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Forward Head Posture and Upper Cross Syndrome In Teenagers
Brittany Beltram
February 15, 2018
Comprehensive Global
Dubai, U.A.E
2017-18
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Abstract
Overview of F.H.P and Upper cross syndrome
Condition, statistics, research
Forward Head Posture is when the head is in a position that is anterior of its neutral.
This can be due to sitting, posture, injury or bad habits. Upper Cross Syndrome is
characterized by an internal rotation of the shoulders and a roundness in the upper
back. Today’s generation is tech driven with regard to education and entertainment.
Children and teens are leading a more sedentary life whether is familial environmental
factors or social obligations and expectations. Teens are experiencing fixation of fascia
and additional tightness in their musculature because of factors outside of normal
growth stages. It is primarily due to less activity and movement. Schools are often
cutting recess short in an effort to reduce playground bullying while not providing
more opportunities for movement inside the classroom. Teenagers are participating in
less organized sports while online gaming participation is skyrocketing. These trends
are only exacerbating the postural imbalances of the 21st century teen.
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Table of contents
Overview
Anatomical description and detail of Forward head Posture and Upper Cross
Syndrome
Case Study
Comprehensive Program Using BASI Block system
Conclusion
Bibliography
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Anatomical description and detail of Forward head Posture and Upper Cross Syndrome
Forward head posture (FHP) is most often described as excessive anterior
positioning of the head in relation to a vertical reference line, involving increased
cervical spine lordosis (head forward, middle cervical spine extended, lower cervical
spine flexed) and rounded shoulders with thoracic kyphosis. Forward Head posture is a
muscle imbalance that is comprised of long, weakened deep cervical flexors and
extensors, trapezius muscles and rhomboids. It also means that the sub occipital
muscles are shortened, along with an imbalance in the sternocleidomastoid and
scalenes.
As a compensatory action for the postural deformity of FHP, severe extension
arises between the upper cervical joint and atlanto-occipital joint, and the upper
cervical vertebrae relatively protrude forward while the face directs upwards. Change in
the curvature of the neck bone causes upper-crossed syndrome due to an imbalance in
muscular pattern, which subsequently leads to rounded shoulder posture (RSP).
Rounded shoulder is a protrusion of the acromion of the shoulder joint relative to the
centerline of gravity of the body, causing stooped posture along with elevation,
protraction, and downward rotation of the scapula, and an increased angle between the
lower neck bone and upper spine. (www.ncbi.nlm.nih.gov/pmc/articles/PMC5088155/)
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The atlanto-occipital joint (articulation between the atlas and the occipital bone) it
consists of a pair of condyloid joints. The atlanto-occipital joint is a synovial joint. The
movements permitted in this joint are:
• (a) flexion and extension around the mediolateral axis, which give rise to the
ordinary forward and backward nodding of the head.
• (b) slight lateral motion, lateroflexion, to one or other side around the
anteroposterior axis.
Flexion is produced mainly by the action of the longi capitis and recti capitis anteriores;
extension by the recti capitis posteriores major and minor, the obliquus capitis superior,
the semispinalis capitis, splenius capitis, sternocleidomastoideus, and upper fibers of
the trapezius. en.wikipedia.org/wiki/Atlanto-occipital_joint. A deviation from the natural
Cervical curve occurs with the repetitive motion of looking down. This happens at the
apex of C4/C5. The brain wants the eyes to be level and not looking down so
hyperextension occurs in an effort to bring the gaze forward.
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www.spineuniverse.com/conditions/kyphosis/kyphosis-description-diagnosis
Upper-Crossed Syndrome (UCS) is also referred to as proximal or shoulder girdle
crossed syndrome. In UCS, tightness of the upper trapezius and levator scapula on the
dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the
deep cervical flexors ventrally crosses with weakness of the middle and lower trapezius.
This pattern of imbalance creates joint dysfunction, particularly at the atlanto-occipital
joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment.
Janda noted that these focal areas of stress within the spine correspond to transitional
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zones in which neighboring vertebrae change in morphology. Specific postural changes
are seen in UCS, including forward head posture, increased cervical lordosis and
thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and
winging of the scapulae. These postural changes decrease glenohumeral stability as the
glenoid fossa becomes more vertical due to serratus anterior weakness leading to
abduction, rotation, and winging of the scapulae. This loss of stability requires the
levator scapula and upper trapezius to increase activation to maintain glenohumeral
centration (Janda 1988) (www.muscleimbalancesyndromes.com/janda-
syndromes/upper-crossed-syndrome/).
Upper Cross posture creates an excessive arch in the neck from tight sub occipital
muscles. Shoulder blades spread and rolling inward as thumbs point to the hips rather
than forward. As the head moves forward it has less ability to rotate. For each inch
forward it doubles the weight and applies additional force to the cervical thoracic
junction.
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Case Study
Rémi is a 17 year old homeschool student and musician. At the age of 10, he was
diagnosed with Complex Partial Seizures. Due to a rigorous schooling program, he
spends six to eight hours at a desk. He stands at 5’11 and has long legs and torso. His
size has him often slouching at his desk while working on tasks. He is also a musician
and plays guitar, drums and bass. All of these musical disciplines favor an Upper Cross
Syndrome Posture. While playing guitar he is continuously, intermittently looking down
at the fret board. As a result of the Forward Head Posture he has become an open
mouth breather at night, while he is sleeping. It is known that when you stop nose
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breathing and your mouth is open, you suffer from deficiencies in O2 (oxygen), CO2
(carbon dioxide), and NO (nitric oxide) in body cells due to hyperventilation. This can
lead to over excited nerve cells and sleep deprivation. Rémi’s main trigger for seizures
is sleep deprivation.
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Comprehensive Program Using the BASI Block System
Initial Assessment -
When viewing client in the saggital plane the deviations along the plumbline are
prominent in the cervical spine. The ear is forward of the plumbline and
the shoulders are rolled forward, creating mild thoracic kyphosis.
Warm Up-
Will initially begin with Fundamental Warm Up Series and progress to
Comprehensive Warm Up on Cadillac.
Fundamental Warm Up- Mat *begin with Roll Downs
Pelvic Tilt, Pelvic Curl, Chest Lift, Chest Lift with Rotation, Supine Spine Twist.
Warm Up progression-Cadillac
Pelvic Tilt, Roll Up with Roll Up Bar, Mini Roll Ups, Mini Roll Up Oblique, Roll Up
Top Loaded
Foot Work- Wunda Chair
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Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf
Raises, Single Leg Heel, Single Leg Toes. (hand positioning provides
opportunity to stretch Pectoralis muscles)
Ab Work- Step Barrel
Chest Lift, Reach, with progression to Overhead Stretch, Teaser
Prep
*options for- Standing Pike and Reverse Pike on Wunda or Tilt and Teaser Prep
on reformer as client progresses.
Hip Work- Cadillac
Supine Leg Series: Frog, Circles Down Up, Walking, Bicycle
Spinal Articulation- (after 10 sessions)
Cadillac: Monkey, Tower Prep, Wunda Chair: Pelvic Curl
Stretches- Initial sessions will utilize stretch series in an effort to increase RoM
options:
Pole Series: Shoulder Stretch, Overhead Stretch, Side Stretch, Spine Twist
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Ladder Barrel- Shoulder Stretch 1, Glute, Adductor or Shoulder Stretch 2,
Hamstrings, Hip Flexors
option to progress to- Wunda Chair: Side Stretch, Reformer:
Standing Lunge
Full Body Integration- Reformer
Scooter Up Stretch 1, Elephant
* option to progress to include- Down Stretch
Arm Work- Initial work well focus on RoM and rehabilitative weight
progressions
Initial sessions-
Magic Circle: Arms Bent, Straight, Overhead, Single Arm Side Press
or
Cadillac: Shoulder Adduction Single Arm and Double, Sitting Side Prep
Wunda Chair: Shrugs
or
Reformer: Supine Arms Series- Extension, Adduction, Up and Down Circles,
Triceps
*option to progress to following options-
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Cadillac: add Sitting Side
Wunda Chair: add Tricep Press Sit, Tricep Prone
or
Reformer: Arms Kneeling Series (weighted initially at Y to HY) Chest Expansion,
Up Circles, Down Circles, Triceps, Biceps
or
Arm Sitting Series- Chest Expansion, Biceps, Rhomboids, Hug a Tree, Salute
Leg Work- Wunda Chair
Leg Press Standing, Hamstring Curl
* option to progress to include Hip Opener on Wunda Chair or
Reformer: Single Leg Skating
Lateral Flexion/ Rotation- Step Barrel, Ladder Barrel, Reformer
Step Barrel: Side Lift, Ladder Barrel: Side Over Prep, Reformer: Mermaid.
* two of the three with one option as Mermaid once Scapular Stabilization is
acquired. Option to progress to Step Barrel: Corkscrew as part of two
exercise option
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Back Extension- Step Barrel/Ladder Barrel/Wunda/Reformer/Cadillac
* Rest Pose between exercises
Step Barrel: Swan Prep, Ladder Barrel: Swan Prep, Wunda: Swan Basic,
Reformer:Breaststroke Prep
*progressions to Step Barrel: Swan, Ladder Barrel: Swan, Wunda: Swan on
Floor, Back Extension Single Arm, Reformer: Pulling Straps 1, Pulling
Straps 2, Cadillac: Prone 1.
two to three of above options depending on time with interchangeable
progression options when more thoracic opening is achieved and client
mobility in Upper Cross Syndrome is evident in updated
plumbline evaluations.
Cool Down: Roll Downs
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Conclusion
Pilates is designed to improve general body flexibility by focusing on strengthening the
‘core complex’, posture and coordination of breathing with movement. Posture
imbalances are addressed by creating body awareness and increasing proprioception.
The stretching and dynamics of the movements in the BASI system, in different planes,
with varying ranges of movement and weighted in various ways with apparatus, are
sequenced to facilitate opening- increasing RoM, and strengthening of the body.
A program that will work to mitigate symptoms of Forward Head Posture and
Upper Cross Syndrome has the potential to help restore not only his current postural
imbalances but also better breathing practices.
Good breathing mechanics along with core strengthening and stabilization will
aid him in conquering postural abnormalities that are present in the activities that he
enjoys and also the ones that he is required to do. This will provide him with a better
opportunity to maintain optimum health moving forward.
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Bibliography
Journal of Physical Therapy Science
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088155/
Groven, Mark ND:Upper Cross Syndrome Postural Health by naturopathic.org
Isacowitz, Rael: Pilates Second Addition
Isacowitz, Rael, Study Guide: Global Comprehensive Course, Costa Mesa, California:
Body Arts and Sciences International, 2013
Isacowitz, Rael, Clippenger, Karen: Pilates Anatomy, 2011
Websites
www.ncbi.nlm.nih.gov/pmc/articles/PMC5088155/
en.wikipedia.org/wiki/Atlanto-occipital_joint
www.muscleimbalancesyndromes.com/janda-syndromes/upper-crossed-syndrome
www.spineuniverse.com/conditions/