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The Negative Effects of Forward Head Posture on Health & Performance!

I’m your host Dr. Marc Dupuis on this show we discuss tips, tools and strategies for optimizing athletic performance, overall health & wellness!

New forward head posture study, just came out this past July 2022

Journal of Sport Rehabilitation: high level journal
Comparison of Sensorimotor Integration and Skill-Related Physical Fitness Components Between College Athletes With and Without Forward Head Posture
authored by Ibrahim Moustafa, Meeyoung Kim, Deed Harrison.

Case control study.  What is a case control study?
This is pretty neat.  First you identify a condition you want to investigate.  Then you design a study to try and determine, if the condition in question, has any effect on a particular function/task/performance or on health.
Then you must come up with two groups of people to study.
The first group has the condition you want to study
The 2nd group does not have the condition in question.
Next you match the groups in terms of certain factors like age/sex/work/ etc to try to ensure equality in the groups you are comparing minus the key condition being studied

Then determine what types of tests to perform on each group to see if there is a difference between the people with and without the condition

This study looked at the condition of:
Forward head posture

100 Young athletes
College Level athletes high performing athletes
NO symptoms

Q: Was there a Difference in athletic performance skills tests between those with FHP and those without?
How did they determine if someone had FHP?
They used a postural measurement called the CVA (cranial vertebral angle) ear (tragus) relative to C7 spinous relative to horizontal.  This measurement can be confusing to clinicians not familiar with it because a bigger angle, means the head is being held in a more neutral position; while a lower angle means they have more FHP.  Here the CVA cut point was 50° 

The Cut point was based of other well-established studies in the literature
cranial vertebral angle (on 4 view posture screen)

What do these values mean in terms of x-rays

55° or more = Less than 20mm FHP.  That is consistent with what research has shown, most people can get away with about 20mm of FHP and not have any negative consequences.  MC neck p, Has, cervical degeneration & disability

Their cut point of 50° = ~ 25mm or more FHP 1’’

They measured Sensory motor integration: which is how a
stimulus at either the wrist/hand/finger – is processed in the higher centers of the brain

If there is a difference in Sensory motor integration, does it affect athletic skills tests: 

They used 4 key tests, which highlight skills useful in ALL Sports: Basically: Do you have speed/power/strength?
Time sprint T test:
    Sprint 10m straight
    Sprint left 5m
    Sprint right 10m makes “T”
    Sprint back to center 5m
    Sprint back to start

Vertical Leap

Static Single Leg Balance Test – stork

Dynamic Stretch Balance Test – 3 plane dynamic stretch test for agility

Findings: They DID Find a Difference between the 2 groups in amplitude in regions of the brain that process sensory motor integration as it goes into the motor cortex.  Problems in this region would in theory create down going / descending motor cortex issues. As we have known for some time, abnormal sensory inputs create abnormal motor output. 

The athletes with FHP and differences in sensory motor integration, DID in fact score worse on all 4 of the athletic skills tests, and YES, the differences were statistically significant?

On the T-test: They were 10% slower, 1 full second.  For College level athletes, that is huge! 

They scored 9 cm lower on the vertical jump!

They were Several seconds longer on static balance test!

AND the were Less agile!

As if those findings were not enough the researchers took it one step further.  They wanted to know: Is this difference linearly related: Is the magnitude of the FHP linearly correlated with the actual dysfunction. In other words, did athletes with greater amounts of FHP have worse skills tests? The answer was> YES!


Athletes: if you want to have optimal performance you have to correct FHP if you have it!  This is HUGE, the amount of athletes I see everyday with severe FHP has gone up exponentially in just the last few years!  Two big reasons come to mind, the .1st is obvious = Text neck, all of us are looking down at our phones WAY too much and for some it is literally HOURS per day.  You cannot have poor posture for hours at a time and expect to snap out of it for practice or competition!!

2nd, COVID, I cannot tell you have many kids have developed the bad habit of doing their schoolwork while sitting on their bed.  Sadly, many spent countless hours on zoom classes over the last two years which grossly exaggerated their FHP!

All elite professional, college athletes and of course HS & grade school athletes!!! Addressing this NOW can cause significant improvements in your athletic performance

Journal of sport rehabilitation
July 22, 2022,

Weekend athletes, you are physically weaker when you have FHP.   

Older patients, non-athletes, you are less agile when you have FHP, which can easily lead to a greater risk of falls!  Falls in the elderly can be deadly and as mentioned above, you are weaker with FHP.  Also, FHP increases the functional weight of the head, altering loads in the cervical spine which is a major cause of degenerative joint and degenerative disc disease, which often cause neck stiffness, neck pain, headaches, and disability!

This can be one major factor in developing sarcopenia – loss of skeletal muscle which is correlated with increased insulin resistance and even increased mortality! 

Overall conclusions:

First and foremost, this is extremely important and exciting that this study:
    1. This study Validates that chiropractic subluxation (spinal misalignment/deformity/displacement) causes nerve interference, with real health consequences.  Sadly, too many health providers and even some chiropractors think the adjustment is for just spinal pain.  No, nerve interference can manifest itself in a variety of ways in each individual, many will have loss of function, balance, agility and more!
    2. FHP is linearly correlated with brain body/body brain dysfunction with real word decreases in strength, agility and balance!  The greater the forward head posture, the greater the dysfunction!
    3. FHP over 20mm is enough to cause significant performance impairments.  That is only about 1 inch! Look around, next time you are out in public, you will see many, many people with well over 1 inch of FHP, this is truly another epidemic!
    4.  Athletes of all levels, grade school, high school, college athletes and pros, if you want to perform optimally, you have to keep an eye on your posture.  If you have FHP, text neck, you are likely underperforming and correcting this condition is a must if want to perform at your highest capacity!  Now, let’s talk about correcting forward head posture.  Can you correct forward head posture?  Absolutely, at Back to Health Chiropractic, we utilize Chiropractic BioPhysics methods and strategies to do so.  These are, hands down, the most research supported methods on the planet for forward head posture reduction.  Its it easy? NO.  It takes time and it takes work.  The longer you have had FHP the more time it will take.  We use a mulit-modal program that includes, traditional adjustments, mirror image exercises, mirror image traction in-house and home care exercises.  

So there you have it!

This is another high-quality research study that shows that subluxations can cause significant problems, much more than just pain.  Remember, the people in this study where high-level athletes without pain, yet those with FHP subluxation had measurable decreases in function, decreases that can lead to real health challenges!  So, take some time to look at your posture, check the posture of your family, friends and loved ones and if you spot FHP make sure they see a corrective care chiropractor to get to work ASAP on correcting it.  You can find a corrective care chiropractor near you by going to www.ideal.com. 




This concludes today’s episode of The Peak Performance Podcast, where we discuss tips, tools and strategies for optimizing athletic performance, overall health & wellness! Please SUBSCRIBE to this podcast so that you never miss a future episode, also PLEASE take a moment to Rate & Review us on Apple Podcasts, Thank you very much for listening & Have a Great Day!


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