Transcription
I don't think that most of the posture or rehab community truly understands what forward head posture is. The reason is this: most of the content on the internet centered around fixing forward head posture is very much centered around weak muscles and trying to improve muscular recruitment and activating certain things that will help improve the position of the head. This can be through things like chin tucks or other retraction type activities, through upper back straightening activities, things like that. But that is missing a lot of what the root cause of forward head posture is. That's what I want to get into in this video today.
Forward head posture, to me, is not just tight muscles trying to push the head forward. I want to ask why are those muscles tight in the first place? Why can't they let go to allow the head to become more stacked with the rest of the body? Now there's a lot of research out there that suggests if you don't breathe, you die. So we need to be able to best manage an airway in a position that will open it in a way that will allow us to breathe to some degree of comfort. But our airway can be compromised for several different reasons.
The first reason could be that we have a compressed rib cage. Our rib cage is where our lungs are, obviously, so it should expand in every direction every single breath that we take; it should expand in the front, the back, and the sides. But let's say our rib cage couldn't expand in the way we want to because the ribs are in a depressed position. This is going to pull the head forward, and this is going to allow us to engage muscles on the front side of our neck to elevate our rib cage. These muscles should be secondary assistance muscles of inhalation, but if our diaphragm can't do its job because the ribs are too compressed and turned down and they can't turn up very effectively, and that's often times these neck muscles, which should be assistants, but are now working as primary muscles of getting our ribs to elevate, and that's putting a lot of stress on them. But that's holding us in this position, so it's this sort of feedback loop: our diaphragm doesn't work, so our head goes forward to help give it leverage to elevate our rib cage, and then we can't use our diaphragm more, so it keeps going more and more forward to try to get more expansion that we're lacking.
The other thing is that we could just have a small airway; we could have a restricted airway in some way, shape, or form. And this is usually because we didn't have our jaw and our upper pallet expand enough as we grew up. We probably have some degree of poor tongue posture and tongue function. The tongue serves an absolutely key role in developing our upper, what we call maxilla, and also our jaw, our mandible. Every time that we swallow, we have the tongue pressed up against the roof of the mouth, and that happens thousands of times every day. When we're at rest, the tongue should be at the roof of the mouth, and that should give it very gentle pressure. Now, as we go through our life and as we grow up, that tongue pressure against the roof of the mouth helps create expansion of the upper pallet and moves the teeth away from each other as our teeth grow in, but also as we develop our cranial bones more and more. So this is allowing us to then open up the airway. But let's say that we had a tongue tie, for example, so we have tissues on the underside of the tongue that are pulling the tongue down all the time and restricting its ability to go up to the roof of the mouth. Well, now we have a low-lying tongue; we can't get the tongue to get up to the top of the roof through the mouth without us engaging our neck because if I have a tongue tie, that means I can't dissociate my tongue going up from the tissues on the bottom side of my mouth, and those tissues have an intimate relationship with muscles on the front side of your neck here. So every time you swallow or try to move your tongue up, you're going to engage muscles here, which now we're back to that feedback loop that is going to pull your head forward, and that is problematic.
Another example is many people get teeth pulled before they get braces to help make room for the teeth to realign better within the mouth. A common procedure for this is called a 4 by cuspid extraction. What they often do is take out two teeth on the top, two teeth on the bottom, and that helps create space for them to then make things a little bit straighter. But that over time is going to then bring the teeth closer together, which is going to narrow your mouth and narrow your jaw and narrow your airway. Now you might need to revert to a compensatory mechanism to create more, more airway expansion. So it's not just the muscles; the muscles, yes, can be tight and are tight in many cases, but it's because they're secondarily tight due to an underlying root cause. I'm not saying that chin tuck exercises and those other things are entirely useless, but I do think that they're very much often prescribed in many cases, and it's not totally addressing the root cause for most people. But I want to show you a real-life example. So here's my colleague Mike Cantrell walking through a case study with a patient who has forward head posture.
So what you're seeing in this case is a young man who has some limitations in midfacial development and an inability to control both leaflets of his diaphragm. Now, when there's difficulty controlling both leaflets of the diaphragm, what you'll wind up with is compensatory activity through hyperactivity of the anterior and even the posterior neck, this area that we refer to as the mandibular triangle. Now this issue with hyperactivation of the mandibular triangle tends to cause one of two things to happen: thing number one is forward head, and thing number two is military neck. So imagine in your mind a young man with difficulty of airflow because of poor congruency or functionality of bilateral diaphragms. This issue of limitation then results in what you see on the screen. So what we did in this case is James Anderson, my partner, took this young man and had him begin to crab walk. And you can see in the video as he's doing this crab walk, we're demanding that he control all three diaphragms, the pelvic diaphragm through the use of the ball between the knees. That creates a stable pelvis upon which the rib cage can rotate. As the rib cage learns to rotate on top of a stable pelvic diaphragm, you instantly get inhibition of the anterior neck. The minute the anterior neck is inhibited, then what you see is this after picture of the young man showing a significantly reduced forward head posture within 2 minutes. So this is something that is clear and is, um, objectifiable through observation; you can see what the change is, and it occurs within minutes. So if you do a test retest and in this case a look and a relook, what you see in the after is a different, a definite change in the presentation of the patient, and that change in presentation is enough to motivate the patient. So now what you have is a young man who's seeing with his own eyes the change that occurs, and he'll experience functional mobility improvement in athletic performance. If you want to learn more about the work that Mike, myself, and the Applied Integration Academy team do together, check out this Roundtable discussion where it answers a lot of the common questions I think I'm going to get from this video.
Here's an exercise that I really like to start people with, and this is a really great way you can also teach the neck to not work in overdrive and the diaphragm to work better. Well, we're going to do is get in a 90-90 supported position. Our feet don't necessarily need to be on a wall; just a chair works as long as you have around a 90° bend at both your knees and your hips. The purpose of this is just to make sure that your low back stays relaxed and you're not in an extended position; we just want the rib cage to be down, nice and relaxed here. It is essential that we have a towel roll underneath our neck, and the curvature of our neck is being supported by the thickness of that towel roll. So it will depend how thick that towel is going to be, but the general idea you're looking for is that it's giving you enough support to feel like your chin is pointing directly at the ceiling, but it's not so much to where it's tipping your head back further than that, and it's not so small to where your chin is dropping down. You feel like you can totally relax, and your chin is directly up.
Now we have two yoga blocks right here because we're going to start the exercise by just getting our elbows directly out from our shoulders, right about there, and then just letting them fall back and resting completely passively on those objects. So they don't have to be yoga blocks; you can do whatever you want as long as you're getting an even height on both sides, something about 4 to 6ish inches. If you need something a little bit taller so that way you can stay relaxed, you can do something like that, and that would be totally fine as well. So now the purpose of this is to make sure we can expand our rib cage without engaging our neck whatsoever. It's going to be pretty hard for some people, so here's how I want you to breathe through this: get a nice soft full exhale through your mouth with an open mouth like you're making an O. Do that for about five to 8ish seconds, and at the end of that exhale, you're going to feel your rib cage come down a little bit, and you're going to feel a little bit, hopefully, of side ab engagement—not your six-pack abs, but your side abs—and you're going to maintain a slight bit of tension in those side abs as you close your mouth and put your tongue to the roof of your mouth and inhale very silently through your nose. If you do that full exhale, well, you'll see Trevor's ribs come down. Now he's going to close his mouth, put the tongue on the roof of the mouth, and silently inhale through his nose without engaging his neck whatsoever. So he's going to feel his chest rise a little bit, but again, never at the cost of him feeling his neck engage because the goal of this is to educate our body how to use our diaphragm and breathe without our neck. You need to make sure that your neck stays relaxed. So the biggest problem you're going to have is feeling the front of your neck really want to kick on. So if that's the case, then you can work with more shallow inhales and exhales. So if you feel like when you start to inhale your neck's going to kick on, stop the inhale before that point and then exhale again. If you need to move to strictly just nasal inhalations and exhalations, that's completely fine. Softer and longer breaths are always, always better than harder and more forceful. Here, some common things you might feel which indicate that you're using your neck is obviously tension on the front side, but also the traps raising up like that. Now you are going to get some movement of the chest rising towards the ceiling and the rib cage as a whole, but it should be up, not necessarily shrugging vertically. Now we also want to make sure that our low back stays flat on the ground. So when you inhale, you should not lose that back flatness on the ground. If you're doing that, you might need to drag your heels down into that object, that chair, a little bit; your hamstrings will kick on a little bit, and that'll help you keep your back more flat. [Music]