Forward Head Posture Fix

Forward Head Posture Fix

This ebook guide teaches you the muscles that you need to work to make sure that you have excellent posture all day long, and that you will have the benefits that go along with good posture. You will be able to get rid of many headaches, brain fog, and aching neck muscles by using this workout. There is no need to look old! Stooping is the sign of old age Even if you are an older person you too can work out this muscle group to give you the powerful posture of a much younger person! This bad posture that we are correcting is called texting neck. It comes when you look down at something (like a book or your phone) too often, which puts a huge strain on your neck. You will learn how to fix this problem and help your neck to be in better shape today. Your neck is supposed to remain vertical; we can help put it back where it goes to make sure that you stay healthy for years to come. More here...

Forward Head Posture Fix Summary


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Middle Peripheral Lesions

The syndrome is comprised of weakness of the ipsilateral vocal cord, palate, and pharynx and the trapezius and sternocleidomastoid muscles. A lesion in the retropharyngeal space is responsible for Villaret's syndrome, which involves cranial nerves IX, X, XI, and XII and produces anesthesia of the palate, larynx, and pharynx weakness of the trapezius and sternocleidomastoid muscles atrophy and weakness of the tongue and a Horner's syndrome. This last feature is due to involvement of cervical sympathetic fibers.

An Animal Model Of Periodic Limb Movements Of Sleep

The experiments were performed on Wistar rats. Stainless steel screws were implanted epidurally in the skull to derive the electroencephalogram (EEG). For electromyography (EMG) recording, stainless steel wires were inserted into the neck muscles bilaterally and attached to the skull. For movement detection, two magnets were implanted subcutaneously in both hindlimbs. The animals recovered from surgery before data acquisition.

CD Hall12 and SJ Herdman123

The three systems (visual, somatosensory and vestibular) that provide the main sensory inputs for postural control each contribute unique information regarding body posture and motion. This information is used to generate automatic postural responses and also contributes to voluntary postural control. No single sensory system, however, provides us with sufficient information to definitively determine body position and movement. Vestibular input is used to determine head position relative to gravity and to provide information regarding linear and angular head acceleration to detect self-motion. The vestibular system can detect even the small head movements resulting from body sway during quiet stance. Motor responses to head acceleration are then mediated through the vestibu-lospinal system. Direct stimulation of the vestibular system (via GVS) results in the perception of movement with a resultant increase in leg muscle activation and body sway (Nashner and Wolfson, 1974 Magnusson et...

The surgicalnonsurgical decision in Class II treatment

The soft tissue cephalometric analysis, or STCA, has been advocated by Arnett et al2-3,4 as an aid for orthodontists and surgeons in treatment planning. It recommends analysis using a true vertical line (TVL) through subnasale, with natural head posture. It may also be used to quantify favorable or unfavorable change in the profile after overjet reduction, and hence has an important potential role in post-treatment analysis and in research. The STCA includes normal values for many aspects of facial profile and harmony, but in the following theoretical situations only seven of these will be considered (Fig. 7.1). For reasons of clarity, all other STCA values will be disregarded in this discussion, and it will be assumed that the upper- and mid- thirds of the facial profile are close to ideal, and that the upper incisors are well positioned.

Muscles That Cause Lung Expansion and Contraction

The second method for expanding the lungs is to raise the rib cage. This expands the lungs because, in the natural resting position, the ribs slant downward, as shown on the left side of Figure 37-1, thus allowing the sternum to fall backward toward the vertebral column. But when the rib cage is elevated, the ribs project almost directly forward, so that the sternum also moves forward, away from the spine, making the anteroposterior thickness of the chest about 20 per cent greater during maximum inspiration than during expiration. Therefore, all the muscles that elevate the chest cage are classified as muscles of inspiration, and those muscles that depress the chest cage are classified as muscles of expiration. The most important muscles that raise the rib cage are the external intercostals, but others that help are the (1) sternocleidomastoid muscles, which lift upward on the sternum (2) anterior serrati, which lift many of the ribs and (3) scaleni, which lift the first two ribs.

Lower Motor Neuron Pool

The cervical plexus is formed by the anterior primary rami of C1 through C4 behind the sternocleidomastoid and in front of the scalenus medius and levator scapulae muscles. The motor branches of the plexus supply the muscles of the neck. Injuries to the cervical plexus are infrequent,

Structured And Semistructured Clinical Interviews

Despite the limited amount of free time available during a structured interview, the clinician is faced with the need to establish rapport quickly with the client in order to obtain accurate and complete information (Beutler, 1995 Scheiber, 1994). Beutler (1995) recommended that the clinician ensure that the desired expectation and mind set are developed by the patient (p. 99) by interviewing in a quiet, protected area to provide a relaxing therapeutic milieu of safety and collaboration. In addition, the clinician can, with the skillful use of nonverbal communication (e.g., body posture, etc.), convey a sense of empathy and positive regard throughout the process. Finally, the interviewer will do well to provide the client beforehand with information (e.g., interview format, etc.) that gives the individual some sense of control during the interview process (Beutler, 1995). With such considerations in mind when administering an SI, the clinician can often ascertain important clinical...

Principles of Surgical Treatment

The currently accepted principles of surgery for differentiated thyroid cancer call for complete removal of the local lesion and extensions in the neck. Longer survival and better control of symptoms are obtained if gross tumor is fully removed. This is usually interpreted to mean thyroidectomy and excision of involved regional lymph nodes, with persisting differences of opinion about the need for total thyroidectomy. Because of the pathological behavior of these tumors, nodal metastases are excised by limited regional dissection rather than by standard radical neck dissection. Even in extended node dissection, adjacent structures, such as the sternocleidomastoid muscle and internal jugular vein, are spared whenever possible. The submandibular triangle is rarely involved, but on the other hand, positive nodes do occur pretracheally, in the tracheoesophageal groove, along the length of the internal jugular chain, in the V between the innominate and left carotid arteries, and in the...

Great Auricular Nerve

The only significant structure specific to this approach not mentioned for the retromandibular approach is the great auricular nerve. This sensory nerve begins deep in the neck as spinal roots C2 and C3, which fuse on the scalene muscle to form the great auricular nerve. As the nerve becomes more superficial, it emerges through the deep fascia of the neck at the middle of the posterior border of the sternocleidomastoid muscle. It crosses the sternocleidomastoid muscle at a 45o angle toward the angle of the mandible, covered only by the superficial musculoaponeurotic layer (SMAS) and skin. The nerve lies behind the external jugular vein. The nerve then may split into two branches as it courses superiorly toward the lobe of the ear (Fig. 11-1). Some branches pass through the parotid gland and supply the skin of a part of the outer ear of a variably wide area in the region of the mandibular angle.

Step 1 Preparation and Draping

Figure 11- 1 Anatomic dissection showing the relationship of the great auricular nerve (*) to the sternocleidomastoid muscle (SCM) and ear. Figure 11- 1 Anatomic dissection showing the relationship of the great auricular nerve (*) to the sternocleidomastoid muscle (SCM) and ear.

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Denervation in the sternocleidomastoid. 8. The correct answer is B. Compression at the jugular foramen should injure spinal accessory nerve fibers destined for both the sternocleidomastoid and trapezius. Trapezius weakness causes one form of scapular winging. The geniohyoid is supplied by the hypoglossal nerve, which leaves the skull through the hypoglossal canal. Although skull base tumors will frequently compress both cranial nerves XI and XII, a jugular foramen syndrome spares the latter.

Energy Output Affect

Even in sedentary individuals who perform little or no daily exercise or physical work, significant energy is spent on spontaneous physical activity required to maintain muscle tone and body posture and on other nonexercise activities such as fidgeting. Together, these nonexercise activities account for about 7 per cent of a person's daily energy usage.

Indications and Patient Selection

In contrast, qualitative sedated sleep endoscopy for sleep apnea surgical technique and patient selection using quantitative methods was demonstrated successfully 4 . Differences in outcomes using these tests indicate that interpretation of the test is critical for the examination to be useful. Airway collapse is the result of an interaction of a structurally small airway, ventilatory drive, arousal thresholds, neuromuscular reflexes, lung volume, surface-adhesion forces, body and head position, and level of sleep. To accurately interpret sleep endoscopy, it is necessary to appreciate that the upper airway is a highly variable structure during sleep that is affected by these other physiologic factors. Identification of vibratory tissues or collapse alone is inadequate.

Closure of a Fistula without Tracheal Resection

In the case where there is no tracheal injury except at the site of a fistula to the esophagus, repair does not require tracheal resection.6 Dissection differs at critical points from that just described. A collar incision will provide as good exposure as an oblique incision anterior to the sternocleidomastoid muscle and a better cosmetic result. The collar approach also facilitates bilateral dissection should this become necessary. This can be important if prior attempt at closure has been made. A unilateral approach is used initially in order to minimize the possibility of injury to recurrent laryngeal nerves. If the fistula is midline but low in the neck, the left side is preferably selected. The left recurrent laryngeal nerve enters the neck lying in the tracheoesophageal groove rather than crossing the lower neck obliquely to reach the groove, as on the right. The collar incision is therefore slightly eccentric, with a greater length to the left than to the right. The cuta- neous...

History And Definitions

Important characteristics used to describe and classify hyperkinesias include regularity, velocity and duration, and anatomical distribution. In terms of regularity, tremors are generally rhythmical to-and-fro movements, and likewise, tics and stereotypies are repetitive movements that are highly predictable in quality, although intermittent in frequency. In contrast, chorea is best characterized by rapid movements flowing irregularly from one body part to another without a predictable pattern. In terms of velocity and duration, rapid movements include myoclonus, chorea, ballism, clonic tics, and some tremors. Slow movements are dystonic or athetotic, showing a sustained contraction of muscles, often with a twisting component. Finally, several hyperkinesias have a propensity to involve certain body regions, for example akathitic movements almost always affect the legs, and tics tend to be most prominent in the face, eyes, and neck. Dystonic movements occur in all body regions but are...

Table 162 Ototoxic Medications

In hyperkinesias, key information is obtained by observing the patient at rest in complete repose without talking. Relaxing these patients and finding the best rest position can be a challenge. It is important to recognize that a sitting position is one of rest for the extremities, but one of activation for the trunk. In dystonia, in which movements are often absent during rest and activate with a maintained posture, the examiner must be particularly vigilant to correctly identify postures that are resting and active. As such, in truncal dystonia, a kyphotic posture may be present when the patient is sitting erect or standing in seeming repose, because the trunk muscles are activated in these positions. To test for resolution or diminution in the rest posture, these patients must lie supine or prone. Likewise, neck hyperkinesias must be studied with great care to achieve a rest position. Cervical dystonia may be prominent with the patient quietly sitting, but in fact, the neck muscles...

Directed Neurological Examination Cranial Nerve Xi

A unilateral hemispherical lesion does not usually cause marked deviation of the head, although some weakness may be present. In cortical or subcortical strokes, the head can deviate to the side of the lesion, away from the hemiparetic body, making rehabilitation efforts frustrating. Atrophy and fasciculations are not present in an upper motor neuron lesion.y Irritative cortical foci may result in seizures accompanied by forced deviation of the head to the contralateral side. y A unilateral supranuclear lesion in the upper brain stem may produce dissociated weakness, with ipsilateral weakness of the sternal head of the SCM and contralateral weakness of the trapezius. 11 Nuclear lesions of CN XI are rare. These lesions result in muscle weakness as well as atrophy and fasciculations. Unilateral nerve lesions produce weakness of the involved muscles as well as some deviation and possibly winging of the scapula. Bilateral nerve lesions result in diminished ability to rotate the neck, and...

Directed Neurological Examination

Impaired execution of fine finger movements is tested by bringing each finger of one hand separately in succession to the tip of the thumb. All fingers tend to flex simultaneously, and the ability of the thumb to keep a correct posture is impaired. Investigating a variety of more complex tasks, like buttoning or handling objects, may demonstrate disturbance of activities of everyday life. Prehension involves moving the hand to an object, a coincident shaping of the hand in anticipation of the object, and a finally closing of the fingers to formulate the grasp. y Cerebellar subjects open their fingers excessively wide in anticipation of the object and close their fingers with undue force grasping the object (signe de la prehension). Writing is often affected. Maintaining a low isometric force between thumb and index finger, for example, when holding a pen while writing, is impaired.y The pencil is held incorrectly and is pressed too firmly on the paper. Writing becomes labored and...

Degenerative Muscular Disorders

Apparent, with the proximal extremities more severely affected than the distal extremities, and lower extremities and torso more severely affected than the upper extremities ( ,Fig.,36 5 ). Weakness of the arms may be present but is not obvious without careful examination. The strength of limb and torso muscles continues to decline steadily from ages 6 though 11 years. Proximal muscles continue to be more severely affected than distal muscles, with neck flexors becoming more involved than extensors, wrist extensors more than flexors, biceps and triceps more than deltoid, quadriceps more than hamstrings, and the tibialis anterior and peroni more than the gastrocnemius, soleus, and tibialis anterior. Tendon reflexes decrease and disappear as muscle weakness progresses. By the age of 10 years, 50 percent of patients have lost biceps, triceps, and knee reflexes, in contrast with the ankle reflex, which remains in one third of patients even in end-stage disease. Significant contractures of...

Measurement of Blood Pressure

Cuff of appropriate size, standard arm placement, positioning of the cuff at heart level, having the patient adopt a standard body posture, and assuring use of a calibrated manometer (Pickering et al., 2005). It is also important to obtain blood pressures during periods of silence not only can the examiner hear the Korotkoff sounds better, but talking during blood pressure determinations has been associated with significantly increased blood pressures of the patient (Le Pailleur et al., 2001). Observer errors are also a source of inaccuracy foremost among these is a digit preference for numbers ending in a 5 or 0 (Shapiro et al., 1996). These observer errors, however, can be minimized with the use of a random zero sphygmomanometer (Wright and Dore, 1970), a device gauged so that the actual zero point is unknown to the examiner. Additionally, determining DBP by detecting Phase IV Korotkoff sounds (muffling of the Korotkoff sound) typically results in poorer reliability than using Phase...


The parotid gland is bounded superiorly by the zygomatic arch. Inferiorly, the tail of the parotid gland extends down and abuts the anteromedial margin of the sterno-cleidomastoid muscle. This tail of the parotid gland extends posteriorly over the superior border of the sternocleidomastoid muscle toward the mastoid tip. The deep lobe of the parotid lies within the parapharyngeal space 10 .


The deep cervical fascia continues superiorly to form the parotid fascia, which is split into superficial and deep layers to enclose the parotid gland. The thicker superficial fascia is extended superiorly from the masseter and sternocleidomastoid muscles to the zygomatic arch. The deep layer extends to the stylomandibular ligament (or membrane), which separates the superficial and deep lobes of the parotid gland. The stylomandibular ligament is an important surgical landmark when considering the resection of deep lobe tumors. In fact, stylomandibular tenotomy 22 can be a crucial maneuver in providing exposure for en bloc resections of deep-lobe parotid or other parapharyngeal space tumors. The parotid fascia forms a dense inelastic capsule and, because it also covers the masseter muscle deeply, can sometimes be referred to as the parotid masseteric fascia.

Neural Anatomy

The great auricular nerve is a sensory branch of the cervical plexus, particularly C2 and C3, and innervates the posterior portion of the pinna and the lobule. The nerve parallels the external jugular vein along the lateral surface of the sternocleidomastoid muscle to the tail of the parotid gland, where it splits into anterior and posterior branches. The great auricular nerve is often injured during parotidectomy, which can result in long-term sensory loss in the lobule. Harvesting of this nerve can be used for facial nerve grafting in certain cases.

Venous Drainage

The retromandibular vein, formed by the union of the maxillary vein and the superficial temporal vein, runs through the parotid gland just deep to the facial nerve to join the external jugular vein. There is substantial variation in the surgical anatomy of the retromandibular vein, which may bifurcate into an anterior and posterior branch. The anterior branch can unite with the posterior facial vein, forming the common facial vein. The posterior facial vein lies immediately deep to the marginal mandibular branch of the facial nerve and is therefore often used as a landmark for identification of the nerve branch, especially at the antegonial notch of the mandible where the nerve dips inferiorly 3 . The posterior branch of the retromandibular vein may combine with the postauricular vein above the sternocleidomastoid muscle and drain into the external jugular vein.


Cervical whiplash is a valid clinical syndrome, with symptoms consistent with anatomic sites of injury, and a potential for significant impair-ment.80 Whiplash injuries afflict more than 1 million people in the U.S. each year,81 with an annual incidence of approximately 4 per 1000 population.82 Symptoms in cervical whiplash injuries are due to soft tissue trauma, particularly musculoligamentous sprains and strains to the cervical spine. After a rear-end impact in a motor vehicle accident, the patient is accelerated forward and the lower cervical vertebrae are hyper-extended, especially at the C5-6 interspace. This is followed by flexion of the upper cervical vertebrae, which is limited by the chin striking the chest. Hyperextension commonly causes an injury to the anterior longitudinal ligament of the cervical spine and other soft tissue injuries of the anterior neck including muscle tears, muscle hemorrhage, esophageal hemorrhage, or disc disruption. Muscles most commonly injured...

Vestibular System

Three major white matter pathways connect the vestibular nucleus to the anterior horn cells of the spinal cord. The lateral vestibulospinal tract originates from the ipsilateral lateral vestibular nucleus, which receives the majority of its input from the otoliths and the cerebellum. This pathway generates antigravity postural motor activity, primarily in the lower extremities, in response to the head position changes that occur with respect to gravity. The medial vestibulospinal tract originates from the contralateral medial, superior, and descending vestibular nuclei it mediates ongoing postural changes in response to semicircular canal sensory input (angular head motion). The medial vestibulospinal tract descends only through the cervical spinal cord in the medial longitudinal fasciculus it activates cervical axial musculature.

Paradoxical Sleep

The term paradoxical sleep was introduced in a 1967 Scientific American article on the states of sleep by French researcher Michel Jouvet. Jouvet used the term to describe a period of apparent sleep in cats in which they exhibited high levels of neural activity with completely relaxed neck muscles. In humans, such periods are also characterized by rapid eye movements sleep researchers use the term REM sleep with human subjects but paradoxical sleep with animals because many species do not exhibit eye movements.

W Robert Rout

Glossopharyngeal Neve Left Side Picture

The sternocleidomastoid muscles ( Fig. 18-2 ), one on each side, form a prominence that runs from the mastoid process obliquely downward and medially (anteriorly) across the lateral surface of the neck to the medial portion of the clavicle and its junction with the sternum at the episternal notch. Each sternocleidomastoid muscle divides its side of the neck into an anterior and a posterior triangle. 4. The arch of the cricoid cartilage can be felt (but not seen) in the anterior midline and is just inferior to the thyroid cartilage. It moves up and down on swallowing. Immediately below it, the butterfly-shaped thyroid gland can be palpated (see Fig. 18-2 ). This gland cannot be seen as a surface landmark unless it is enlarged. The cricoid cartilage is at the level of the palpable anterior tuberosity (carotid tubercle of Chassaignac) of the sixth cervical vertebra. This tubercle can be identified by applying pressure at the anterior border of the sternocleidomastoid muscle at this...

Myotonic Dystrophy

The classic presentation of noncongenital DM, which is well described by Harper, includes marked weakness in the face, jaw, and neck muscles and milder distal The person with advanced DM has a characteristic appearance a long, thin face with sunken cheeks due to temporal and masseter wasting, a so-called swan neck because of sternocleidomastoid wasting, and ptosis, with relatively strong muscles in the posterior neck and shoulder girdle.


Clavicular stress fractures have been reported in a javelin thrower, a rower, a gymnast, a diver, a weight lifter, a human tower stuntman, and a baseball player 32-38 . The fractures in the rower and gymnast involved the medial third of the clavicle 33,34 . The lightweight rower presented with increasing pain in her medial clavicular area after rapidly increasing her training intensity over a 3- to 4-week period, after a 5-month period of rest 33 . Plain radiographs demonstrated a right medial clavicular fracture, just lateral to the sternocla-vicular joint. The patient was treated with cessation from rowing activity and a short course of physical therapy to improve posture, scapulothoracic mechanics, and rotator cuff strength until she was pain free, followed by a progressive increase in rowing. After 2 months from the time of diagnosis of the fracture, the rower returned to full competition. The authors suggest that the fracture was a result of the resumption of high-energy cyclic...


Coronoid Notch Self Retaining Retractor

In many patients, dense scarring is found at the level of the stoma as well as at the site of postintubation stenosis. Scarring is heightened by prior surgical procedures. Normal subplatysmal anatomy is therefore identified first at the lateral ends of the transverse incision and dissection carried along the surface and border of the sternocleidomastoid muscles, both above and below on either side. The surgeon then works toward the midline and gradually elevates the skin and what is left of the platysma from the strap muscles and the midline points of adherence to the trachea. Initial dissection in almost every case is carried up to the level of the cricoid cartilage. A long-necked patient requires a longer horizontal incision so that the upper flap may be raised higher. I have avoided U-shaped incisions, which are less cosmetic and offer no better exposure. Inferiorly, the cutaneous and platysmal flaps are raised to the sternal notch. The anterior borders of the sternocleidomastoid...


The retromandibular approach to the mandible varies with surgeons in the position of the skin incision - which also dictates the underlying dissection. Some surgeons advocate placing an incision approximately 2 cm posterior to the ramus. The parotid gland is approached from behind and sharply dissected from the sternocleidomastoid muscle, allowing retraction of the gland superiorly and anteriorly to gain access to the ramus. The theoretic advantage to this approach is that it avoids the branching facial nerve, which is contained within the parotid gland. Unfortunately, the primary advantage of the retromandibular approach, the direct proximity of the skin incision to the mandible, is then lost. An alternate approach, presented here, was described by Hinds (2). The incision is placed at the posterior ramus, just below the earlobe. Dissection to the posterior border of the mandible is direct, traversing the parotid gland and exposing some branches of the facial nerve.


Beware of the spinal accessory nerve in the posterior triangle of the neck. The spinal accessory nerve pierces through the posterior border of the sternocleidomastoid muscle a little above its midportion and enters the posterior triangle of the neck. The spinal accessory nerve then travels superficially just below the subcutaneous fat in the investing fascia covering the posterior triangle. There is also a chain of lymph nodes intimately associated with the spinal accessory nerve along its course in the posterior triangle. This nerve has been transected by those aware of its superficial location as well as by those unaware. Good judgment is based on experience, which is often based on bad judgment.


The cervical incision is made first to determine whether the lesion can be removed and reconstruction accomplished. The initial incision is transverse and follows the line of the clavicles at the base of the neck (Figure 34-1). If resection is to be performed, the incision is extended laterally and turned downward slightly at either end as the shoulder is reached in order to allow the flap to be moved caudad and into the mediastinum more easily. The upper skin flap is elevated superiorly, with platysma attached to a point above the hyoid bone. If skin must be removed with the specimen due to invasion by tumor, this area is outlined during initial elevation of the flaps and remains with the specimen. In such case, the incision will require individual planning. Inferiorly, the skin flap is initially raised to the sternal notch. The mode of exploration will necessarily vary with the lesion. Strap muscles are usually left attached to a bulky tumor in the case of thyroid carcinoma. If not...

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