected]
Abstract
OBJECTIVES:
To determine the association between hyperkyphotic posture and rate of mortality and cause-specific mortality in older persons.
DESIGN:
Prospective cohort study.
SETTING:
Rancho Bernardo, California.
PARTICIPANTS:
Subjects were 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit between 1988 and 1991.
MEASURES:
Kyphotic posture was measured as the number of 1.7-cm blocks that needed to be placed under the participant's head to achieve a neutral head position when lying supine on a radiology table. Demographic and clinical characteristics and health behaviors were assessed at a clinic visit using standard questionnaires. Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates.
RESULTS:
Hyperkyphotic posture, defined as requiring one or more blocks under the occiput to achieve a neutral head position while lying supine, was more common in men than women (44% in men, 22% of women, P<.0001). In age- and sex-adjusted analyses, persons with hyperkyphotic posture had a 1.44 greater rate of mortality (95% confidence interval (CI)=1.12-1.86, P=.005). In multiply adjusted models, the increased rate of death associated with hyperkyphotic posture remained significant (relative hazard=1.40, 95% CI=1.08-1.81, P=.012). In cause-specific mortality analyses, hyperkyphotic posture was specifically associated with an increased rate of death due to atherosclerosis.
CONCLUSION:
Older men and women with hyperkyphotic posture have higher mortality rates.
________________________________________________________________________________
Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study
J Gerontol A Biol Sci Med Sci. 2005 May;60(5):633-7.
Kado DM, Huang MH, Barrett-Connor E, Greendale GA.
Source
Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave., Suite 2339, Los Angeles, CA, USA. [email protected]
Abstract
BACKGROUND:
Physical functional decline is often the determining factor that leads to loss of independence in older persons. Identifying risk factors for physical disability may lead to interventions that may prevent or delay the onset of functional decline. Our study objective was to determine the association between hyperkyphotic posture and physical functional limitations.
METHODS:
Participants were 1578 older men and women from the Rancho Bernardo Study who had kyphotic posture measured as the distance from the occiput to table (units = 1.7-cm blocks, placed under the participant's head when lying supine on a radiology table). Self-reported difficulty in bending, walking, and climbing was assessed by standard questionnaires. Physical performance was assessed by measuring grip strength and ability to rise from a chair without the use of the arms.
RESULTS:
Men were more likely to be hyperkyphotic than were women (p <.0001). In multiply adjusted comparisons, there was a graded stepwise increase in difficulty in bending, walking and climbing, measured grip strength, and ability to rise from a chair. For example, the odds ratio (OR) of having to use the arms to stand up from a chair increased from 1.6 (95% confidence interval [CI]: 0.9-3.0) for individuals defined as hyperkyphotic by 1 block to 2.9 (95% CI: 1.7-5.1) for individuals defined as hyperkyphotic by 2 blocks to 3.7 (95% CI: 2.1-6.3) for individuals defined as hyperkyphotic by > or = 3 blocks compared to those who were not hyperkyphotic (p for trend < .0001).
CONCLUSIONS:
Older persons with hyperkyphotic posture are more likely to have physical functional difficulties.
________________________________________________________________________________
Hyperkyphotic posture and risk of injurious falls in older persons: the Rancho Bernardo Study
J Gerontol A Biol Sci Med Sci. 2007 Jun;62(6):652-7.
Kado DM, Huang MH, Nguyen CB, Barrett-Connor E, Greendale GA.
Source
David Geffen School of Medicine, Los Angeles, CA 90095, USA. [email protected]
Abstract
OBJECTIVE:
Falls among older adults can have serious physical and emotional consequences, ultimately leading to a loss of independence. Improved identification of those at risk for falls could lead to effective interventions. Because hyperkyphotic posture is associated with impaired physical functioning, we hypothesized that kyphosis may also be associated with falls.
METHODS:
Participants were 1883 older adults from the Rancho Bernardo Study. Between 1988 and 1991, kyphosis was measured using a system of 1.7-cm blocks placed under the participants' heads if they were unable to lie flat without neck hyperextension. Data on falls including injurious falls, demographics, health, and habits were obtained from a self-administered questionnaire completed at the same visit.
RESULTS:
Hyperkyphosis was defined as requiring the use of > or = 1 blocks (n = 595, 31.6%). In this cohort, men were more likely to be hyperkyphotic than were women (p <.0001). Of those who fell, 36.3% were hyperkyphotic, versus 30.2% among those who did not fall (p =.015). Those who fell were older, more likely to be women, had lower body mass index, did not exercise, did not drink alcohol, and had poor self-reported physical and emotional health. In age- and sex-adjusted models, those with hyperkyphosis were at 1.38-fold increased odds of experiencing an injurious fall (95% confidence interval [CI], 1.05-1.91; p =.02) that increased to 1.48 using a cutoff of > or = 2 blocks versus < or = 1 blocks (95% CI, 1.10-2.00; p =.01). Although women were more likely to fall, after adjustment for possible confounders, men with moderate hyperkyphosis were at greatest fall risk.
CONCLUSIONS:
Moderate hyperkyphotic posture may signify an easily identifiable independent risk factor for injurious falls in older men, with the association being less pronounced in older women.
________________________________________________________________________________
Influence of age on cervicothoracic spinal curvature: an ex vivo radiographic survey
Clin Biomech (Bristol, Avon). 2002 Jun;17(5):361-7.
Boyle JJ, Milne N, Singer KP.
Source
Department of Surgery, Centre for Musculoskeletal Studies, The University of Western Australia, Royal Perth Hospital, Level 2, MRF Building, WA Medical Res. Inst. Bldg., Rear 50 Murray Street, WA 6000, Australia.
Abstract
OBJECTIVE:
To define the post-mortem cervicothoracic spinal curvature relative to age.
DESIGN:
Spinal curvature assessment of lateral cervicothoracic radiographs.
BACKGROUND:
A late consequence of age is the progressive accentuation of spinal curvatures, particularly the thoracic kyphosis. Little is known about the influence of the kyphosis on the alignment of the cervical spine.
METHOD:
One hundred and seventy two lateral spinal radiographs (113 males, 59 females) were analysed using two procedures: (1) sagittal curve deformation angles were derived, according to the method of Cobb, for thoracic (T1-T12), cervical (C2-C7) and cervicothoracic junctional regions (C6-T4); and (2) the cervicothoracic curvatures were digitised (C2-T12), to derive the apex of both curves and the inflexion point.
RESULTS:
A significantly increasing thoracic spinal curvature was determined for both genders, with the mean apex of the kyphosis close to T6. The cervical lordosis tended to flatten with increasing age, particularly in males, with the cervical apex location shifting cranially. This association was significant in older males and females. The mean location of the cervicothoracic curve inflexion point moved from T3 towards C7-T1 with increasing age.
CONCLUSION:
The cervicothoracic spinal curvature undergoes progressive change through the lifespan with a subsequent cranial migration of the inflexion point between the thoracic kyphosis and cervical lordosis, accompanied by a similar shift in the cervical apex.
RELEVANCE:
Sensitive measures of spinal curvature have utility in determining changes attributed to age, deformity or trauma on cervicothoracic spinal alignment. The value of assessing the location of curve inflexion lies in the ability to quantify changes in the relationship between different regions of the human spine without problems associated with identifying specific vertebral landmarks.
_________________________________________________________________________________
Exercise capacity, respiratory mechanics and posture in mouth breathers
Braz J Otorhinolaryngol. 2011 Sep-Oct;77(5):656-62.
Okuro RT, Morcillo AM, Sakano E, Schivinski CI, Ribeiro MÂ, Ribeiro JD.
Source
Campinas State University-Universidade Estadual de Campinas .
Abstract
Chronic and persistent mouth or oral breathing (OB) has been associated with postural changes. Although posture changes in OB causes decreased respiratory muscle strength, reduced chest expansion and impaired pulmonary ventilation with consequences in the exercise capacity, few studies have verified all these assumptions.
OBJECTIVE:
To evaluate exercise tolerance, respiratory muscle strength and body posture in oral breathing (OB) compared with nasal breathing (NB) children.
MATERIAL AND METHOD:
A cross-sectional contemporary cohort study that included OB and NB children aged 8-11 years old. Children with obesity, asthma, chronic respiratory diseases, neurological and orthopedic disorders, and cardiac conditions were excluded. All participants underwent a postural assessment, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), the six-minute walk test (6MWT), and otorhinolaryngologic evaluation.
RESULTS:
There were 107 children (45 OB and 62 NB). There was an association between abnormal cervical posture and breathing pattern: 36 (80.0%) OB and 30 (48.4%) NB presented abnormal head posture (OR=4.27 [95% CI: 1.63-11,42], p<0.001). The mean MIP and MEP were lower in OB (p=0.003 and p=0.004).
CONCLUSION:
OB children had cervical spine postural changes and decreased respiratory muscle strength compared with NB.
________________________________________________________________________________
Lumbar hyperlordosis in children and adolescents at a privative school in southern Brazil: occurrence and associated factors
Cad Saude Publica. 2012 Apr;28(4):781-8.
Lemos AT, Santos FR, Gaya AC.
Source
Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil. [email protected]
Abstract
Posture assessment during childhood and adolescence allows early detection of postural disorders and adoption of preventive measures. This study evaluated the occurrence of lumbar hyperlordosis and associated factors in 467 children and adolescents aged 10 to 16 years at a school in Porto Alegre, Rio Grande do Sul State, Brazil. Lumbar hyperlordosis was defined as increased lumbar curvature evaluated by photography. Prevalence of lumbar hyperlordosis was 78%. Factors positively associated with lumbar hyperlordosis were female gender (PR = 1.08; 95%CI: 1.03; 1.13), abdominal strength below the 20th percentile (PR = 1.10; 95%CI: 1.05; 1.15), and flexibility below the 20th percentile (PR = 1.07; 95%CI: 1.01; 1.12). Lumbar hyperlordois was negatively associated with lumbar mobility (PR = 0.90; 95%CI: 0.85; 0.96) and height (PR = 0.995; 95%CI: 0.99; 0.999). Effective strategies to improve physical fitness in schoolchildren are necessary, because low abdominal strength and low flexibility were associated with lumbar hyperlordosis.
_____________________________________________________________________________
Effect of sagittal alignment on kinematic changes and degree of disc degeneration in the lumbar spine: an analysis using positional MRI
Spine (Phila Pa 1976). 2011 May 15;36(11):893-8.
Keorochana G, Taghavi CE, Lee KB, Yoo JH, Liao JC, Fei Z, Wang JC.
Source
Department of Orthopaedics, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Abstract
STUDY DESIGN:
Retrospective analysis using positional MRI.
OBJECTIVE:
To determine the effects of total sagittal lordosis on spinal kinematics and degree of disc degeneration in the lumbar spine.
SUMMARY OF BACKGROUND DATA:
Changes in sagittal lordosis alter the load on the spine and may affect spinal mobility. There is increasing recognition of the clinical impact that sagittal alignment has on back pain, especially its possible role in accelerating adjacent segment degeneration after spinal fusion. However, its relationship to segmental mobility and degeneration of the lumbar spine has yet to be determined.
METHODS:
Four hundred and thirty patients who had low back pain with or without leg pain (241 males and 189 females) with a mean age of 42.98 years (range, 16-85 years) were included. Total sagittal lordosis (T12-S1) was divided into three groups; Group A: Straight or Kyphosis (<20°, n = 84), Group B: Normal lordosis (20-50°, n = 294), and Group C: Hyperlordosis (>50°, n = 52). The degree of disc degeneration was graded using midsagittal T2-weighted MR images. Segmental mobility, including translational motion and angular variation, was measured using positional MRI. Their relationship with total segmental lordosis was identified.
RESULTS:
When compared with group B, the segmental motion in group C tended to be lower at the border of lordosis and higher at the apex of lordosis, with a significant difference in angular motion at L2-L3. The contrary finding was identified in group A, which had a higher segmental motion at border segments and lower motion at apical segments of lordosis, with significant difference of translational motion at L3-L4 and angular motion at L1-L2. Apical segments contributed more, whereas border segments contributed less to the total angular mobility in more lordotic spines. The opposite was seen in more kyphotic spines. Disc degeneration tended to be greater at all levels in group C, and at L1-L2 and L5-S1 in group A.
CONCLUSION:
Changes in sagittal alignment may lead to kinematic changes in the lumbar spine. This may subsequently influence load bearing and the distribution of disc degeneration at each level. Sagittal alignment, disc degeneration, and segmental mobility likely have a reciprocal influence on one another.
______________________________________________________________________________
Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons
Arch Phys Med Rehabil. 2009 Apr;90(4):669-74.
Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI.
Source
Faculty of Health, Leeds Metropolitan University, Leeds, UK.
Abstract
OBJECTIVE:
To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals.
DESIGN:
Single-blind (assessor) cross-sectional study.
SETTING:
Hospital and general community.
PARTICIPANTS:
Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40).
INTERVENTIONS:
Not applicable.
MAIN OUTCOME MEASURES:
Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images.
RESULTS:
NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean +/- SD, 45.4 degrees +/-6.8 degrees ; pain-free, mean +/- SD, 48.6 degrees +/-7.1 degrees ; P<.05; confidence interval [CI] for the difference between groups, 0.9 degrees -6.3 degrees ). Dividing the population according to age into younger (</=50y) and older (>50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean +/- SD, 46.1 degrees +/-6.7 degrees ; pain-free, mean +/- SD, 51.8 degrees +/-5.9 degrees ; P<.01; CI for the difference between groups, 1.8 degrees -9.7 degrees ) but no difference for the older group (NP, mean +/- SD, 44.8 degrees +/-7.1 degrees ; pain-free, mean +/- SD, 45.1 degrees +/-6.7 degrees ; P>.05; CI for the difference between groups, -4.9 degrees -4.2 degrees ). No other differences were found between patients and pain-free participants.
CONCLUSIONS:
Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful.
________________________________________________________________________________
Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome
J Orthop Sports Phys Ther. 2009 Sep;39(9):658-64.
De-la-Llave-Rincón AI, Fernández-de-las-Peñas C, Palacios-Ceña D, Cleland JA.
Source
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Abstract
STUDY DESIGN:
Case control study.
OBJECTIVES:
To compare the amount of forward head posture (FHP) and cervical range of motion between patients with moderate carpal tunnel syndrome (CTS) and healthy controls. We also sought to assess the relationships among FHP, cervical range of motion, and clinical variables related to the intensity and temporal profile of pain due to CTS.
BACKGROUND:
It is plausible that the cervical spine may be involved in patients with CTS. No studies have investigated the possible associations among FHP, cervical range of motion, and symptoms related to CTS.
METHODS:
FHP and cervical range of motion were assessed in 25 women with CTS and 25 matched healthy women. Side-view pictures were taken in both relaxed-sitting and standing positions to measure the craniovertebral angle. A CROM device was used to assess cervical range of motion. Posture and mobility measurements were performed by an experienced therapist blinded to the subjects' condition. Differences in cervical range of motion were examined using the nonparametric Mann-Whitney U test. A 2-way mixed-model analysis of variance (ANOVA) was used to evaluate differences in FHP between groups and positions.
RESULTS:
The ANOVA revealed significant differences between groups (F = 30.4; P<.001) and between positions (F = 6.5; P<.01) for FHP assessment. Patients with CTS had a smaller craniovertebral angle (greater FHP) than controls (P<.001) in both standing and sitting. Additionally, patients with CTS showed decreased cervical range of motion in all directions when compared to controls (P<.001). Only cervical flexion (rs = -0.43; P = .02) and lateral flexion contralateral to the side of the CTS (rs = -0.51; P = .01) were associated with the reported lowest pain experienced in the preceding week. A positive association between FHP and cervical range of motion was identified in both groups: the smaller the craniovertebral angle (reflective of a greater FHP), the smaller the range of motion (r values between 0.27 and 0.45; P<.05). Finally, cervical range of motion and FHP were negatively associated with age in the control group but not in the group with CTS.
CONCLUSIONS:
Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion. However, a cause-and-effect relationship cannot be inferred from this study. Future research should investigate if FHP and restricted cervical range of motion is a consequence or a causative factor of CTS and related symptoms (eg, pain).
____________________________________________________________________________
The relationship between head posture and severity and disability of patients with neck pain
Man Ther. 2008 May;13(2):148-54. Epub 2007 Mar 23.
Yip CH, Chiu TT, Poon AT.
Source
Physiotherapy Department, Queen Mary Hospital, Hong Kong.
Abstract
STUDY DESIGN:
A cross-sectional correlation study.
OBJECTIVES:
To investigate the relationship between head posture with pain and disability in patients with neck pain.
METHOD:
Sixty-two subjects with neck pain and 52 normal subjects were recruited by convenience sampling. The forward head posture was measured via the craniovertebral (CV) angle by using the Head Posture Spinal Curvature Instrument (HPSCI). The Chinese version of Northwick Park Neck Pain Questionnaire (NPQ) and Numeric Pain Rating Scale (NPRS) were used to assess neck pain disability and severity. The difference in CV angles between the two groups and Pearson's correlation coefficient between the CV angle, NPQ and NPRS were determined.
RESULTS:
There was a significant difference in the CV angle between subjects with and without neck pain. CV angle was negatively correlated with NPQ (r(p)=-0.3101, p=0.015) and NPRS (r(p)=-0.329,p=0.009). It was also negatively correlated with age (r(p)=-0.380,p=0.002). When age was taken into account, the CV angle was negatively correlated with NPQ (r(p)=-0.3101,p=0.015) but showed no significant correlation with NPRS (r(p)=-0.1848,p=0.154).
CONCLUSION:
The CV angle in subjects with neck pain is significantly smaller than that in normal subjects. There is moderate negative correlation between CV angle and neck disability. Patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability.
________________________________________________________________________________
Upper crossed syndrome and its relationship to cervicogenic headache
J Manipulative Physiol Ther. 2004 Jul-Aug;27(6):414-20.
Moore MK.
Source
[email protected]
Abstract
OBJECTIVE:
To discuss the management of upper crossed syndrome and cervicogenic headache with chiropractic care, myofascial release, and exercise.
CLINICAL FEATURES:
A 56-year-old male writer had been having constant 1-sided headaches radiating into the right eye twice weekly for the past 5 years. Tenderness to palpation was elicited from the occiput to T4 bilaterally. Trigger points were palpated in the pectoralis major, levator scapulae, upper trapezius, and supraspinatus muscles bilaterally. Range of motion in the cervical region was decreased in all ranges and was painful. Visual examination demonstrated severe forward translation of the head, rounded shoulders, and right cervical translation.
INTERVENTION AND OUTCOME:
The patient was adjusted using high-velocity, short-lever arm manipulation procedures (diversified technique) and was given interferential myofascial release and cryotherapy 3 times weekly for 2 weeks. He progressed to stretching and isometric exercise, McKenzie retraction exercises, and physioball for proprioception, among other therapies. The patient's initial headache lasted 4 days. He had a second headache for 1.5 days during his exercise training. During the next 7 months while returning to the clinic twice monthly for an elective chiropractic maintenance program, his headaches did not recur. He also had improvement on radiograph.
CONCLUSION:
The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache.
J Pak Med Assoc. 2012 Mar;62(3 Suppl 2):S20-5.
Aghili MM, Asilian H, Poursafa P.
Source
Ministry of Health and Medical Education, Tehran. [email protected]
Abstract
INTRODUCTION:
A 15-year research conducted in USA showed that compensation expenses paid to workers for musculoskeletal disorders (MSDs) of back exceeded 128 million Dollars calculated on the basis of 0.97 Dollars per hour of work. In addition, according to the latest studies carried out in relation with disease burdens with risk factors in Iran, DALYs indices for low back pain, knee arthrosis and other musculoskeletal disorders have been reported to be 307772, 291305 and 872633 respectively, which have caused the work related diseases to occupy the second position in the country, after cardiovascular diseases. On the other hand, in accordance with occupational health indices of Iranian health ministry, 37% of all working population had had poor work postures with 15% of all working population had been working with inappropriate working tools in the year 2009.
METHODS:
This was a case study comparing exposed workers with control group using Standard Nordic Questionnair in sewing machine operators of a shoe manufacturing factory in Iran. In this study, the mentioned questionnaires were filled out for the exposed group (25 sewing machine operators with average age of 43.5 years with work records of 16.8 years) and control group (15 employees from administrative department with average age of 39.8 years with work records of 13.4 years) which both were selected through simple random method.
RESULTS:
There were statistically significant differences in age between musculoskeletal disorders of right elbow (p = 0.033), thigh (p = 0.044), both knees (p = 0.019) and ankles (p = 0.039). There were also statistically significant association between gender and musculoskeletal disorders of right elbow (p = 0.028), thigh (p = 0.026) both knees (p = 0.011); right shoulder disorders (p = 0.018) and work records; disorders of both knees (p = 0.031) and number of cigarettes smoked.
CONCLUSIONS:
In general, prevalence of disorders of cervical area, shoulders with hands, vertebral column, back, knees, thigh with feet were higher in exposed group due to poor work posture. Meanwhile, female workers were inflicted more than males. On the other hand, these disorders were seen more with increased work records and age in which, improvement of work postures, training for better execution of tasks and conducting periodic screening tests are being recommended.
_________________________________________________________________________________
The rehabilitation of hyperkyphotic posture in the elderly
Eur J Phys Rehabil Med. 2009 Dec;45(4):583-93.
Kado DM.
Source
Department of Orthopedic Surgery, UCLA Orthopaedic Hospital, Los Angeles, CA 90095, USA. [email protected]
Abstract
The angle of thoracic kyphosis tends to increase with age resulting in hyperkyphosis in some individuals. While the term "kyphotic" is occasionally used to describe someone with accentuated thoracic curvature, hyperkyphosis is preferred since kyphosis itself refers to the normal sagittal angle of thoracic curvature. Epidemiolo-gic studies have demonstrated that age-related hyperkyphosis commonly affects the elderly population with estimates ranging from 20% to 40%. In addition, hyperkyphosis affects a substantial number of older men. Apart from being a cosmetic deformity, older persons who suffer from hyperkyphosis are at increased risk for a variety of adverse health outcomes that include poor physical function, pulmonary compromise, falls, fractures, and even earlier mortality. Most clinicians and patients have assumed that thoracic hyperkyphosis is a result of underlying spinal osteoporosis, but approximately two thirds of those who are most hyperkyphotic don't have vertebral fractures. Over the past few years, there has been increased awareness and focus on potential effective treatments for age-related hyperkyphosis. Of these treatments, exercise based interventions and spinal orthoses are conservative rehabilitation management techniques that have shown promise in potentially improving health outcomes for affected patients. To date, all of these types of trials have been small in scale, and most short in duration. In the future, larger rigorously designed clinical trials will be needed to test and confirm the efficacy and feasibility of the most promising treatments for age-related hyperkyphosis. This invited review will discuss hyperkyphosis in terms of its etiology, clinical associations, and treatment in elderly individuals.
________________________________________________________________________________
Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study
J Am Geriatr Soc. 2004 Oct;52(10):1662-7.
Kado DM, Huang MH, Karlamangla AS, Barrett-Connor E, Greendale GA.
Source
Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California 90095, USA. [email protected]
Abstract
OBJECTIVES:
To determine the association between hyperkyphotic posture and rate of mortality and cause-specific mortality in older persons.
DESIGN:
Prospective cohort study.
SETTING:
Rancho Bernardo, California.
PARTICIPANTS:
Subjects were 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit between 1988 and 1991.
MEASURES:
Kyphotic posture was measured as the number of 1.7-cm blocks that needed to be placed under the participant's head to achieve a neutral head position when lying supine on a radiology table. Demographic and clinical characteristics and health behaviors were assessed at a clinic visit using standard questionnaires. Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates.
RESULTS:
Hyperkyphotic posture, defined as requiring one or more blocks under the occiput to achieve a neutral head position while lying supine, was more common in men than women (44% in men, 22% of women, P<.0001). In age- and sex-adjusted analyses, persons with hyperkyphotic posture had a 1.44 greater rate of mortality (95% confidence interval (CI)=1.12-1.86, P=.005). In multiply adjusted models, the increased rate of death associated with hyperkyphotic posture remained significant (relative hazard=1.40, 95% CI=1.08-1.81, P=.012). In cause-specific mortality analyses, hyperkyphotic posture was specifically associated with an increased rate of death due to atherosclerosis.
CONCLUSION:
Older men and women with hyperkyphotic posture have higher mortality rates.
________________________________________________________________________________
Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study
J Gerontol A Biol Sci Med Sci. 2005 May;60(5):633-7.
Kado DM, Huang MH, Barrett-Connor E, Greendale GA.
Source
Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave., Suite 2339, Los Angeles, CA, USA. [email protected]
Abstract
BACKGROUND:
Physical functional decline is often the determining factor that leads to loss of independence in older persons. Identifying risk factors for physical disability may lead to interventions that may prevent or delay the onset of functional decline. Our study objective was to determine the association between hyperkyphotic posture and physical functional limitations.
METHODS:
Participants were 1578 older men and women from the Rancho Bernardo Study who had kyphotic posture measured as the distance from the occiput to table (units = 1.7-cm blocks, placed under the participant's head when lying supine on a radiology table). Self-reported difficulty in bending, walking, and climbing was assessed by standard questionnaires. Physical performance was assessed by measuring grip strength and ability to rise from a chair without the use of the arms.
RESULTS:
Men were more likely to be hyperkyphotic than were women (p <.0001). In multiply adjusted comparisons, there was a graded stepwise increase in difficulty in bending, walking and climbing, measured grip strength, and ability to rise from a chair. For example, the odds ratio (OR) of having to use the arms to stand up from a chair increased from 1.6 (95% confidence interval [CI]: 0.9-3.0) for individuals defined as hyperkyphotic by 1 block to 2.9 (95% CI: 1.7-5.1) for individuals defined as hyperkyphotic by 2 blocks to 3.7 (95% CI: 2.1-6.3) for individuals defined as hyperkyphotic by > or = 3 blocks compared to those who were not hyperkyphotic (p for trend < .0001).
CONCLUSIONS:
Older persons with hyperkyphotic posture are more likely to have physical functional difficulties.
________________________________________________________________________________
Hyperkyphotic posture and risk of injurious falls in older persons: the Rancho Bernardo Study
J Gerontol A Biol Sci Med Sci. 2007 Jun;62(6):652-7.
Kado DM, Huang MH, Nguyen CB, Barrett-Connor E, Greendale GA.
Source
David Geffen School of Medicine, Los Angeles, CA 90095, USA. [email protected]
Abstract
OBJECTIVE:
Falls among older adults can have serious physical and emotional consequences, ultimately leading to a loss of independence. Improved identification of those at risk for falls could lead to effective interventions. Because hyperkyphotic posture is associated with impaired physical functioning, we hypothesized that kyphosis may also be associated with falls.
METHODS:
Participants were 1883 older adults from the Rancho Bernardo Study. Between 1988 and 1991, kyphosis was measured using a system of 1.7-cm blocks placed under the participants' heads if they were unable to lie flat without neck hyperextension. Data on falls including injurious falls, demographics, health, and habits were obtained from a self-administered questionnaire completed at the same visit.
RESULTS:
Hyperkyphosis was defined as requiring the use of > or = 1 blocks (n = 595, 31.6%). In this cohort, men were more likely to be hyperkyphotic than were women (p <.0001). Of those who fell, 36.3% were hyperkyphotic, versus 30.2% among those who did not fall (p =.015). Those who fell were older, more likely to be women, had lower body mass index, did not exercise, did not drink alcohol, and had poor self-reported physical and emotional health. In age- and sex-adjusted models, those with hyperkyphosis were at 1.38-fold increased odds of experiencing an injurious fall (95% confidence interval [CI], 1.05-1.91; p =.02) that increased to 1.48 using a cutoff of > or = 2 blocks versus < or = 1 blocks (95% CI, 1.10-2.00; p =.01). Although women were more likely to fall, after adjustment for possible confounders, men with moderate hyperkyphosis were at greatest fall risk.
CONCLUSIONS:
Moderate hyperkyphotic posture may signify an easily identifiable independent risk factor for injurious falls in older men, with the association being less pronounced in older women.
________________________________________________________________________________
Influence of age on cervicothoracic spinal curvature: an ex vivo radiographic survey
Clin Biomech (Bristol, Avon). 2002 Jun;17(5):361-7.
Boyle JJ, Milne N, Singer KP.
Source
Department of Surgery, Centre for Musculoskeletal Studies, The University of Western Australia, Royal Perth Hospital, Level 2, MRF Building, WA Medical Res. Inst. Bldg., Rear 50 Murray Street, WA 6000, Australia.
Abstract
OBJECTIVE:
To define the post-mortem cervicothoracic spinal curvature relative to age.
DESIGN:
Spinal curvature assessment of lateral cervicothoracic radiographs.
BACKGROUND:
A late consequence of age is the progressive accentuation of spinal curvatures, particularly the thoracic kyphosis. Little is known about the influence of the kyphosis on the alignment of the cervical spine.
METHOD:
One hundred and seventy two lateral spinal radiographs (113 males, 59 females) were analysed using two procedures: (1) sagittal curve deformation angles were derived, according to the method of Cobb, for thoracic (T1-T12), cervical (C2-C7) and cervicothoracic junctional regions (C6-T4); and (2) the cervicothoracic curvatures were digitised (C2-T12), to derive the apex of both curves and the inflexion point.
RESULTS:
A significantly increasing thoracic spinal curvature was determined for both genders, with the mean apex of the kyphosis close to T6. The cervical lordosis tended to flatten with increasing age, particularly in males, with the cervical apex location shifting cranially. This association was significant in older males and females. The mean location of the cervicothoracic curve inflexion point moved from T3 towards C7-T1 with increasing age.
CONCLUSION:
The cervicothoracic spinal curvature undergoes progressive change through the lifespan with a subsequent cranial migration of the inflexion point between the thoracic kyphosis and cervical lordosis, accompanied by a similar shift in the cervical apex.
RELEVANCE:
Sensitive measures of spinal curvature have utility in determining changes attributed to age, deformity or trauma on cervicothoracic spinal alignment. The value of assessing the location of curve inflexion lies in the ability to quantify changes in the relationship between different regions of the human spine without problems associated with identifying specific vertebral landmarks.
_________________________________________________________________________________
Exercise capacity, respiratory mechanics and posture in mouth breathers
Braz J Otorhinolaryngol. 2011 Sep-Oct;77(5):656-62.
Okuro RT, Morcillo AM, Sakano E, Schivinski CI, Ribeiro MÂ, Ribeiro JD.
Source
Campinas State University-Universidade Estadual de Campinas .
Abstract
Chronic and persistent mouth or oral breathing (OB) has been associated with postural changes. Although posture changes in OB causes decreased respiratory muscle strength, reduced chest expansion and impaired pulmonary ventilation with consequences in the exercise capacity, few studies have verified all these assumptions.
OBJECTIVE:
To evaluate exercise tolerance, respiratory muscle strength and body posture in oral breathing (OB) compared with nasal breathing (NB) children.
MATERIAL AND METHOD:
A cross-sectional contemporary cohort study that included OB and NB children aged 8-11 years old. Children with obesity, asthma, chronic respiratory diseases, neurological and orthopedic disorders, and cardiac conditions were excluded. All participants underwent a postural assessment, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), the six-minute walk test (6MWT), and otorhinolaryngologic evaluation.
RESULTS:
There were 107 children (45 OB and 62 NB). There was an association between abnormal cervical posture and breathing pattern: 36 (80.0%) OB and 30 (48.4%) NB presented abnormal head posture (OR=4.27 [95% CI: 1.63-11,42], p<0.001). The mean MIP and MEP were lower in OB (p=0.003 and p=0.004).
CONCLUSION:
OB children had cervical spine postural changes and decreased respiratory muscle strength compared with NB.
________________________________________________________________________________
Lumbar hyperlordosis in children and adolescents at a privative school in southern Brazil: occurrence and associated factors
Cad Saude Publica. 2012 Apr;28(4):781-8.
Lemos AT, Santos FR, Gaya AC.
Source
Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil. [email protected]
Abstract
Posture assessment during childhood and adolescence allows early detection of postural disorders and adoption of preventive measures. This study evaluated the occurrence of lumbar hyperlordosis and associated factors in 467 children and adolescents aged 10 to 16 years at a school in Porto Alegre, Rio Grande do Sul State, Brazil. Lumbar hyperlordosis was defined as increased lumbar curvature evaluated by photography. Prevalence of lumbar hyperlordosis was 78%. Factors positively associated with lumbar hyperlordosis were female gender (PR = 1.08; 95%CI: 1.03; 1.13), abdominal strength below the 20th percentile (PR = 1.10; 95%CI: 1.05; 1.15), and flexibility below the 20th percentile (PR = 1.07; 95%CI: 1.01; 1.12). Lumbar hyperlordois was negatively associated with lumbar mobility (PR = 0.90; 95%CI: 0.85; 0.96) and height (PR = 0.995; 95%CI: 0.99; 0.999). Effective strategies to improve physical fitness in schoolchildren are necessary, because low abdominal strength and low flexibility were associated with lumbar hyperlordosis.
_____________________________________________________________________________
Effect of sagittal alignment on kinematic changes and degree of disc degeneration in the lumbar spine: an analysis using positional MRI
Spine (Phila Pa 1976). 2011 May 15;36(11):893-8.
Keorochana G, Taghavi CE, Lee KB, Yoo JH, Liao JC, Fei Z, Wang JC.
Source
Department of Orthopaedics, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Abstract
STUDY DESIGN:
Retrospective analysis using positional MRI.
OBJECTIVE:
To determine the effects of total sagittal lordosis on spinal kinematics and degree of disc degeneration in the lumbar spine.
SUMMARY OF BACKGROUND DATA:
Changes in sagittal lordosis alter the load on the spine and may affect spinal mobility. There is increasing recognition of the clinical impact that sagittal alignment has on back pain, especially its possible role in accelerating adjacent segment degeneration after spinal fusion. However, its relationship to segmental mobility and degeneration of the lumbar spine has yet to be determined.
METHODS:
Four hundred and thirty patients who had low back pain with or without leg pain (241 males and 189 females) with a mean age of 42.98 years (range, 16-85 years) were included. Total sagittal lordosis (T12-S1) was divided into three groups; Group A: Straight or Kyphosis (<20°, n = 84), Group B: Normal lordosis (20-50°, n = 294), and Group C: Hyperlordosis (>50°, n = 52). The degree of disc degeneration was graded using midsagittal T2-weighted MR images. Segmental mobility, including translational motion and angular variation, was measured using positional MRI. Their relationship with total segmental lordosis was identified.
RESULTS:
When compared with group B, the segmental motion in group C tended to be lower at the border of lordosis and higher at the apex of lordosis, with a significant difference in angular motion at L2-L3. The contrary finding was identified in group A, which had a higher segmental motion at border segments and lower motion at apical segments of lordosis, with significant difference of translational motion at L3-L4 and angular motion at L1-L2. Apical segments contributed more, whereas border segments contributed less to the total angular mobility in more lordotic spines. The opposite was seen in more kyphotic spines. Disc degeneration tended to be greater at all levels in group C, and at L1-L2 and L5-S1 in group A.
CONCLUSION:
Changes in sagittal alignment may lead to kinematic changes in the lumbar spine. This may subsequently influence load bearing and the distribution of disc degeneration at each level. Sagittal alignment, disc degeneration, and segmental mobility likely have a reciprocal influence on one another.
______________________________________________________________________________
Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons
Arch Phys Med Rehabil. 2009 Apr;90(4):669-74.
Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI.
Source
Faculty of Health, Leeds Metropolitan University, Leeds, UK.
Abstract
OBJECTIVE:
To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals.
DESIGN:
Single-blind (assessor) cross-sectional study.
SETTING:
Hospital and general community.
PARTICIPANTS:
Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40).
INTERVENTIONS:
Not applicable.
MAIN OUTCOME MEASURES:
Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images.
RESULTS:
NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean +/- SD, 45.4 degrees +/-6.8 degrees ; pain-free, mean +/- SD, 48.6 degrees +/-7.1 degrees ; P<.05; confidence interval [CI] for the difference between groups, 0.9 degrees -6.3 degrees ). Dividing the population according to age into younger (</=50y) and older (>50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean +/- SD, 46.1 degrees +/-6.7 degrees ; pain-free, mean +/- SD, 51.8 degrees +/-5.9 degrees ; P<.01; CI for the difference between groups, 1.8 degrees -9.7 degrees ) but no difference for the older group (NP, mean +/- SD, 44.8 degrees +/-7.1 degrees ; pain-free, mean +/- SD, 45.1 degrees +/-6.7 degrees ; P>.05; CI for the difference between groups, -4.9 degrees -4.2 degrees ). No other differences were found between patients and pain-free participants.
CONCLUSIONS:
Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful.
________________________________________________________________________________
Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome
J Orthop Sports Phys Ther. 2009 Sep;39(9):658-64.
De-la-Llave-Rincón AI, Fernández-de-las-Peñas C, Palacios-Ceña D, Cleland JA.
Source
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Abstract
STUDY DESIGN:
Case control study.
OBJECTIVES:
To compare the amount of forward head posture (FHP) and cervical range of motion between patients with moderate carpal tunnel syndrome (CTS) and healthy controls. We also sought to assess the relationships among FHP, cervical range of motion, and clinical variables related to the intensity and temporal profile of pain due to CTS.
BACKGROUND:
It is plausible that the cervical spine may be involved in patients with CTS. No studies have investigated the possible associations among FHP, cervical range of motion, and symptoms related to CTS.
METHODS:
FHP and cervical range of motion were assessed in 25 women with CTS and 25 matched healthy women. Side-view pictures were taken in both relaxed-sitting and standing positions to measure the craniovertebral angle. A CROM device was used to assess cervical range of motion. Posture and mobility measurements were performed by an experienced therapist blinded to the subjects' condition. Differences in cervical range of motion were examined using the nonparametric Mann-Whitney U test. A 2-way mixed-model analysis of variance (ANOVA) was used to evaluate differences in FHP between groups and positions.
RESULTS:
The ANOVA revealed significant differences between groups (F = 30.4; P<.001) and between positions (F = 6.5; P<.01) for FHP assessment. Patients with CTS had a smaller craniovertebral angle (greater FHP) than controls (P<.001) in both standing and sitting. Additionally, patients with CTS showed decreased cervical range of motion in all directions when compared to controls (P<.001). Only cervical flexion (rs = -0.43; P = .02) and lateral flexion contralateral to the side of the CTS (rs = -0.51; P = .01) were associated with the reported lowest pain experienced in the preceding week. A positive association between FHP and cervical range of motion was identified in both groups: the smaller the craniovertebral angle (reflective of a greater FHP), the smaller the range of motion (r values between 0.27 and 0.45; P<.05). Finally, cervical range of motion and FHP were negatively associated with age in the control group but not in the group with CTS.
CONCLUSIONS:
Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion. However, a cause-and-effect relationship cannot be inferred from this study. Future research should investigate if FHP and restricted cervical range of motion is a consequence or a causative factor of CTS and related symptoms (eg, pain).
____________________________________________________________________________
The relationship between head posture and severity and disability of patients with neck pain
Man Ther. 2008 May;13(2):148-54. Epub 2007 Mar 23.
Yip CH, Chiu TT, Poon AT.
Source
Physiotherapy Department, Queen Mary Hospital, Hong Kong.
Abstract
STUDY DESIGN:
A cross-sectional correlation study.
OBJECTIVES:
To investigate the relationship between head posture with pain and disability in patients with neck pain.
METHOD:
Sixty-two subjects with neck pain and 52 normal subjects were recruited by convenience sampling. The forward head posture was measured via the craniovertebral (CV) angle by using the Head Posture Spinal Curvature Instrument (HPSCI). The Chinese version of Northwick Park Neck Pain Questionnaire (NPQ) and Numeric Pain Rating Scale (NPRS) were used to assess neck pain disability and severity. The difference in CV angles between the two groups and Pearson's correlation coefficient between the CV angle, NPQ and NPRS were determined.
RESULTS:
There was a significant difference in the CV angle between subjects with and without neck pain. CV angle was negatively correlated with NPQ (r(p)=-0.3101, p=0.015) and NPRS (r(p)=-0.329,p=0.009). It was also negatively correlated with age (r(p)=-0.380,p=0.002). When age was taken into account, the CV angle was negatively correlated with NPQ (r(p)=-0.3101,p=0.015) but showed no significant correlation with NPRS (r(p)=-0.1848,p=0.154).
CONCLUSION:
The CV angle in subjects with neck pain is significantly smaller than that in normal subjects. There is moderate negative correlation between CV angle and neck disability. Patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability.
________________________________________________________________________________
Upper crossed syndrome and its relationship to cervicogenic headache
J Manipulative Physiol Ther. 2004 Jul-Aug;27(6):414-20.
Moore MK.
Source
[email protected]
Abstract
OBJECTIVE:
To discuss the management of upper crossed syndrome and cervicogenic headache with chiropractic care, myofascial release, and exercise.
CLINICAL FEATURES:
A 56-year-old male writer had been having constant 1-sided headaches radiating into the right eye twice weekly for the past 5 years. Tenderness to palpation was elicited from the occiput to T4 bilaterally. Trigger points were palpated in the pectoralis major, levator scapulae, upper trapezius, and supraspinatus muscles bilaterally. Range of motion in the cervical region was decreased in all ranges and was painful. Visual examination demonstrated severe forward translation of the head, rounded shoulders, and right cervical translation.
INTERVENTION AND OUTCOME:
The patient was adjusted using high-velocity, short-lever arm manipulation procedures (diversified technique) and was given interferential myofascial release and cryotherapy 3 times weekly for 2 weeks. He progressed to stretching and isometric exercise, McKenzie retraction exercises, and physioball for proprioception, among other therapies. The patient's initial headache lasted 4 days. He had a second headache for 1.5 days during his exercise training. During the next 7 months while returning to the clinic twice monthly for an elective chiropractic maintenance program, his headaches did not recur. He also had improvement on radiograph.
CONCLUSION:
The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache.
©2024 Abundant Universe, Inc., All Rights Reserved