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What is Anterior Head Carriage?

Modern society has transitioned and adapted to an electronic-orientated lifestyle. Our cellphone and computer use have increased exponentially in the past 10 years. In Hong Kong, we are surrounded by people on their phones or electronic devices with anterior head carriage on a daily basis. Sometimes, the forward posture of anterior head carriage is also referred to as “tech-neck” or “text-neck”. Our cervical spine (neck) is responsible for carrying the weight of the head and supporting it at an upright position. Prolonged anterior position of the head will increase the load bearing of the neck and cervical discs causing spinal problems. Research has shown that for every 15 degrees of anterior shift, the weight bearing of the head will increase by 10 pounds. An average “tech-neck” posture will increase the weight bearing of the head by 20-30 pounds. In severe circumstances where the cervical nerves are affected, patients might experience neurological symptoms.

Cause and Symptoms

The cervical spine should have a lordotic curvature of 30-40 degrees to be able to effectively support the head.

The relationship of the facets and spinal discs in bearing weight is extremely important. The improper weight distribution can result in degeneration if not corrected. Changes to the lordotic curve not only affects the neck but can also refer pain to the shoulders and scapula. Prolonged uncorrected changes to the cervical curve can lead to inflammation of the spinal discs and stenosis which can cause neurological symptoms such as tinnitus, migraines, cervicogenic headaches, tension headaches, blurry vision and insomnia. Research has reported patients experienced short-term memory loss and other behavioral issues with prolonged anterior head carriage.

Forward posture of the upper body will also affect the thoracic spine. Similar to the cervical spine, neurological symptoms such as radiating numbness or tingling sensation into the upper limbs can result from irritation to the spinal discs. If the condition worsens, patients can develop weakness and decreased sensation in the upper limbs as well. Respiratory-related issues have also been reported as an associated symptom with forward posture. Scoliosis patients should be extra attentive in their posture as shift in the body’s center of gravity can worsen a scoliotic curve.

Anterior weight shift can also apply when sitting. Office workers most commonly suffer from low back pain that arises due to prolonged sitting. The lumbar spine is responsible for upholding our upper body; however, if the upper body weight is shifted forward, the lumbar spine and spinal discs will also be affected. Aside from low back pain and soreness, neurological symptoms such as numbness in the lower limbs with radiating pain, weakness or unable to stand without support and sciatica can be present. Severe conditions can involve the digestive system causing nausea, constipation and diarrhea. Patients have also reported cases of incontinence and impotence, more common over the age of 50.

Treatment Option

There are three conventional treatment options for anterior posture or anterior head carriage; chiropractic care, rehabilitation exercise/ therapy and corrective devices such as the Denneroll.

Chiropractic care is a common non-invasive treatment option that can correct the spinal posture and disc bearing. We focus stabilizing the biomechanical structure of the spine to allow better support of cervical region and head. Our goal is to decrease inflammation and irritation to the spine by shifting the weight bearing into an optimal position.

Rehabilitation exercise/ therapy can provide an increase in range of motion of the spine and strengthening the supporting musculature which can also benefit postural change. It is important to incorporate rehabilitation therapy into patient care management as it can provide a long-term solution for anterior posture.

Lastly, corrective devices such as the Denneroll is a great evidence-based supportive treatment for anterior posture. It is prescribed by the healthcare provide during the period of treatment and for the patient to take home. Instructions should be given (frequency and duration) depending on the patient’s condition to provide long-term changes to the spinal curvatures.

Dr. Lai’s Recommendations:

We understand that electronic use is inevitable as our society advances. However, we can always find a balance between usage and spinal health. Intervals at work or cellphone use with rehabilitation exercises and stretches are great ways to combat the stagnant anterior posture. It allows our posture to reset and provides mobility to our spine and musculature. Proper sitting posture is also important, it reduces the stress added to our spine; especially our lumbar spine when sitting. 

Dr. Lai recommends 5 minutes of rehabilitation exercise or stretch for every 45mins. of work. Simple mobility exercises of the upper thoracic and activating the deep cervical muscles make a great difference when incorporated into your daily habit.

In conclusion, it should be reminded that habits and improper posture are developed over time. Anterior head carriage symptoms; especially severe symptoms are typically manifested rather than incidental. The key takeaway is that breaking a bad habit requires a lifestyle consistency, not one-time fix solution.

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