Forward head posture – a pain in the neck Dr Shwetha S Hegde Consultant, Oral Medicine and Radiology Australian Dental Board Certified Dr Shwetha S Hegde

What is forward head posture? A major postural imbalance Anterior positioning of the cervical spine Common occupational hazard Dr Shwetha S Hegde

The mechanism.. Poor posture alters spine position mandible shifts forward the upper and lower teeth misalign skull moves back on the spinal column. If not addressed, pain and inflammation in the muscles and jaw joints will develop when the mouth opens and closes. Forward Head Posture (FHP) is a very common postural issue, and it is estimated to occur in between 66% and 90%  of the population. Dr Shwetha S Hegde

Role of the mandible in posture Mandibular posture and head posture are inversely proportional in an antero-posterior (forward- backward) plane. Shifting the mandible backward causes the head to shift forward, and shifting the head forward causes the mandible to shift backward. Dr Shwetha S Hegde

FHP is strongly correlated with backward mandibular posture FHP is strongly correlated with backward mandibular posture.  TMJ disorder patients typically have both FHP and backward mandibular posture. Dr Shwetha S Hegde

Protective mechanism Dr Shwetha S Hegde FHP Increases passive tension in muscles of mastication Backward mandibular posture Decreased resting freeway space   Protective mechanism Dr Shwetha S Hegde

Head and jaw posture are both controlled by a hierarchy of neuromuscular reflexes, and airway protection is top priority.   For every inch the neck goes forward there is an extra 4.5 kg of weight on the neck.  Dr Shwetha S Hegde

FHP produces a progressive loss and then a reversal of the normal cervical curve (lordosis) of the neck Dr Shwetha S Hegde

Changes occurring in the curvature of the spine over time due to FHP Dr Shwetha S Hegde

This leads to stiffness and arthritic changes in the spine FHP causes realignment of the curvature of the spine due shifting of the weight of the head. The weight is distributed unevenly on the intervertebral spine causing compressive strain on the intervertebral disc This leads to stiffness and arthritic changes in the spine Since muscles function in groups, muscles determining posture are also affected Dr Shwetha S Hegde

Effects on tmJ Pain in the muscles of mastication and infrahyoid muscles Pain in the TM joints Change in occlusion due backward shift of the mandible Dr Shwetha S Hegde

THE ROLE OF STRESS Stress worsens muscle tension by a measurable decrease in muscle circulation Brings down threshold for jaw muscle pain due to inhibition of endorphin release Dr Shwetha S Hegde

THE ROLE OF ATTITUDE Attitude influences posture and resting muscle tensions in the jaw area just like it does in the rest of the body.  Dr Shwetha S Hegde

Signs and symptoms Chronic neck pain Headaches Tingling and numbness in the arms and hands Improper breathing Poor neck posture with outward stretching of neck Chronic fatigue Dr Shwetha S Hegde

Treatment goals Re-establishing a stable balanced resting posture for the head and the mandible. Has mechanical and psychological components. Mechanical component- paying attention to posture while standing, sitting sleeping etc  The psychological component involves the way your mental state affects the resting postures of your muscles and thereby also the stance you use for weight bearing.   Dr Shwetha S Hegde

Treatment: EXERCISE STRETCHING PASSIVE PHYSICAL SUPPORT Dr Shwetha S Hegde

Short term treatment: Anti inflammatory drugs Ultrasound TENS Cortisone injections Use of neck brace Dr Shwetha S Hegde

exercise Neck exercises because the neck muscles are the primary determinants of head posture. Resistance exercises to strengthen neck muscles Dr Shwetha S Hegde

Stretching: Yoga, Tai Chi, and swimming are popular exercises which provide both stretching and strengthening.  Another way to combine strengthening with stretching is to pull oneself upward using overhead bars. Dr Shwetha S Hegde

Passive physical support: Ergonomically perfect chair A simple foam rubber mattress or a relatively hard mattress is preferable Passive support using a pillow under the neck Dr Shwetha S Hegde

Do's and don'ts… Make sure your computer monitor is ergonomically set up. top third of your screen is at eye-level. distance from your monitor to your eyes to should be 18 to 24 inches Never carry heavy bags, backpacks or purses Dr Shwetha S Hegde

Buy a supportive neck pillow, if you often wake up with a sore neck. Get up and walk around every half an hour that you work at a desk, work in front of a computer or watch television. Buy a supportive neck pillow, if you often wake up with a sore neck. Dr Shwetha S Hegde

Who are the potential patients? People in the software field Surgeons Dentists Factory/high precision workers People with a desk job People with sedentary lifestyle-prolonged TV watching Dr Shwetha S Hegde

Role of a oral medicine and radiology specialist.. Create awareness among the target population Counsel them to develop better posture and eliminate parafunctional habits Treat the symptoms Dr Shwetha S Hegde

Thank You Dr Shwetha S Hegde