Chiropractor

[Jones]

Thought this chart might be helpful for those who are suffering various conditions, have attempted other means of dealing with them with limited success. I've seen chiropractors in the past, but went for a fresh assessment with a new chiro today to address some neurological symptoms I've been dealing with. Waiting on his report on the x-rays that he ordered, but at the initial assessment he has identified areas that might need attention. Thing is, I've been seeing a neurologist and they know there is something going on with my nerves, but their approach to reading images doesn't reveal any site of pathology in my thoracic spine. The chiropractor feels that I have misalignments at a number of levels at this stage, so am hopeful that adjustments might help. Wish me luck!

For those interested in polyvagal theory, note that the sympathetic ganglion is between T1 and T5 and the lines from the first pink diamond from the top of the page show how that area is sympathetically linked to the head, face and chest.

 

[Jones]

The chiropractor that I'm seeing has some posters in his practice that address emotional and stress and how that can impact the alignment of the spine. We can apparently subluxate ourselves as a stress or trauma response.

He had heard of polyvagal theory, but admitted that he doesn't know much about it. He did, however, say that he recognises sympathetic dominance patterns in spinal alignment. Said that he treats a woman with PTSD, and after her first few adjustments she mentioned that her night terrors had stopped. He can also tell now when he assesses her spine before each adjustment whether her night terrors have returned.

Last visit, he mentioned the SD Protocol (SD for Sympathetic Dominance). This protocol was developed by a chiropractor, Dr Wayne Todd, when he recognised the match between posture/spinal alignment, hormonal problems, gut problems, and neurological problems. I'm just early into following up on this material and at the moment it seems as though Todd has not taken PVT into account in his system as he is operating under the old paradigm of sympathetic and parasympathetic in tension with each other. Still it's helpful to know that posture can impact wellbeing and maybe even access to ventral vagal state.

At this point I can say that Todd, and my chiropractor, believe that a 'head forward' posture indicates sympathetic dominance and that 'tech neck' can actually put a person into a sympathetic state. There may be more postural clues revealed as I delve into the material. Dr Todd says that for each cm that the head deviates forward, the misaligning force on the spine increases by 4kg. This is an easy one to get an objective measure on. Have someone take a side-on picture of you standing beside a perpendicular upright like a post or door frame. Ideally you should be able to draw a straight line from ears, through shoulders to hips.

I imagine that misalignments due to stress or trauma might also create a feedback loop where misalignments trigger a warning that something is wrong internally and that might add to the overall given what Porges says about neuroception where the nervous system is on the lookout for welcome or warning signals internally, in the environment and between people.

I haven't read Dr Todds book yet, also available on amazon, but am watching one of his lectures on the video below. If interested, start the video at around 15:15 as before that they are dealing with tech problems etc. that haven't been edited out.

One of the other ways that I think paying attention to posture aside from health and ANS impacts might be helpful is that in the work on the Persistent Predatory Personality, apparently one of the clues that these people use to distinguish possible easy prey is posture and gait.

The other thing I like about the chiropractor that I'm seeing at the moment is that he can give very objective feedback. In the initial physical/neurological assessment he had protractor to measure and record angles compare the differences on each side of my body and to an ideal, as well as a ruler to measure and record distances. He requested xrays and has marked on them a blue line to show ideal alignment, and a red line to show my current misalignments and subluxations. All of these measurements will be repeated after 3 months.

He feels that I'm moving faster through the adjustments than what is common for my age group. Said if he saw my spine in a 20yo, he would be aiming for around 2 months of adjustments, in an 80yo around 2 years. So he figured initially that I'd need somewhere between 12 to 18 months of adjustments, but will revisit that after 3 months. As he's aware of sympathetic dominance, he has started with lighter adjustments to prevent too much sympathetic arousal. That process might be assisted by my knowledge and application of polyvagal theory. He is interested to know more about PVT so I will lend him Deb Dana's flip chart which is what she uses to teach her clients about the ANS through the PVT lens.

 

[aragorn]

Very interesting, thank you!

As he's aware of sympathetic dominance, he has started with lighter adjustments to prevent too much sympathetic arousal.

Can you elaborate on this part? Does this mean that if you adjust and 'snap' the spine too heavily and too often during a short period, that it will trigger a flood of sympathetic arousal?

I'm asking this, because in my late 20's I suffered a fall, landing on my back on a concrete floor. Due to the injury, I started visiting a osteopath, who recommended that I'd see him multiple times. He always did the same routine, which ended in a massive 'side twist push' of the spine (big cracking sounds!). After someting like 4–5 visits, I started getting extremely anxious, with many unpleasant memories surfacing, and also having panic attacks. I remember calling him to ask if this was common, to which he said yes, that this can happen.

 

[Jones]

Can you elaborate on this part? Does this mean that if you adjust and 'snap' the spine too heavily and too often during a short period, that it will trigger a flood of sympathetic arousal?

I think it could.

I did ask the chiro if he gets clients having emotional stuff come up after or during adjustments and he said that he doesn't tend to, though he hears other chiro's talking about that. He reckons he doesn't tend to attract clients who might have emotional releases because he isn't very demonstrative himself, but it also could be because he does adjust his approach if he seems to be stirring things up and since he's looking for signs of sympathetic arousal and he can feel it in the alignment of and muscle tension around the spine. He also seems to be very self aware and does communicate if he has momentarily lost focus - that's one of the things that Deb Dana stresses in the therapeutic environment. Because of neuroception, a clients nervous system will pick up on the change of state of the practitioner even if the client isn't totally consciously aware of that and the nervous system can respond to warning signals. So it's better to tell the client that it has happened so the client can relax.

The chiro did do one adjustment on my thoracic spine that sounds similar to what you describe, but it really hurt and the next time he decided on a different approach. In that approach he stood me up, stood behind me and wrapped his arms around my chest and under my arms and lifted me up and backwards. I still get the popping sound in that approach, but it doesn't hurt at all. In the first thoracic adjustment that seems similar to yours he said 'oh, I think you might get some nausea from that one.' I could be a slow reactor though because after the pain subsided, I felt fine. However, around 3 hours later I felt super nauseous - not to the point of actual vomiting, but had the sick taste in the back of my throat.

I guess any kind of body work has the potential to stir up emotional stuff and if body workers are at least attuned to sympathetic arousal if not totally PVT informed, then they may adjust approach to help clients navigate that.

In PVT, recovery outcomes are apparently better if a ventral vagal state can either be maintained or the client has the capacity to return to it flexibly. So Deb Dana's statement along the lines of 'slower and gentler is faster and stronger' could apply to body work where the client seems to either get sympathetically aroused or go into an overwhelmed shut down response. Also PVT says that even though organ or muscle disfunction might be the end result, the stressor or trauma is stored in the nervous system.

In the initial appointment the chiro explained that it's not just about the adjustment approach, but also the amount of force he puts behind the adjustment that can make it a light or heavy adjustment, so I might be in for bigger yet! He also explained that the popping sound isn't a bone on bone sound. If you dampen your hands and press your palms together then pull them apart suddenly, the popping sound you get then is similar to what is happening in the liquids and gasses in the joint.

Overall, I've felt very comfortable with him, though I have noticed a certain relaxation diminishing at times and I've been careful to be aware of that and counter it if I can.

 

[Jones]

My regular chiro is away and so have been getting treated by his stand in. While he has been doing the same adjustment approaches, he feels for tight muscles first and releases them before the adjustment. The muscle release was quite painful, but manageable. What I wasn't expecting was that he then put a lot more force behind the adjustments. Even though none of the adjustments themselves actually hurt, I could feel the shock to my nervous system and was feeling a bit teary and jittery afterwards. I didn't actually say anything to him, and figured that I could work my way through that shock. I felt as though what I really needed after that adjustment was a big bear hug. On the next visit he used less force and asked was that better, so he read the situation without me saying anything.

For those that are interested there is an app that assesses posture and misalignments of the spine. It works by having a picture taken with both front and side views and the app recognises target posture alignment points on the body and draws lines between them and calculates degrees of misalignment.

It's called APECS Body Posture Evaluation. Thet free version gives a basic analysis of posture and suggests corrective exercises that can be saved in a .pdf report. I don't know if the exercises suggested are the best as my chiro has given me different ones to what the app suggests.

A short intro video here:

 

[Arwenn]

My chiros are usually gentle, but I can sometimes feel emotional or just a bit discombobulated after a treatment. I definitely think adjustments release trapped emotions or stored survival stress. I make sure to be very kind to myself after an adjustment, helps to journal about stuff that comes up too.

One of Irene Lyon’s recent newsletters stated that:
“Trauma is everywhere in our world, but it is NOT in the event…it’s in the nervous system…This is why the same event can trigger different responses in different peoples’ systems.” Makes sense

Incidentally, I slept on a special chiropractic pillow last night & my neck feels much better. Our C6 gets hit hard with so much looking down at devices, & with my work in particular. I’m going to stick with it and see if that helps some of the chronic tension stored in the shoulders.

 

[Beau]

Incidentally, I slept on a special chiropractic pillow last night & my neck feels much better. Our C6 gets hit hard with so much looking down at devices, & with my work in particular. I’m going to stick with it and see if that helps some of the chronic tension stored in the shoulders.

A few years ago I had persistent neck issues from my job and at one point was going to a chiro twice a week. The worst time for me was always when I woke up in the morning. Many days spent at work basically unable to move my neck side to side. Getting a chiropractic pillow was a lifesaver for my neck. Best $50 I ever spent. Yes, stick with it. I think it'll do wonders. I also got a massage gun for my neck and trapezius. That thing was really helpful too. Once your neck muscles tighten, it seems to affect the shoulders and then down to the shoulder blade and spinal area.

 

[Arwenn]

I also got a massage gun for my neck and trapezius. That thing was really helpful too. Once your neck muscles tighten, it seems to affect the shoulders and then down to the shoulder blade and spinal area.

Cheers Beau, might look into one of those too, sounds like something I could definitely do with as well. What you wrote above is exactly what has been happening for me, with lots of tension in my neck, shoulders and upper back.

 

[Beau]

Cheers Beau, might look into one of those too, sounds like something I could definitely do with as well. What you wrote above is exactly what has been happening for me, with lots of tension in my neck, shoulders and upper back.

I don't know how helpful this comment will be but once I switched jobs, everything pretty much went away, even the GERD-like symptoms that started after the mask mandates at work in 2020. The ocular migraines stopped too. My body was definitely saying NO!

 

[Jones]

Bit of a penny drop moment at the chiro today.

He has had me doing some core strength exercises, that are different to the ones I've been doing with the physio, because posture check in revealed that the curve in my lumbar area was going a little too far in the right direction.

Today he also reminded me about belly breathing. I asked him how he resolves the conflict between core strength bracing exercises and belly breathing because when I was doing the stomach bracing exercise I was sucking my stomach in to do it. He explained that when bracing the stomach muscles for core strength exercises, do them with stomach extended - i.e. pushing belly out and holding the muscles in that position because that gives the diaphragm room to keep doing its thing properly and then the diaphragm is not also braced as part of the exercise if that makes sense.

Not sure if that is supposed to be the case with all core strength exercises or if it's even a common suggestion. In any case it seems to work the core muscles differently to what I've been accustomed to.

 

[TheTodd]

There are a bunch youtube videos on proper belly breathing while bracing your abdomen (or while weight exercising). Maybe they will you give you some answers. Here are some:

Generaly, I am not so sure about breathing while exercising, because many of us have very bad breathing habbits even with regular EE. But an interesting question, how do we breathe while exercising? Ok, when you are relaxed/seated, you breathe with your diaphragm and you can see the result, your belly protruding, but how to breathe exactly while exercising, when all of your muscles are tense? Some say with your diaphragm, into the belly with abdominal muscles contracted. But is that really with the diaphragm?

Some offer explanation of diaphragmatic breathing while weight lifting:

Here is mention that if you breath properly during exercises, your body increases flexibility:

And many many more videos on youtube speak of the same thing.

Many of them mention that breathing with your belly, and not your chest(!), is one of the most important things when lifting/exercising - because of core stability, spine position, safety, oxigen uptake, proper muscle activation and so on.

So, recommendations from these youtube videos are: breathe into your belly whenever possible (not just exercising) and when your abdomen is activated/contracted enough, your chest should rise also. And that should be diaphragmal breathing (very roughly speaking). Avoid shallow chest breathing.

 

[Jones]

Thanks for those videos @TheTodd, they help lots

 

[Jones]

He did, however, say that he recognises sympathetic dominance patterns in spinal alignment. Said that he treats a woman with PTSD, and after her first few adjustments she mentioned that her night terrors had stopped. He can also tell now when he assesses her spine before each adjustment whether her night terrors have returned.

At one of my session a fortnight ago, the chiro asked if I'd been under any unusual stressors because some of my adjustmenst seemed to have gone backwards since previous appointment. I couldn't remember anything significant at the time other than my great-nieces first birthday - I didn't really consider that stressful, but there was a lot of preparation for it. He said that maybe it was just that there was a lot to get done and that was enough to relapse into old patterns.

Later I remembered that there'd been an incident at work! Not a biggie in the scheme of things, but it did rattle me at the time. A co-worker lost her temper while changing some stock on the shelf and knocked it all to the floor in impatience or frustration after she fumbled and dropped a few things. In that moment I did feel a shift into fight/flight for a few minutes as a result of the sudden and explosive nature of the incident and walked away briefly to catch my breath, but it was quickly over as we worked to clean up the mess and finish the stocking and got on with the days work. All in all it was done and finished inside 10 mins and I'd forgotten about it.

In any case, the feedback from the chiro was super helpful to be able to pinpoint a personal example of auto subluxation.

He has decided to do a course in polyvagal theory from a Dr of Chiropractic who also has a Masters in Neuroscience, Dr Monique Andrews.

 

[Jones]

Been looking into the effects of loss of lordosis - or the natural curve - in the cervical spine. That happens in a head forward position. These days it's called tech neck because of computers and mobile phones, but it's been around for some time with papers and books addressing it going back to the '70's and further. I'm pretty sure that I had a tech neck thing going on long before I had tech, but whatever.

There's a page that lists some mechanical, neurological and other health impacts of loss of lordosis and head forward tech neck here.

Forward head posture symptoms and complications​

Ross Hauser, MD

If you suffer from forward head posture you do not need an explanation as to what the condition is further than the image below. Most people who contact us will immediately identify that their head sits far in front of their shoulders. What causes this? In many people, it starts when the cervical ligaments, the bands of connective tissue that hold the cervical vertebrae in place, weaken, and the natural cervical lordotic curve of the neck is lost and the plumb line (and thus weight) of the head falls in front of the cervical curve. As the head continues to gradually slide forward, the continued and increased strain causes more stretching and tearing on the back of the neck supporting structures and puts nerves and veins in the front of the neck at risk for herniation, compression, and injury. As the cervical spine destabilizes and moves forward, so do the vital structures (nerves, arteries, veins) within the neck undergo torsion, stretch and compression including the autonomic nervous system nerves (which can cause dysfunction in heart rate, digestion, breathing among other symptoms) and blood vessels on their way to or from the brain. (Possibly causing issues with dizziness and fainting). This combination of symptoms is frequently discussed in people’s communications with us.

Looking for answers.

A person’s story: Cervical spondylosis without myelopathy with forward head posture. I have been having symptoms for many years and they are getting progressively worse. I can trace these symptoms back to having fever like symptoms without a fever, slight swallowing problem and fatigue. Lower cervical upper back slight pain and tightness, MRI showed cervical arthritis. Now having constant fatigue, slight facial burning sensation, brain fog, dysautonomic symptoms and lower cervical slight pain, etc. Have been tested for Multiple Sclerosis, Lyme Disease, Hypothyroid, Testosterone levels and all negative. Looking for answers.

A theory in search of answers.

A person’s story: I have been suffering from more than 40 symptoms for the last four years. Symptoms vary in severity. The main symptom is severe fatigue that comes in waves. I also suffer from brain fog, dizziness, cognitive problems, gastroparesis, difficultly swallowing, blurry vision, tinnitus which coincides with the fatigue, unexplained emotions, anxiety attacks, and more. I work long hours in front of the computer and to offset this I do weight training. I have spoken to many doctors and specialists with no luck. After researching I find strong evidence that virtually all symptoms are caused by poor posture, specifically effecting the vagus nerve through forward head posture.

CREEP​

How does this happen? One explanation is that flexion and extension of the cervical spine generate tension and pull on the brain stem, medulla, and cranial nerves V-XII (The vagus nerve mentioned above is cranial nerve X). The many and varied symptoms this causes are further discussed below. In this condition, when a person looks down, the brain stem may make contact with the anterior wall of the foramen magnum (the opening in which the brain stem and other vital arteries, veins, and nerves pass). This could block cerebrospinal fluid dynamics (flow) and the symptoms of intracranial pressure. When the neck is flexed even the lumbosacral nerve roots move contributing to low back and extremity pain in the legs.

Cervical ligament laxity can slowly develop through many repeated hours of forward head posture, such as practiced when working on the computer or bent over a smartphone. This phenomenon, defined as the elongation of a ligament under constant or repetitive stress, is known as CREEP.

The caption reads: How heavy is your head?

For every inch of forward head posture, the force on the spine increases by an additional 10-12 pounds. A forward head posture causes a slow stretching of posterior neck ligaments which is a phenomenon known as ligament creep. On the right, the head weight pressure of the neck is equal to balancing a 42-pound weight. This is where neck problems accelerate.



Creep does not occur in an acute way; on the contrary, the problem develops and evolves over time. While this gradual ligament degenerative disease represents a “low level” sub-failure ligament injuries, I contend that they represent the vast majority of cervical instability cases and can potentially incapacitate people (from a pain and disability standpoint) with unremitting pain and vertigo, tinnitus, and the host of potential symptoms that occur from cervical instability. Therefore ligamentous cervical instability (neck instability caused by stretched ligaments), especially upper cervical instability caused by ligament stretching, is often the missing structural cause and/or co-morbidity for many chronic disabling symptoms and diagnoses.

In this article and video, I will be discussing the cervical spine ligaments, the importance of the lordotic (natural) curve of the neck, and how cervical degenerative disc disease and cervical instability can be caused by slow capsular ligament stretching (creep) caused by the forward head/facedown lifestyle of looking at cell phones. We will see how excessive computer and cellphone usage can lead to a breakdown of the cervical curve (called cervical dysstructure) progresses.

Article Summary:

• The stretching of the cervical neck ligaments in forward head posture.
• A Cause of Forward Head Posture: Cell phone use.
• Excessive neck bending could exaggerate the stretch of the cervical spine and all of the spinal structures below it.
• The effect of the posture of using smartphones on head and neck angles.
• Symptoms of cervical spine neck ligament Creep.
• Abnormal or forward head posture has a significant effect on the entire body
• Forward Head Posture and low back pain in older patients
  • Forward Head Posture and neck pain in older patients.
• Forward head posture makes it hard to breathe.
• Stabilizing the scapular and thoracic spine helps respiration in forward-head posture patients.
• Forward head posture and sleep apnea.
• TMJ, Forward Head Posture, Reduced Airways.
• The drawing nearer of the chin to the third cervical vertebra. The hyoid bone and facial pain.
• The development of headaches and neck muscle spasms in forward head posture.
• Injections and physical therapy for forward head posture headaches and migraines.
• Exercise and physical therapy in forward head posture headaches.
• The shoulders pull on the neck in a forward head posture.
• “Manual therapy can be recommended to improve forward head posture, thoracic kyphosis, and pelvic alignment in the short and medium term.”
• Improving posture while texting, cervical manipulation, and extension traction therapy.
• Balance Body Tape and Forward Head Posture.
• “Resolution of radiculopathy and significant improvement in neck pain level.”
• Treating cervical ligament weakness and starting the journey to restoring proper cervical curves.

The stretching of the cervical neck ligaments in forward head posture​

In the image below the caption reads: When a person looks up, the cervical vertebrae move closer together as the posterior cervical muscles and ligaments tighten. When a person faces down, as when we look at cell phones, the muscles relax and the vertebrae spread apart as the posterior cervical ligaments stretch and lengthen.

A Cause of Forward Head Posture: Cell phone use​

As most human activities are in front of the body and involve the head and neck being forward and flexed, all the ligaments except for the anterior longitudinal ligament are at risk of being injured by creep’s slow stretching over long periods of time. The cervical intervertebral disc is subjected to creep forces during flexion as well. These ligaments are also injured during the flexion portion of a whiplash injury. The anterior longitudinal ligament is stretched during the extension portion of a whiplash injury. Since the capsular ligaments are the main restraints to axial rotation, they are especially vulnerable to injury when a force is applied with the head forward and the neck turned to the side.

In the video below I describe how as our neck gets more flexed, (bent forward) the pressure on the neck ligaments and the neck muscles to keep our head aligned (our ear is over our shoulder) is increased. To explain this please see the image below. In this video, I will describe how forward head posture from hours of computer work and cell phone usage can result in cervical ligament laxity and the problem of stretched-out cervical spine/neck ligaments. In this stretched-out ligament condition, the neck will bend forward, eventually leading to arthritic degeneration of the cervical spine and the loss or even reversing the loss of the natural cervical curve. The slow stretching of ligaments is called CREEP.

The video also discusses a 2014 paper by Dr. Kenneth K Hansraj of the New York Spine Surgery & Rehabilitation Medicine New York published in the journal Surgical Technology International. (1). Since its publications, over sixty research papers have cited the paper’s data. The paper begins: “Billions of people are using cell phone devices on the planet, essentially in poor posture. The purpose of this study is to assess the forces incrementally seen by the cervical spine as the head is tilted forward, into worsening posture.”

More recently a February 2023 paper (2) by Italian researchers cited this research and wrote: “There are real concerns about the influence of head posture and workplace ergonomics on health among IT (Information technology) professionals. We consider that it is necessary to adopt preventive measures to address neck disability and improve workspace ergonomics.”

Excessive neck bending could exaggerate the stretch of the cervical spine and all of the spinal structures below it.​

A May 2020 study in the Journal of Family Medicine and Primary Care (3) examined how excessive neck bending could exaggerate stretching (hyper stretching) of the cervical spine and all of the spinal structures below it. The researchers noted that “forward head posture can cause a multitude of disorders including cervical radiculopathy, cervicogenic headaches, and cervicogenic dizziness. Most of these conditions manifest with clusters of painful symptoms and spine dysfunctions.” The researchers also noted: “The cervical spine is responsible for allowing mobility and stability to the head and neck. Any deviation to the center of gravity of the head results in an increase in cantilever loads (excessive loads at the front and back of the neck), which can be particularly damaging to the upper cervical joints. ”

What these researchers did was take images of three random patients with symptoms of neck pain and related disorders who had undergone cervical adjustment for cervical pain. Specifically, they looked at the joint space between the occipito-axial (C0-C2) and atlanto-axial (C1-C2) joints. By comparing the radiographs of before-and-after intervention of each patient, a regressive (hyper stretching was being reversed) joint spacing was observed.

The effect of the posture of using smartphones on head and neck angles​

A May 2022 paper in the journal Ergonomics (4) aimed to compare the effect of the posture of using smartphones on head and neck angles among eighty college students. The Severity of Neck Pain (SNP) and the head and neck tilt angles, the gaze angle, (this is the angle of the eye’s line of vision within the orbit. If your head is looking down but you shift your eyes upwards to observe something, that is the gaze angle. The gaze angle is important in helping to stabilize upright balance) and the amount of change in the forward head posture was determined.

Most of the participants (51.3%) in this study reported moderate and severe neck pain. The angles during using smartphones had a significant difference in different positions so that the best head and neck tilt angles and gaze angles were in the sitting position with leaning on the backrest of the chair. Head and neck tilt angles and the forward head posture have the worst posture in sitting position on a chair without a backrest while the gaze angle has the most awkward posture in standing. The researchers were able to connect the neck and back pain The angles during using smartphones had a significant difference in different positions. The gaze angle was most negatively affected in the head down looking at the phone position.

The image below will help explain the angles. The patients in this study who had a greater than the 51-degree angle in the triangle created by the C7, ear landmark, and a horizontal line were considered patients suffering from forward head posture. These would be patients whose heads would be in the habitual position represented by the two images to the right, between 45 degrees and 60 degrees.

Symptoms of cervical spine neck ligament Creep​

As discussed above, Creep is a medical condition that results from the elongation of the ligaments that hold our bones together due to long-term tension upon them. This can be caused by various types of bad posture, including the forward head posture involved in text neck. In our neck, we have seven vertebrae that are held together by ligaments. Text neck causes these ligaments to get too loose, to the point where they can no longer hold these seven vertebrae together. The bones shift and can pinch other nearby structures causing tightness across the shoulders, headaches, and neck soreness. Also pain in the back, arms, fingers, hands, wrists, and elbows. Some sufferers may also notice numbness and tingling in their upper extremities.

The major cervical ligaments that are over-stretched slowly and daily by the text neck, and forward head posture are those of the posterior ligament complex (PLC), especially the capsular ligaments of the facet (zygapophyseal) joints, as these are the major joints in the cervical spine. While there are many types of motions and forces damaging cervical ligaments, they have a propensity to hit the capsular ligaments.

In the image below we see the various types of neck injuries that can cause neck ligament injuries. The fourth image from the left is hyperflexion. This is the chronic injury of the head down face forward lifestyle and the head snap forward as seen in whiplash-associated disorders.

Abnormal or forward head posture has a significant effect on the entire body​

As we discussed, the current ever-prevalent face-down lifestyle looking at cell phones, causes a destabilization of the normal cervical curve and a loss of the normal architecture of the cervical lordotic curve, caused by a stretch of the cervical ligaments causing symptoms. The cervical spine because of face down – forward head posture goes into a state of flexion (kyphosis), pushing the upper cervical vertebrae to the front to their normal plumbline position and forcing them into hyperextension. Gradually this altered neck posture, affects the neurovascular tissues at the craniocervical junction, especially around the atlas (C1) and axis (C2), as they undergo torsion, shear, stretch, and compression. Some of these structures are in the carotid sheath including the vagus nerve, glossopharyngeal nerve, spinal accessory nerve, internal jugular vein, and carotid artery, as well as other neck structures including the various cervical sympathetic ganglion, vertebral arteries, and veins, spinal cord, brainstem especially the medulla and spinal nerve roots.

A July 2020 study in the International Journal of Occupational Medicine and Environmental Health (5) offered such research. Here researchers took the data results from 16 studies to show that “the position of the head has a significant effect on the human body. Research findings show that abnormal head position changes affect muscle activity, proprioception (the sense of how to move, walking without thinking about how to take steps), the pattern of breathing, and neck pain.” The researchers noted in their study that “this is the first systematic review of the relationship between the head posture, and the functioning of the human body. The results of this study seem to be promising if used in therapeutic practice.”

As the habitual forward head posture causes changes throughout the body including protracted and medial rotated scapula, as well as increased pressure on the cervical facet joints by forces that lead to upper cervical extension, lower cervical flexion, and exaggerated thoracic kyphosis and lumbar lordosis. All of these faulty positions keep the head in front of the center of gravity so the head and eyes are level and looking forward. It leads to numerous dysfunctional musculoskeletal scenarios. It ends up costing the person a lot, including the development of:

• Cervical instability
• Temporomandibular Joint Syndrome. Please see my related article TMJ, cervical neck instability, neck muscle spasms, myofascial pain, breathing problems, digestive disorders, and dizziness.
• Upper Crossed Syndrome. When shoulder, neck, and chest muscles are not in sync or out of balance with some muscles being too tight and other muscles being too weak.
• Occipital and trigeminal neuralgia
• myofascial pain syndrome
• thoracic, lower back, and pelvis abnormalities and physical complaints.

As noted above: A habitual forward head posture makes the point that deviation in one part of the body long-term will lead to a deviation in another part of the body in an attempt to maintain the correct center of gravity so the body feels somewhat balanced and the eyes can look forward. The habitual forward head posture and all of the negative ramifications of it are the most common postural deviation seen. Even on the pelvis, the effects are enormous. With exaggerated lumbar lordosis, there is an increase in the pelvic angle to 40o (normal is 30o) as well as anterior pelvic tilt, both of which put increased strain on the sacroiliac and iliolumbar ligaments—a very common cause of low back pain. This is another example of how any type of instability leads to compensatory changes in adjacent and distant musculoskeletal structures and may all need to be addressed to resolve a person’s chronic pain.

Forward Head Posture and the Brain Stem​

All spinal postures will deform the neural elements within the spinal canal and close to it, with flexion causing the largest canal length changes and hence, the largest nervous system deformations. Flexion on any part of the spinal column (but especially the neck) can generate axial tension in the entire cord, brainstem, and nerve roots. With the advent and excessive use of cellular mobile devices, malrotations of the cervical spine cause stresses and strains on the cervical spinal cord and brain stem, and all the cranial and peripheral nerves that connect to it. Excessive motions of the craniocervical junction and cervical spine, especially when motion is combined with postural loads with the forward head being one of them, cause tremendous deformations on the cervical spinal cord, brainstem, and neural tissues that connect to them.

Forward Head Posture and low back pain in older patients​

An October 2021 study in the Journal of Bodywork and Movement Therapies (6) assessed the impact of forward head posture on low back pain in older patients. Here are the summary findings.: “Abnormal spinopelvic posture relates to chronic mechanical low back pain. There are significant associations among pain intensity, Forward Head Posture, and lumbopelvic sagittal alignment in chronic mechanical low back pain patients.”

Forward Head Posture and neck pain in older patients​

A December 2019 paper from Cairo University published in the journal Current Reviews in Musculoskeletal Medicine (7) found that “age played an important role as a confounding factor in the relation between forward head posture and neck pain. Also, the results showed that adults with neck pain show increased forward head posture when compared to asymptomatic adults and that forward head posture is significantly correlated with neck pain measures in adults and older adults.”

Forward Head Posture and cognitive decline​

Numerous studies have indicated that loss of hand grip and pinch strength, (generalized loss of muscle strength) in the elderly would provide evidence of the onset or development of dementia. Yet an April 2023 paper in the Journal of Clinical Medicine (8) offered this assessment of the current medical research. “To our knowledge, there is no study examining the association of forward head posture with cognition, hand grip strength, and pinch strength, and the mediator role of forward head posture on the association of cognition with hand grip and pinch strength in older adults. Considering that forward head posture is one of the most common postural deviations related to advanced age in older adults, this is remarkable.”

This study was able to suggest and support “the hypothesis that “higher cognitive function would be associated with better head posture, and better head posture, in turn, would be associated with greater hand grip and pinch strength.”

Forward Head Posture makes it hard to breath​

A May 2020 study (9) from the Ankara University School of Medicine in Turkey investigated the relationship between forward head posture and respiratory dysfunctions in patients with chronic neck pain. To do this they examined 99 patients (11 males, 88 females; an average age of 54 with the youngest person being 38 and the oldest 75). What they found was that the people who had worse head posture, were in part measured by the C7 vertebrae angle position. Based on measurements of the chest exhaling and inhaling the researchers concluded that on our study results, Forward Head Posture is associated with expiratory (exhale) muscle weakness in chronic neck pain patients.

Treatment: Stabilizing the scapular and thoracic spine helps respiration in forward head posture patients​

A September 2021 paper in the Turkish Journal of Physical Medicine and Rehabilitation (10) investigated how exercise programs not directly applied to the cervical spine affect office workers with forward head posture.

• A total of 32 office workers with forward head postures (13 males, 19 females; average age 36.63 years were equally randomized either to experimental or control groups. Scapular stabilization and thoracic extension exercises were applied to the experimental group and cervical stabilization and stretching exercises to the control group.

Results: “The combination of scapular stabilization and thoracic extension exercises, not directly applied to the cervical spine, has an effect on improving the posture, respiration, neck pain, and disability in office workers with forward head posture.

Forward head posture and sleep apnea​

In February 2020, researchers (11) wrote in the Frontiers in Medicine of their findings connecting obstructive sleep apnea syndrome, abnormal spinal curvature, and the pathological interaction between posture and ventilatory (getting air into the lungs) functions.

The researchers wrote: “This study provides evidence for abnormal spinal alignment and disturbances of balance in obstructive sleep apnea syndrome patients, and calls for these to be sought in clinical practice in order to mitigate their consequences. The determination of posturo-respiratory coupling allows early screening for postural dysfunction and refines the understanding of its obstructive sleep apnea syndrome-related character. Finally, the potential correlation between the specific postural dysfunction of obstructive sleep apnea syndrome, the changes in the mechanical properties of the upper airways, and respiratory cortical adaptation to waking and cognitive problems mean that correcting mechanical anomalies of the upper airways should be considered.”|

In other words, instability in the cervical spine, what the researchers called “cervical hyperextension with an anterior projection of the head (forward head posture)” causes respiratory instability and sleep apnea.

TMJ, Forward Head Posture, Reduced Airways​

A December 2020 study in the Journal of Oral and Maxillofacial Surgery (12) discussed the connection between Temporomandibular (TMJ) joint osteoarthritis, airway dimensions, and head and neck posture.

• In total, 114 temporomandibular disorders patients participated in this research.;
  • Among 114 patients, 28 had no pathologic bony changes in the TMJ condyles, 45 had progressive TMJ osteoarthritis, and 41 demonstrated TMJ osteoarthritis which had not progressed for 12 months.

The volume change of the oropharynx (the rear third of the tongue, the soft palate, the throat’s side and back walls, and the tonsils) in the supine position was more prominent in the progressive TMJ osteoarthritis than in the TMJ osteoarthritis which had not progressed but no significant differences in changes in the pharyngeal airway while in an upright position were detected. The retrognathic facial profile (the lower jaw is set back further) became more remarkable at T1 in the progressive TMJ osteoarthritis and not progressive TMJ osteoarthritis compared to those at T0. The forward head posture seemed to be progressed in the progressive TMJ osteoarthritis than in either the not progressive TMJ osteoarthritis or no pathologic bony changes (bone spur formation) in the TMJ condyles.

Conclusion: progressive TMJ osteoarthritis may have associations with retrognathia (the law jaw moving back further) and decreased oropharyngeal airway volume in the supine position but not in the upright position. Progressive TMJ osteoarthritis may be related to altered head posture in the upright position to compensate for reduced airway dimensions.

In the image below we see muscle pain and muscle tightness from the forward head posture.

More on muscle tightness and pulling on the cervical spine​

These muscles are extremely tight in forward head posture. Since the carotid sheath, which houses the vagus nerve, also basically sits on this muscle, it is easy to imagine this and other nerves undergoing destructive traction on them with the cervical instability-induced collapse of the cervical curve.

A December 2022 study (13) suggests that among the many problems and ways forward head posture can cause cervicogenic dizziness is the impact on the correct tension the posture creates on the myodural bridges of suboccipital muscles. Myodural bridge issues are associated with cervicocephalic headaches, cervicocephalic pain syndromes, sensorimotor function, and postural control. Also noted is that the suboccipital muscles might work as a pump via the myodural bridge to provide power for cerebrospinal fluid circulation.

The drawing nearer of the chin to the third cervical vertebra. The hyoid bone and facial pain​

In March 2020, doctors at the MedCenter TMJ, TMD/Orofacial Pain Clinic, Michael E. DeBakey Veterans Affairs Medical Center, University of Texas Health Science Center, School of Dentistry, and Louisiana State University, School of Dentistry investigated changes in hyoid bone position in patients suffering from myofascial pain. (14)

In this study, 30 female patients who received treatment for and had resolved myofascial pain were reviewed. The resolution of their myofascial pain showed a drawing nearer the chin to the third cervical vertebra (reduction in forward head posture) and a release of the hyoid bone away from the floor of the mouth. They concluded: “These findings suggest resolution of myofascial pain may correlate with decreased forward head posture and relaxation of suprahyoid musculature. The potential for change in oropharyngeal dimension and airway is evident.”

Let’s explain the image below beyond the caption:

• The hyoid bone, as you can see in the image below is located at the front of the neck, below the lower jaw. It supports the tongue and plays a critical role in speech and swallowing.

A forward head posture shows one mechanism by which passive tension in selected suprahyoid and infrahyoid muscles (the muscles that help elevate the hyoid bone to allow swallowing) alter the resting position of the mandible. The mandible is pulled inferiorly (downward) and posteriorly (backward) changing the position of the condyle within the TMJ. Note the interrelationship between the cervical spine and the scapula of the shoulder.

The development of headaches and neck muscle spasms in forward head posture​

A story:

I have chronic neck and shoulder pain. This is traced back to a forward head posture following years of computer work. I few years back I started having chronic headaches with an increased number of migraines each month. Last year I went on disability because the constant headaches increased to level 7 with the migraines coming 3 – 4 days apart. I had physical therapy on my neck for 6 months I changed my sitting position to one of proper posture position. Unfortunately, it did not solve my problems. I’ve had neck ablations which help reduce the neck pain but it did not help my headaches. The ablations only lasted a few months before the neck pain was back. I’ve tried all the usual medications for migraine including botox with no results.

The symptomatology of headache can be caused by (and surely is made worse by) a habitually forward head posture causing shortening of the anterior neck muscles (sternocleidomastoid, longus colli, longus capitis, rectus capitis anterior and lateralis, scalene, and multiple hyoid muscles). When these muscles are shortened, the craniocervical region has to be in the protracted position to keep the head looking forward, as in viewing a computer screen, smartphone, or television. This excessive shortening of the anterior neck muscles then stretches and “stresses” the extensor muscles including the levator scapula, semispinalis capitis, and suboccipital muscles such as the rectus capitis posterior major. The ‘stressor’ on these muscles is having to continually contract to “level” the head and eyes. This forward head posture moves the center of mass from on top of the cervical spine to in front of it. This necessitates compensatory contraction of the posterior neck musculature including the suboccipital muscles, semispinalis capitis, and levator scapulae muscles to contract in order to counterbalance the weight of the head. Over time, the muscles fatigue and spasm, developing trigger points that can refer pain to the head, scalp, and face.

Most headaches are in the posterior head region, specifically in the suboccipital region where many small muscles attach to the C1 and C2 vertebrae. Most people with headaches have muscle tightness and tenderness in the suboccipital muscles. When a person has a forward head posture causing a decrease in cervical lordosis, the upper cervical spine has to go into hyperlordosis (excessive curvature). This is an additional factor that makes the upper cervical ligaments more prone to stretch injury. The combination of upper cervical hyperlordosis, instability, and resultant suboccipital muscle spasms can lead to irritation or compression of one of the occipital nerves and occipital neuralgia. When asked where their headaches start, most people will point to the suboccipital region.

Why someone can have neck-related symptoms but NOT have neck pain. Part 1: Jugular vein​

A summary transcript and explanatory notes of this video are available here: Why someone can have neck-related symptoms but NOT have neck pain. Part 1

Treatment: Injections and physical therapy for forward head posture headaches and migraines​

Below we will discuss the use of Prolotherapy (dextrose) injections. In a March 2022 paper (15) from the Department of Medical, Surgical and Health Sciences, University of Trieste in Italy, doctors compared the effect of physiotherapy to onabolulinumtoxin-A, and their combination, in relation to cervical and headache parameters in patients with chronic migraine and identified with forward head posture.

• This study was conducted on 30 patients with chronic migraine.
• The patients were distributed in three groups of treatments for three months:
  • onabolulinumtoxin-A only,
  • physiotherapy only, and
  • onabolulinumtoxin-A plus physiotherapy.

Results: After 3 months of each treatment, the scores obtained for the headache-related disability and the frequency of migraine decreased significantly for all groups, but the pain intensity scores changed significantly only in the onabolulinumtoxin-A and in the onabolulinumtoxin-A plus physiotherapy groups. On the other hand, the forward head posture was reduced significantly in the physiotherapy and in the onabolulinumtoxin-A plus physiotherapy groups. The cervical range of motion increased significantly in certain directions in the physiotherapy group and in the onabolulinumtoxin-A plus physiotherapy groups. The researchers concluded: “it can be said that the combined treatment was more useful than a mono-therapy alone. From our results, it can be concluded that onabolulinumtoxin-A plus physiotherapy could be a good option in the management of chronic migraine.”



Please see my related articles:

• Occipital neuralgia and Suboccipital headache – C2 neuralgia treatments without nerve block or surgery.
• Cervicogenic headaches: Migraines, tension headaches, and cervical spine instability

Treatment: Exercise and physical therapy for forward head posture headaches​

A 2021 paper in the Journal of Back and Musculoskeletal Rehabilitation (16) noted that when compared with healthy people, patients with chronic tension-type headaches are likely to have forward head postures and a higher number of active trigger points on the suboccipital muscle. The purpose of this study was to verify how forward head posture correction exercise can effectively reduce symptoms of chronic tension-type headache patients.

• The subjects of this study were 45 individuals with chronic tension-type headaches, divided into three groups of 15 patients each:
  • a) the suboccipital muscle inhibition group using the myofascial release technique – interventions twice a week for four consecutive weeks.
    • The technique is when a physical therapist slowly raises the skull to release or relax the suboccipital muscles
  • b) the group which received suboccipital muscle inhibition therapy and forward head posture correction exercises; – interventions twice a week for four consecutive weeks and
  • c) the control group.
  • Both treatment groups went through the headache impact test (HIT-6) and examinations on the pressure pain threshold (PPT) of the headache areas, the type and number of myofascial trigger points, the soft tissue pressure pain threshold, and the posture before and after the intervention.

Results: There was a significant improvement in the headache impact test (HIT-6), the headache pressure pain threshold, the soft tissue pressure pain threshold, the trigger points, and the posture in both treatment group patients. The biggest reduction and increase in the headache impact test (HIT-6) and the headache pressure pain threshold respectively were seen in the suboccipital muscle inhibition therapy and forward head posture correction exercises group.

A March 2021 study in the International Journal of Environmental Research and Public Health (17) “(indicated) that flexion exercise of the deep cervical muscles in patients with tension headaches and forward head posture will improve the quality of life and activities of daily life by mitigating headaches and sleep disorders.

The shoulder’s pull on the neck in forward head posture​

The caption of this image reads Shoulder-cervical instability connection. Shoulder instability causes scapulae contraction which can increase the symptoms of cervical instability through its attachment at C1-C4. Sometimes to resolve upper cervical instability, the shoulder instability has to be treated as well.



Forward head posture puts a strain or stretch on the posterior neck muscles, such as the forementioned levator scapula and rectus capitis major, and a tightening of the sternocleidomastoid and scalenus anterior. The scalenus anterior attaches to the anterior transverse processes, putting an anterior translational force on the vertebrae. The levator scapula attaches to the lateral portion of the C1-C4 transverse processes. If a person has right shoulder instability, for example, this would force the right levator scapula to contract more to help stabilize the scapula during shoulder motions. This force then gets translated to the C1-C2 vertebrae, often causing that joint to sublux or move to the right. In this instance, the person would need treatment stabilization of not only the upper cervical vertebrae but also the right shoulder. Treating the C1-C2 vertebrae alone would be helpful but because the shoulder instability was not addressed, most likely the cervical instability would return with continued use of the right arm. For more on this subject see our companion article Is neck instability causing your shoulder pain?

A June 2022 paper in the European Journal of Physical and Rehabilitation Medicine (18) suggested that both scapular stabilization and postural correction exercise increase the craniovertebral angle and pressure pain threshold and decrease muscle activity and disability. Scapular stabilization alone increases craniovertebral angle and pressure pain threshold and decreases muscle activity and disability more than postural correction exercise.

Treatment: “Manual therapy can be recommended to improve forward head posture, thoracic kyphosis, and pelvic alignment in the short and medium term”​

A June 2022 paper in the journal Gait Posture (19) comes to us from Brazilian researchers. In this paper, the researchers sought to validate the effectiveness of manual therapy on body posture and forward head posture. To provide this validation the researchers examined previously published studies in which the primary intervention was the use of any manual therapy technique and studies that evaluated the immediate, short, medium, or long-term effects of interventions on body posture. After compiling the data the researchers wrote:

“The results allowed us to conclude with moderate certainty in the evidence that, when compared to no intervention or sham, in the short and medium term, manual therapy reduced the forward head posture (14 studies, 584 individuals), reduced thoracic kyphosis (5 studies, 217 individuals) improved lateral pelvic tilt (5 studies, 211 individuals) and pelvic torsion (2 studies, 120 individuals) and increased plantar (surface) area (decreasing pressure on the foot) (3 studies, 134 individuals). With moderate certainty, there was no significant effect on shoulder protrusion (5 studies, 176 individuals), shoulder alignment in the frontal plane (3 studies, 160 individuals), scoliosis (2 studies, 26 individuals), and pelvic anteversion (5 studies, 233 individuals).”

Conclusion significance: “Manual therapy can be recommended to improve forward head posture, thoracic kyphosis, and pelvic alignment in the short and medium term, but not shoulder posture and scoliosis. Manual therapy reduces the height of the plantar arch (making more surface area) and this must be taken into account in physical therapy planning.”

Treatment: Improving posture while texting, cervical manipulation, and extension traction therapy​

Dr. Eric Chun-Pu Chu of the New York Chiropractic and Physiotherapy Centre in China presented this January 2022 case study in the journal Radiology Case Reports. (20) A 24-year-old man had a history of a 12-month problem of head and neck pain and paresthesia of the right upper limb. The patient worked as a YouTuber and has been editing and posting videos on the website for three years. . . Based on cervical radiographs, the diagnosis of cervical spondylosis was given. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief during the subsequent year. However, a severe flare-up of the symptoms occurred, which was brought about by working for extended periods on his smartphone, for which the patient sought chiropractic attention. X-ray imaging showed cervical kyphosis with C5 vertebral rotation, hypertonicity of the paraspinal muscles, and paresthesia in the right C6 dermatome distribution, which was consistent with text neck syndrome associated with cervical spondylosis and right C6 radiculopathy.

The intervention consisted of improving posture while texting, cervical manipulation, and extension traction therapy. After 9 months of treatment sessions, the patient exhibited symptomatic and functional improvement. Frequent breaks along with correct posture while using smartphones will be the key entities to preventing the occurrence of text neck syndrome. For more on treatments please see my article Dynamic Structural Medicine Ross Hauser MD Review of Treatments for Cervical Spine Instability.

Treatment: Balance Body Tape and Forward Head Posture​

A February 2022 study in the journal BioMed Central Musculoskeletal Disorders (21) examined Balance Body Tape a recently developed taping method with the aim to reduce pain and improve posture through change in movement behavior. However, the researchers note, the potential effects of treatment with Balance Body Tape are scarcely documented. Therefore, the aim of their study was to investigate the effect of a three-week Balance body tape treatment on the intensity of perceived neck, shoulder, and back pain and forward head posture. The results the researchers found: “A short treatment period with Balance Body Tape may, compared to no treatment, have a small reducing effect on pain intensity in neck, back and/or shoulders. However, no effect was found on forward head posture in this study.”

Posterior cervical weighing orthosis​

In April 2024, an international team of researchers wrote in the Journal of orthopaedics (24) of outcomes in patients with forward head posture who were given posterior neck weighting as an “innovative orthosis to correct head posture within FHP participants and improve co-related mechanical neck pain.”

Sixty-one patients with forward head posture; were randomly assigned to one of two groups posterior cervical weighing orthosis or deep cervical flexion exercise. Over the course of treatments, testing showed a statistically significant change improvement regarding posture, disability and pain, improvements in the posterior cervical weighing orthosis, and of the deep cervical flexion exercise.

“Resolution of radiculopathy and significant improvement in neck pain level”​

A patient case history was presented in the Journal of Physical Therapy Science (22) The case report was titled: Non-Surgical Relief of Cervical Radiculopathy Through Reduction of Forward Head Posture and Restoration of Cervical Lordosis. In this case, doctors were able to demonstrate relief of cervical radiculopathy following the dramatic reduction of forward head posture and restoration of the cervical lordosis by the use of a multi-modal rehabilitation program incorporating cervical extension traction.

Here is what the doctors wrote:

“A 31-year-old male patient presented with severe cervical radiculopathy and muscle weakness as well as neck pain. The patient had limited neck range of motion and multiple positive orthopedic tests. Radiography revealed excessive forward head posture with cervical kyphosis. The patient received a multi-modal rehabilitation protocol including mirror image extension exercises, cervical extension traction, and spinal manipulative therapy. After forty treatments over 17 weeks, the patient reported a complete resolution of radiculopathy and significant improvement in neck pain level.”

This case history was used as evidence for this treatment method in a, October 2021 paper also published in the Journal of physical therapy science (23). Here a team of doctors reviewed previously published literature on the use of cervical extension traction methods for increasing cervical lordosis in those with hypolordosis and cervical spine disorders. In the conclusion of their findings, the doctors wrote: “There are several high-quality controlled clinical trials substantiating that increasing cervical lordosis by extension traction as part of a spinal rehabilitation program reduces pain and disability and improves functional measures and that these improvements are maintained long-term. Comparative groups who receive multimodal rehabilitation but not extension traction experience temporary relief that regresses after treatment cessation. (the extension traction experience was seen as a key component of the treatment).

Prolotherapy is referred to as a regenerative injection technique (RIT) because it is based on the premise that the regenerative healing process can rebuild and repair damaged soft tissue structures. It is a simple injection treatment that addresses very complex issues.

In the absence of access to manipulative therapies, thoracic extension and scapular stabilisation exercises and stretches can help shift the head back into a more neutral position and assist with recreating natural cervical lordosis without directly working the neck. In addition these exercises, according to my chiro, encourage the segments of the spine to start communicating with each other proprioceptively again so that posture continuously adjusts through different movements to return to neutral balance more often. Apparently this communication stops where misalignment has been chronic.

 

[loreta]

I had a contracture recently that was really painful, so much so that I felt like I'd aged 20 years. It was horrible. The contracture was on the right side of my back, at the top. I also have a crooked spine. The pain was so bad that I had difficulty breathing and also pain when walking. Creams, heat, nothing took away my pain. I went to see my masseur, who did nothing. No matter how much I told him my pain was upstairs, he persisted in massaging my lumbago. He didn't listen to me and probably made my situation worse. Fortunately, I had an appointment with my dentist, who told me to go and see a clinic that did osteopathy and acupuncture. I made an appointment right away.

The osteopath immediately told me when he saw me that that my body was not straight. First of all, I had a long, good massage, and then the osteopath did what osteopaths do: cric, crac croc!!! with my skeleton, from head to toe. It was the first time in my life I'd visited an osteopath, so I was amazed at what he did with my bones. It was painful, but I was totally confident that everything was for the best. After the osteopathy session, he gave me acupuncture and then touched up my diaphragm.

The next day I no longer had a contracture.
Why did I have a contracture? Because I went up to the fifth floor (no elevator) with a very, very heavy trolley.

Now I have regained the 20 years that I lost during those three painful weeks and where I felt 80 years old. The osteopath put my skeleton back in order a little and I will go back next month. My back has always been crooked partly because I have always carried bags full of books but also because my walk has never been very good, even if I walk a lot, because of my complicated feet. So I recently invested in good walking shoes and also became aware of all the little crosses that I have carried on my back. I do Yoga 3 times a week, so I am aware of the vital importance of the back. And of taking care of it.

Thanks for all the information you bring to this thread, I hope I'm not making noise with my experience.