This time, I'd like to talk about neck pain and forward neck position.
When you go to an osteopath for neck pain, you will probably be told that it is caused by posture.
When I was working at an osteopathic clinic, I was trained to explain the relationship between neck pain and posture as part of the policy there.
It's not hard to understand from an anatomical point of view, but the human body is not something that can be simply derived.
Can you answer those questions? Here are the conclusions of the study.
Contents of the study
Forward displaced head posture (FHP) and muscle dysfunction may be factors in chronic neck pain (CNP), but there are inconsistent findings regarding the relationship between these factors and the characteristics of clinical CNP.
The FHP, a study comparing neck muscle size and endurance in asymptomatic participants with CNP, will be a study investigating the relationship between pain and disability, and the relative involvement of deep/superficial and flexor/extensor muscles.The study included 32 patients with CNP and 35 asymptomatic participants.
FHP in standing, extensor and flexor endurance and dimensions were assessed using digital photography, clinical examination and ultrasound imaging, respectively.
A visual analog scale and a neck disability index were also used to assess the clinical characteristics of CNP patients.
According to the results, the size of the deep flexor and extensor muscles was found to be significantly smaller in CNP patients.
CNP patients showed lower levels of flexor and extensor endurance.
FHP did not differ between the groups and was not correlated with any of the dependent variables.
Neither FHP nor endurance correlated with pain/disability.
Extensor endurance in both groups and flexor endurance in the asymptomatic group correlated significantly with muscle size.
Thus, FHP did not differ between the groups and did not correlate with muscle performance or clinical features of CNP.
Muscle endurance in the neck was found to be lower in patients with CNP, but was not associated with pain or disability.
The relationship between muscle size and endurance seems to be more complex in the presence of NP.
Deeper muscles appear to be affected differently in the presence of CNP, but the changes do not appear to be uniform across flexor and extensor groups.
Discussion
The anterior head tilt posture showed that there was no association with neck pain, but there were differences in muscular endurance and other factors.
As for the relationship, some cases were reported to be somewhat related rather than "not at all," but some research results suggest that the relationship is about 10% of the intensity of pain and disability.
All of this suggests that it is better to focus on muscle activation rather than on posture.Muscle size and other factors were also known to make a difference, but there is no evidence that muscle size is directly related to actual neck pain.
If it's weak, train it! some might think, but it is unclear whether hypertrophy will reduce neck pain.
Instead, it would be more clinically meaningful to focus on the low muscular endurance and other factors, and identify which muscle groups to activate for therapeutic intervention.
Ghamkhar L, Kahlaee AH. Is forward head posture relevant to cervical muscle performance and neck pain? A case-control study. Braz J Phys Ther. 2019;23(4 ):346-354. doi:10.1016/j.bjpt.2018.08.007
Conclusion
The results suggest that it may be better to forget the perception that neck pain cannot be cured because of poor posture.
As I wrote in another article, it is not uncommon for people to stubbornly believe in their own clinical practice as the absolute truth, or to intervene unwillingly due to lack of support from patients, even when such information is presented.
These are things that can be changed with one way of interacting with them, so try to make changes that do not negate their personality.
