ATMS Journal Autumn 2022 (Public Version)

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FHP with dysfunction but not Pain

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Figure 2 . Cervicocranial extensor musculature . Superficial , intermediate , and deep views .

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( Figures 2AB courtesy of Muscolino , Joseph E ; The Muscular System Manual – The Skeletal Muscles of the Human Body , 4th edition . Elsevier , 2017 )

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I have posited that the counterbalancing extension force to prevent the head and neck from falling into flexion is created by isometric contraction of cervicocranial extensor musculature in the back of the neck . However , that is not necessarily true . And I discovered this with an octogenarian patient who presented to me with the most pronounced FHP ( stemming largely from an incredibly hyperkyphotic thoracic spine – see Box on Upper Crossed Syndrome ) that I had ever seen . I fully expected upon palpation examination to find that the muscles in the back of the neck would be extremely tight . But they weren ’ t . In fact , they were extremely loose . And he had zero neck pain . Why ? I found out during joint mobilization examination . His cervical spinal joints were effectively locked with no range of motion . I did not have the benefit of an X-ray or any other radiographic imaging to view , but I would venture to say that his body had probably taken the load off his neck musculature by having increased fibrosis of his posterior cervical fascial tissues , including the facet joint capsules , and perhaps osteoarthrotic bony fusion throughout his cervical spine . With the adhesions and fusing of these “ passive ” tissues , his “ active ” musculature was relieved of all work and responsibility to maintain the otherwise imbalanced posture of this head . Certainly , this individual would be an example of a person with FHP ( indeed , even severe FHP ) who had no pain at all , but with all ranges of motion lost , did have quite severe dysfunction .

JATMS | Autumn 2022 | 9

ATMS Journal Autumn 2022 (Public Version) | Page 9