tight cervical extensor musculature also predisposes the person to tension headaches , cervical spine osteoarthrosis , and disc pathology . None of these effects must follow , but the likelihood of these biomechanical sequelae increases with FHP
Now , will a person with FHP necessarily experience pain and / or dysfunction ? No . The human body has the ability to deal with a great deal of structural asymmetry without necessarily spilling over into patterns of pain and dysfunction . Further , it would make sense from a mechanical point of view that this repetitive physical stress would take many years before tissues are overloaded to the point that pain and dysfunction would occur .
The Relationship Between FHP and Pain
Now let ’ s turn out attention to the relationship between FHP and pain . In a previous journal article , I recently addressed the advent of what I term “ negative ideologies ,” examining the ideology that has gained favor in recent years that certain muscles cannot be stretched . I would like to address here another somewhat new negative ideology that FHP , and indeed most all postural distortion patterns do not cause pain .
I always try to be careful with my verbiage . I do not believe that FHP must cause pain , or that it must cause dysfunction for that matter . In fact , I believe that function is much more important than structure , including good and bad postures . Clinically , I often counsel my patients that a small degree of scoliosis , or pronated feet , or FHP for that matter , are rarely important to their quality of life .
But biomechanics , and therefore these pathomechanics , do matter . The presence of any structural condition , any asymmetry of hard or soft tissues , must , by definition , place physical stress forces into the body . The only question is whether they will accumulate to reach a threshold tipping point that impacts the person ’ s life with pain and / or dysfunction .
So , when a person presents with a small postural distortion pattern , I do not alarm them about all the horrible things that must inevitably befall them with their condition . I do not try to scare them or convince them that they need long treatment programs because of the postural distortion pattern that they have . Instead , I reassure them that their condition is mild and need not impact their life . But … I do explain to them that if they do not take the healthful steps to improve their health , that their condition might progress to the point that it will cause pain and / or dysfunction .
Again , biomechanics do matter . They must matter . Structure must inevitably affect function , at least in most cases . So , like dominoes falling , if a condition like FHP is allowed to progress , the person will , most likely , experience some type of pain or dysfunction . And when it finally surfaces , it will likely be much harder to treat , and the prognosis for improvement will be diminished .
New Study
My motivation for writing this article is the release of a new research study that examines the correlation between FHP and neck pain . I feel that this study , and its interpretation , are the perfect example of what is so wonderful and at the same time so frustrating to me about evidence-based research , and its place in the clinical world of manual and movement therapy , because advocates of the belief that there is no correlation between postural distortion and pain have used this study to advance their ideology .
So , let ’ s explore this study 1 …
A review of previously done studies ( a metastudy ) was done , and the conclusion was that there is no correlation between the presence of FHP and neck pain . Hmm … This seems to back up the new negative ideology that there is no correlation between posture and pain . Isn ’ t research wonderful !
But wait , there was a problem with the analysis of the data , because the presence of neck pain was also related to the age of the person . So , it depends on the criteria of the study and the interpretation . Isn ’ t research problematic !
So , the results for the adolescents and adults were separated out and , lo and behold , there IS a correlation between FHP and neck pain in adults , but there is not in adolescents . Isn ’ t research wonderful again !
But then , why do adults with FHP have neck pain but adolescents with FHP do not ?
The authors make a few proposals , both of which I feel are reasonable ( perhaps the degree of FHP is greater in adults ; and adults may have an imbalance of deep versus superficial muscle activity ), but here is where I find research problematic again !
Because proposing reasons for the difference between these age groups comes back to interpretation and I feel that they missed the biggest and most likely interpretative reason for this difference … that is that FHP posture is an overuse repetitive injury .
FHP places an increased physical stress load on the tissues to support this imbalanced posture , and that stress load builds up over time . This increased physical stress was mentioned in the study , but the concept of physical stress being like a repetitive-stress microtrauma that accumulates was not .
I think that this idea of accumulated physical stress is the most obvious explanation and I believe that most any manual therapist or movement professional would likely come to this conclusion because we pay attention to the mechanics of the human body , specifically the mechanics of the
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