Physiotherapy with 3 shortcut exercises for forward head and neck pain.

             

            Forward head posture is one of the most common abnormal body characteristics which have been seen regularly. It is defined as front displacement of the head, together with over – backward bending of neck vertebral spine. This position shows round shoulders, increasing of anterior cervical convexity, and a decrease of craniovertebral angle which is the angle between the line from the external auditory meatus to the horizontal line at the level of the seventh cervical vertebra.

The forward head posture increases the loads on the necks and shoulders; it causes neck and back pain in 30% of monitor staff workers. Due to, the head is in front of the body-center that leads to a 3.6 times greater load than normal posture. Consequence is work related musculoskeletal disorders, such as pains of neck, shoulder, and headaches.

The forward head posture was first reported through investigation of muscle imbalance syndromes with a reduction in the length of the upper trapezius, the posterior part of the cervical extensor muscles (suboccipitals, semispinalis capitis, splenius capitis-cervicis), the sternocleidomastoid and the scapular elevator. Moreover, the Longus Capitus which is a deep neck flexor gets weak that causes Sternocleidomastoid fire first. As Sternocleidomastoid receives overactive tension, tone, and fatigues, this influences disability and neck pain in patients.  

To solve this problem needs to improve posture and reduction of tone and pain intensity. Therapeutic exercise protocols include general exercise and specific exercises aimed at strengthening particular muscles and soft tissue release technique.

             Strengthening of the Longus Capitus, the deep neck flexor, is a crucial specific strengthening exercise that does chin tuck as goal standard. This exercise can be done alone or combined with other muscles if necessary, for example, the latissimus dorsi pull down, shoulder external rotation exercise, prone horizontal shoulder abduction exercise, shoulder abduction exercise, shoulder flexion exercise and shoulder extension exercise. These exercises contribute shoulder and scapular stability that can improve rounded shoulders.  

             Stretching exercise of the upper trapezius, the posterior part of the cervical extensor muscles (suboccipitals, semispinalis capitis, splenius capitis and splenius cervicis), the sternocleidomastoid and the scapular elevator to release tension and increase specific range of motion in essential direction for reverse forward head.

             Some researchers said prolonged forward head posture will develop wrong alignment memory of neuromuscular. Therefore, neutral head position training to correct posture as a new habit is one of the important components.  

            

This article concluded 3 shortcut exercises to walk away from forward head and neck pain.

Exercise #1: Tennis ball massage at sub – skull

             Tennis ball or spike massage ball is between the sub skull and wall or floor. You can glide your head around and static compress for a while. Make this message until you feel release, then do other exercise

 

Exercise #2: Sternocleidomastoid stretch

             Start with bending the neck backward, then put both hands on the collar bone (clavicle), then slide both hands downward which holds 30 seconds for 5 reps, then start again. 

 

Exercise #3: Chin tuck exercise

             It sounds easy in terms of “glide your head backward” but some patients go in the wrong direction in the first session. The wrong direction includes bending the neck forward or bend neck backward so that you will see the floor or ceiling. Thus, the correct direction is to glide or slide the head backward so that you will look straight ahead. When gliding as far as possible, it is necessary to hold a few seconds and relax. According to exercise fundamentals are 15 reps/set for 3 sets. Intensive exercise needs only 10 reps for every hour during the day.

 

Remark: You can study various of neck stretching on https://rehabcompanion.blogspot.com/2022/04/physiotherapy-with-9-stretching_26.html

 

Reference:

https://www.researchgate.net/publication/344013528_A_Comparison_Study_of_Posture_and_Fatigue_of_Neck_According_to_Monitor_Types_Moving_and_Fixed_Monitor_by_Using_Flexion_Relaxation_Phenomenon_FRP_and_Craniovertebral_Angle_CVA

https://www.researchgate.net/publication/354683774_The_effects_of_therapeutic_exercise_in_improving_forward_head_posture_and_functionality_in_patients_with_neck_pain/link/61463e86519a1a381f6c1286/download

 

https://www.researchgate.net/publication/327397586_Efficacy_of_Suboccipital_and_Sternocleidomastoid_Release_Technique_in_Forward_Head_Posture_Patients_With_Neck_Pain_A_Randomized_Control_Trial/link/5cdd3766458515712eae3e2c/download

https://www.researchgate.net/publication/354683774_The_effects_of_therapeutic_exercise_in_improving_forward_head_posture_and_functionality_in_patients_with_neck_pain

What is physiotherapy recommend to reverse forward head

         Forward head is one of the most common health problem in physiotherapy clinics. It is a postural imbalance of the head to the trunk that may develop muscle neck pain, fatigue, headaches, less neck mobility,  and poor personality.  

Ref: https://health.kapook.com/view142254.html 

  Forward head posture is called more than one name, include; “Scholar’s Neck”, “Wearsie Neck”, “I Hunch”, and “Reading Neck” or “Texting Neck”.  It is defined as a poor habitual neck posture that induces biomechanical changes in the head and spinal columns including protraction of craniocevical region. According to the forward head posture term, head away from the body centraline anteriorly. The structural change in the positioning of the cervical vertebrae in which the upper vertebrae is extended and the lower vertebrae is bent as result of which increase weight of the head over the neck. 

This type of curvature changing is found often in upper cross syndrome that is strongly associated with impairmed muscles. First muscle impairment is shortness of suboccipital muscles that reduce neck mobility. Second is weakness of neck flexors. Third is sensorimotor dysfunction increases posture fluctuation when measured in an upright position without disturbance. All of them provide high stress on cervical extensors such as levator scapulae and semi spinalis capitis and fatigue in suboccipitals like rectus capitis posterior major. 

Left: ideal posture, Right: upper cross syndrome
(Ref: https://www.manchesterosteopathy.co.uk/neck-pain)

Finally, high stress on neck muscles causes neck pain. Pain is an unpleasant sensation associated with actual or potential tissue damage. The sensory processing of affected body parts becomes abnormal and can detect changes in the central information processing system in the state of pain experience and chronic pain.

Common treatment approaches include client postural education, respiratory exercise, ergonomic office facilities, different exercise protocols, motor learning approaches and manual techniques. An important component of physiotherapy intervention provided to patients with neck pain using a combination of stretching, strengthening and sensory training. 

Physiotherapists may start treatment with neck stretching to improve neck motion. You can study neck stretching in https://rehabcompanion.blogspot.com/2022/04/physiotherapy-with-9-stretching.html . Moreover, tennis ball massage which is self - massage with your body weight and tennis ball. This procedure plays the role to soften soft tissue and increase neck motion. 

Tennis ball

Spike massage ball

One of the most common exercises for neck pain is “Chin tuck” which is a static exercise, but could not facilitate the function of cervical stabilizers while it increases the strength of cervical extensors and flexibility of cervical flexors. Additional, chin tuck exercises may improve neck pain, neck mobility, and sensorimotor. Sensorimotor or self - perception on posture should also be considered to correct posture that can enhance participants' posture awareness and potentially alter their habitual posture.

Basic physiotherapy intervention for improve forward head

Exercise #1: Tennis ball massage at sub - skull muscles: Duration of massage is not clear. When muscles decrease tension, you can start stretching or strengthening.

Exercise#2: Chin tuck: Direction of the chin tuck exercise is glide head backward. The goal standard recommends 10  - 15 reps/set for 3 sets a day. In my clinic experience, however, the recommendation is 10 reps per hour. It means chin tuck exercise happens between after waking up until going to bed.

Remark: In case of worse pain and/or any head discomfort, you should stop exercising and observe symptoms for a while. If you do not get better, you should consult doctor or physiotherapist. 

Reference: 

https://www.researchgate.net/publication/333691225_Comparison_of_Sensorimotor_Training_using_Chin-Tuck_Exercise_with_Therapeutic_Stretching_Training_on_Neck_Pain_and_Mobility_in_Individuals_with_Chronic_Non-Specific_Neck_Pain_A_pilot_randomized_contro  

https://biomedpharmajournal.org/vol14no4/immediate-effect-of-chin-tuck-exercises-on-craniovertebral-angle-and-shoulder-angle-among-collegiates-with-forward-head-posture/#:~:text=Chin%20tuck%20in%20exercise%20is%20helpful%20in%20correcting%20forward%20head,forward%20head%20posture%20(FHP). 

https://www.researchgate.net/publication/324685603_Comparing_the_immediate_effect_of_chin_tuck_and_turtle_exercises_on_forward_head_posture_a_single_blind_randomized_clinical_trial 

Physiotherapy with 9 stretching exercises of neck muscles

 

(Ref: https://www.primalpictures.com/blogs/text-neck-anatomy-modern-spine-condition/) 

Suffering from neck muscle pain can be found in worker and athlete populations. Many careers which are prolonged static gazing during working, for example, dentist, goalsmith, computer office worker, or online - student, etc. Some sports can induce neck muscle pain, including; swimming, cycling, running, or weight lifting, etc.  

Muscle stretching is one of the gold standard protocols in physiotherapy to treat neck pain. It is always suggested to people to prevent muscle tension or tightness.  

Benefits of stretching, include;

1. Release neck muscle tension and pain

2. Decrease tension headache 

3. Increase muscle flexibility 

4. Decrease joint stress

5. Decrease forward head posture

6. Decrease risk of muscle pain

Precautions of neck stretching

Precautions determine stretch carefully because the neck region consists of many complicated structures, such as the nerve, vascular, joint, ligaments, bones, and muscles. Although neck stretching is a simple method which can be done generally, but, there are some conditions that subjects have to see a specialist doctor or physiotherapist before stretching. They are include;

1. Past history of neck surgery

2. Past history of neck trauma or injury

3. Present and past history of signs and symptoms of cervical radiculopathy or myelopathy that mean numbness and/or weakness of your arms. They indicated abnormal neurological signs.

4. Present and past history of signs and symptoms of systemic illness or connective tissue disorders.

5. Present illness such as rheumatoid arthritis or spondyloarthropathy. They are conditions of bone and joint degenerative or deformity. 

  6. Constant severe pain

Contraindicated for neck stretching

Contraindications indicate signs and symptoms which must stop neck stretching, include; 

1. Acute inflammation affecting the joint or surrounding tissues (soreness, warm, swelling, redness), 

2. Sharp pain associated with stretch

3. local hematoma as a result of an overstretch injury.

4. Dizzy and head discomfort

5. Be sick (Nausea) and vomit

6. Numbness of shoulder and arm

If you feel something is wrong, please feel free to contact a specialist doctor or physiotherapist. It is to consult for more information or make appointments for more investigation.

How to do stretching?

The way to stretch neck muscles is as simple as ordinary muscle. Subjects are often instructed to continue the stretch to the point where “tightness without pain” or “noticeable tension without pain”. The stretch timing is various, but, the most common prescription from physiotherapist is hold the pose 30 seconds with 3 - 4 repetitions for one muscle. 

9 physiotherapy neck stretchings 

Exercise #1: Lateral neck stretching

Exercise #2: Posterior neck stretching

Exercise #3: Posterolateral with rotation neck stretching (Remark: in case of you feel dizzy, sick, loss consciousness or awareness, you have to stop stretching and observe the symptoms. Please contact doctor if get worse)

Exercise #4: Anterolateral neck stretching (Remark: in case of you feel dizzy, sick, loss consciousness or awareness, you have to stop stretching and observe the symptoms. Please contact doctor if get worse)

Exercise #5: SCM muscle stretching (Remark: in case of you feel dizzy, sick, loss consciousness or awareness, you have to stop stretching and observe the symptoms. Please contact doctor if get worse)

Exercise #6: Posterior sub - skull stretching

Exercise #7: Lateral sub - skull stretching

Exercise #8: Levator scapulae muscle stretching

Exercise #9: Splenius muscle stretching

Reference:

https://www.researchgate.net/publication/5912554_Neck_pain_in_multisport_athletes/link/57751a2b08aeb9427e25a470/download

https://he01.tci-thaijo.org/index.php/bulletinAMS/article/view/60061/49344 

https://www.researchgate.net/publication/273700612_The_effectiveness_of_a_neck_and_shoulder_stretching_exercise_program_among_office_workers_with_neck_pain_A_randomized_controlled_trial/link/563196c208ae506cea67977d/download 

https://www.researchgate.net/publication/5819336_Warm-Up_and_Stretching_in_the_Prevention_of_Muscular_Injury/link/5739c46c08ae9ace840dade0/download