Forward Head Posture Assessment Test

This is an excerpt from “The Posture Window” in the September/October 2017 issue of Massage & Bodywork magazine, sent to ABMP members as a benefit of membership. Read the full article online at www.massageandbodyworkdigital.com.  

There are three quick, surefire ways to confirm a suspected forward head posture (FHP):

1. Active Range of Motion Testing: (A) With the client standing, have them flex, extend, rotate, and laterally flex their neck. (B) A normal spine in terms of shape and mobility will be able to achieve 50 degrees of flexion, 60 degrees of extension, 90 degrees of rotation, and 45 degrees of lateral flexion. Movements should be smooth, symmetrical, and pain-free. (C) When FHP is present, we should expect to see a decrease in cervical range of motion. Often, pain is present and the client will hesitate as they approach their end range.

2. Lying Flat Test: (A) Have the client lie supine on the treatment table. (B) A normal spine in terms of shape and mobility will allow the client to lie flat with the head and neck in a neutral position. (C) When FHP is present, we should expect to see the head and neck collapse into hyperextension and the chin shoot upward because of compensatory rigidity in the thoracic spine.

3. Deep Neck Flexor Endurance Test: (A) Have the client lie supine on the treatment table. (B) Place your hands underneath the base of their skull, supporting the weight of their head as you lift the head 1 inch off the table. (C) Tuck the client’s chin to achieve a neutral head position. (D) Inform the client that you’re going to slowly remove your hands and that they are to keep their head in this position, not allowing it to move. (E) A normal spine in terms of shape, mobility, and strength should be able to hold the neutral position with the head off the table for 25–40 seconds. (F) When FHP is present, we should expect to see the chin shoot upward again as the sternocleidomastoid and/or platysma take over for the mechanically disadvantaged deep neck flexors.

Once FHP has been confirmed, we will want to keep several key points in mind:

1. First, explain to the client why they are having the pain/symptoms they are having and outline your plan for addressing their issues.

2. Convey that something the client is doing, or not doing, is creating and/ or contributing to their problem. We must work with the client to try to identify the causes and then provide ideas and strategies to reduce or eliminate those suspected causes.

3. Understand that head position drives body position—“Where the head goes, the body will follow.” Because of this, the head is often the best place to begin therapy. So, by reducing FHP, we will inevitably help restore normal length-tension relationships of soft tissue throughout the body.

4. Perform all in-office work and make all recommendations while working within the pattern that’s in place. Make certain we are not reducing the tension, weakening and limiting the client’s ability to stabilize their body. 

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