1. Forward head posture – a pain in the neck
Dr Shwetha S Hegde
Consultant,
Oral Medicine and Radiology
Australian Dental Board Certified
Dr Shwetha S Hegde

2. What is forward head posture?
A major postural imbalance
Anterior positioning of the cervical spine
Common occupational hazard
Dr Shwetha S Hegde

3. The mechanism..
Poor posture alters spine position mandible shifts forward the upper and lower teeth misalign skull moves back on the spinal column.
If not addressed, pain and inflammation in the muscles and jaw joints will develop when the mouth opens and closes.
Forward Head Posture (FHP) is a very common postural issue, and it is estimated to occur in between 66% and 90%  of the population.
Dr Shwetha S Hegde

4. Role of the mandible in posture
Mandibular posture and head posture are inversely proportional in an antero-posterior (forward- backward) plane.
Shifting the mandible backward causes the head to shift forward, and shifting the head forward causes the mandible to shift backward.
Dr Shwetha S Hegde

5. FHP is strongly correlated with backward mandibular posture
FHP is strongly correlated with backward mandibular posture.  TMJ disorder patients typically have both FHP and backward mandibular posture.
Dr Shwetha S Hegde

6. Protective mechanism Dr Shwetha S Hegde FHP
Increases passive tension in muscles of mastication
Backward mandibular posture
Decreased resting freeway space
Protective mechanism
Dr Shwetha S Hegde

7. Head and jaw posture are both controlled by a hierarchy of neuromuscular reflexes, and airway protection is top priority.  
For every inch the neck goes forward there is an extra 4.5 kg of weight on the neck. 
Dr Shwetha S Hegde

8. FHP produces a progressive loss and then a reversal of the normal cervical curve (lordosis) of the neck
Dr Shwetha S Hegde

9. Changes occurring in the curvature of the spine over time due to FHP
Dr Shwetha S Hegde

10. This leads to stiffness and arthritic changes in the spine
FHP causes realignment of the curvature of the spine due shifting of the weight of the head.
The weight is distributed unevenly on the intervertebral spine causing compressive strain on the intervertebral disc
This leads to stiffness and arthritic changes in the spine
Since muscles function in groups, muscles determining posture are also affected
Dr Shwetha S Hegde

11. Effects on tmJ
Pain in the muscles of mastication and infrahyoid muscles
Pain in the TM joints
Change in occlusion due backward shift of the mandible
Dr Shwetha S Hegde

12. THE ROLE OF STRESS
Stress worsens muscle tension by a measurable decrease in muscle circulation
Brings down threshold for jaw muscle pain due to inhibition of endorphin release
Dr Shwetha S Hegde

13. THE ROLE OF ATTITUDE
Attitude influences posture and resting muscle tensions in the jaw area just like it does in the rest of the body. 
Dr Shwetha S Hegde

14. Signs and symptoms Chronic neck pain Headaches
Tingling and numbness in the arms and hands
Improper breathing
Poor neck posture with outward stretching of neck
Chronic fatigue
Dr Shwetha S Hegde

15. Treatment goals
Re-establishing a stable balanced resting posture for the head and the mandible.
Has mechanical and psychological components.
Mechanical component- paying attention to posture while standing, sitting sleeping etc
 The psychological component involves the way your mental state affects the resting postures of your muscles and thereby also the stance you use for weight bearing.  
Dr Shwetha S Hegde

16. Treatment: EXERCISE STRETCHING PASSIVE PHYSICAL SUPPORT
Dr Shwetha S Hegde

17. Short term treatment: Anti inflammatory drugs Ultrasound TENS
Cortisone injections
Use of neck brace
Dr Shwetha S Hegde

18. exercise
Neck exercises because the neck muscles are the primary determinants of head posture.
Resistance exercises to strengthen neck muscles
Dr Shwetha S Hegde

19. Stretching:
Yoga, Tai Chi, and swimming are popular exercises which provide both stretching and strengthening. 
Another way to combine strengthening with stretching is to pull oneself upward using overhead bars.
Dr Shwetha S Hegde

20. Passive physical support:
Ergonomically perfect chair
A simple foam rubber mattress or a relatively hard mattress is preferable
Passive support using a pillow under the neck
Dr Shwetha S Hegde

21. Do's and don'ts…
Make sure your computer monitor is ergonomically set up.
top third of your screen is at eye-level.
distance from your monitor to your eyes to should be 18 to 24 inches
Never carry heavy bags, backpacks or purses
Dr Shwetha S Hegde

22. Buy a supportive neck pillow, if you often wake up with a sore neck.
Get up and walk around every half an hour that you work at a desk, work in front of a computer or watch television.
Buy a supportive neck pillow, if you often wake up with a sore neck.
Dr Shwetha S Hegde

23. Who are the potential patients?
People in the software field
Surgeons
Dentists
Factory/high precision workers
People with a desk job
People with sedentary lifestyle-prolonged TV watching
Dr Shwetha S Hegde

24. Role of a oral medicine and radiology specialist..
Create awareness among the target population
Counsel them to develop better posture and eliminate parafunctional habits
Treat the symptoms
Dr Shwetha S Hegde

25. Thank You
Dr Shwetha S Hegde