Upper Crossed Syndrome
A
FHP rarely occurs in isolation by itself . Usually , it is part of a larger postural distortion pattern know as upper crossed syndrome ( Figure 3A ). Upper crossed syndrome involves excessive thoracic kyphosis , which then causes the excessive flexion of the cervical spine , which then results in the head being held forward ( protracted and hyperextended ). Upper crossed syndrome also results in excessive protraction of the shoulder girdles as well as medially rotated humeri at the glenohumeral joints .
Cervicocranial extensors
Deep neck flexors
Weak thoracic extensors and scapular retractors
Trunk flexor , scapular protractors , humeral medial rotators
B
Regarding musculature , the name upper crossed syndrome is given because of the characteristic patterns of locked short and locked long musculature in the upper aspect of the body , forming an “ X ” ( Figure 3B ). Appreciating these relationships is extremely important because it is extremely unlikely that FHP posture can be improved unless the underlying thoracic hyperkyphosis of upper crossed syndrome is first addressed and improved .
So , whenever the person is sitting or standing , which is probably between 16-18 hours a day , cervicocranial neck extensor musculature must isometrically work every second of every minute of every one of these hours , every day of every year of every decade . This use / overuse / misuse / abuse of the extensor musculature of the neck will likely result in neck pain . And the mechanical effects of FHP are not limited to the posterior extensor musculature . The chronic posture of holding the head forward will result in adaptive shortening of the flexor musculature of the cervical spine in the front of the neck . Chronically tight posterior and anterior musculature would then result in decreased range of motion . And if the anteriorly located scalenes lock short , then the possibility of anterior scalene syndrome ( a version of thoracic outlet syndrome ) arises . And tight scalenes might pull the first rib up , approximating it toward the clavicle , thereby decreasing the costoclavicular space and predisposing the person toward costoclavicular syndrome ( another version of thoracic outlet syndrome ). The adaptive shortening of the anterior hyoid musculature , with its pull on the mandible , might even precipitate temporomandibular joint ( TMJ ) syndrome . Chronically
10 | vol28 | no1 | JATMS