Baş Önde Postür: Biyomekanik, Postüral ve Terapötik Yaklaşımlar Açısından İncelenmesi – Güncel Literatür ve Rehabilitasyon Yöntemleri

Year 2025, Volume: 3 Issue: 1, 10 - 17, 25.04.2025

Gürkan Demirtaş , Nevin A. Güzel

https://doi.org/10.5281/zenodo.15277916

Abstract

Baş Önde Postür (BÖP), başın öne doğru yer değiştirdiği bir postüral bozukluk olup servikal-torasik-omuz bölgesini etkileyen en yaygın postüral anormalliklerden biridir. Bu yer değişikliği ile birlikte, C0-C2 segmentlerinde ekstansiyon ve lordoz artışı gözlemlenirken, C2-C7 segmentlerinde fleksiyon artışı ve lordoz azalması meydana gelir. Meydana gelen bu postüral değişikliklere çevre kaslar, uzayarak veya kısalarak uyum sağlamaktadır. Omurganın birbirine bağlı kinetik bir zincir olarak çalıştığı göz önünde bulundurulduğunda, nötral spinal hizadan sapma diğer omurga eğrilerinde de telafi edici değişikliklere neden olmaktadır. Bu bağlamda, BÖP; torasik kifoz, yuvarlak omuzlar ve skapular diskinezi gibi postüral anormalliklerle yakından ilişkilidir.
BÖP’ün tedavi planlamasında bireyin duruş özellikleri, ağrı kaynakları ve kas dengesizliklerinin detaylı değerlendirilmesi esastır. Tedavide germe, güçlendirme, stabilizasyon, düzeltici egzersizler, kas enerji teknikleri ve manuel terapi gibi fizyoterapi yöntemleri kullanılmaktadır. Çalışmalar, çok yönlü tedavi yaklaşımlarının daha etkili olduğunu göstermektedir. Egzersiz programlarının etkinliği değişkenlik göstermekle birlikte, en yaygın kullanılan yaklaşımlar, kas dengesini sağlamak amacıyla zayıflamış kasları güçlendirme ve kısalmış kasları esnetme üzerine odaklanmaktadır.
Derin boyun fleksörleri ve skapular kasların güçlendirilmesi, BÖP’ün düzeltilmesinde kritik bir rol oynar. Sternokleidomastoid (SCM) kasının aktivasyonunun azaltılması, derin boyun fleksörlerinin aktivasyonunu artırarak postürün düzeltilmesine katkı sağlar. Çeşitli tedavi yaklaşımları etkili olmakla birlikte, çok yönlü bir yaklaşım en kapsamlı sonuçları sağlamaktadır.

Keywords

Baş önde postür, Biyomekanik, Çok yönlü tedavi, Egzersiz, Terapötik

Forward Head Posture: Examination from Biomechanical, Postural, and Therapeutic Perspectives – Current Literature and Rehabilitation Methods

Abstract

Forward Head Posture (FHP) is a postural disorder in which the head shifts forward, making it one of the most common postural abnormalities affecting the cervical-thoracic-shoulder region. This displacement is accompanied by an increase in extension and lordosis in the C0-C2 segments, whereas the C2-C7 segments experience increased flexion and reduced lordosis. The surrounding muscles adapt to these postural changes by either lengthening or shortening. Considering that the spine functions as a connected kinetic chain, any deviation from the neutral spinal alignment leads to compensatory changes in other spinal curves. In this context, FHP is closely associated with postural abnormalities such as thoracic kyphosis, rounded shoulders, and scapular dyskinesis.
A detailed assessment of an individual's posture, pain sources, and muscle imbalances is essential in planning the treatment of FHP. Physiotherapy methods such as stretching, strengthening, stabilization, corrective exercises, muscle energy techniques and manual therapy are used in treatment. Studies indicate that multimodal treatment approaches are more effective. While the effectiveness of exercise programs varies, the most commonly used approaches focus on strengthening weakened muscles and stretching shortened muscles to restore muscle balance.
Strengthening deep neck flexors and scapular muscles plays a crucial role in correcting FHP. Reducing the activation of the sternocleidomastoid (SCM) muscle enhances the activation of deep neck flexors, contributing to postural correction. Although various treatment approaches are effective, a multimodal approach provides the most comprehensive results.

Keywords

Forward head posture, Biomechanics, Multimodal treatment, Exercise, Therapeutics

References

• 1. Singla D, Vegar Z. Associtian Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature. J Chiropr Med. 2017;16(3):220-9.
• 2. Lee TH, Liu TY. Postural and muscular responses while viewing different heights of screen. Int J Occup Saf Ergon. 2013;19(2):251–8.
• 3. Neumann DA. Kinesiology of the Musculoskeletal System, Foundations for Rehabilitation. Third Edition. Elsevier; 2017:391–436.
• 4. Khayatzadeh S, Kalmanson OA, Schuit D, Havey RM, Voronov LI, Ghanayem AJ, et al. Cervical Spine Muscle-Tendon Unit Length Differences Between Neutral and Forward Head Postures: Biomechanical Study Using Human Cadaveric Specimens. Phys Ther. 2017;97(7):756–66.
• 5. Patwardhan AG, Khayatzadeh S, Havey RM, Voronov LI, Smith ZA, Kalmanson O, et al. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J. 2018;27(Suppl 1):25–38.
• 6. Patwardhan AG, Havey RM, Khayatzadeh S, Muriuki MG, Voronov LI, Carandang G, et al. Postural Consequences of Cervical Sagittal Imbalance: A Novel Laboratory Model. Spine (Phila Pa 1976). 2015;40(11):783–92.
• 7. Conroy VM., Murray Brian, Alexopulos Quinn, McCreary Jordan, Kendall FP. Kendall’s muscles: testing and function with posture and pain. Sixth edition. Lippincott Williams & Wilkins; 2023
• 8. Lv P, Peng Y, Zhang Y, Ding K, Chen X. Kinematic Causes and Exercise Rehabilitations of Patients with Round Shoulder, Thoracic Kyphosis and Forward Head Posture (FHP). Epidemiology: Open Access. 2016;6(5):1000263.
• 9. Sepehri S, Sheikhhoseini R, Piri H, Sayyadi P. The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024;25(1):105.
• 10. Smith ZA, Khayatzadeh S, Bakhsheshian J, Harvey M, Havey RM, Voronov LI, et al. Dimensions of the cervical neural foramen in conditions of spinal deformity: an ex vivo biomechanical investigation using specimen-specific CT imaging. Eur Spine J. 2016;25(7):2155–65.
• 11. Wilson JM, Loenneke JP, Jo E, Wilson GJ, Zourdos MC, Kim JS. The effects of endurance, strength, and power training on muscle fiber type shifting. J Strength Cond Res. 2012;26(6):1724–9.
• 12. Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976). 2004;29(19):2108–14.
• 13. Sung YH. Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. Medicina (Kaunas). 2022;58(12):1791.
• 14. Armstrong B, McNair P, Taylor D. Head and neck position sense. Sports Med. 2008;38(2):101–17.
• 15. Liu JX, Thornell LE, Pedrosa-Domellöf F. Muscle spindles in the deep muscles of the human neck: A morphological and immunocytochemical study. Journal of Histochemistry and Cytochemistry. 2003;51(2):175–86.
• 16. Armstrong BS, McNair PJ, Williams M. Head and neck position sense in whiplash patients and healthy individuals and the effect of the cranio-cervical flexion action. Clin Biomech (Bristol, Avon). 2005;20(7):675–84.
• 17. Karimian R, Rahnama N, Ghasemi G, Lenjannejadian S. Photogrammetric Analysis of Upper Cross Syndrome among Teachers and the Effects of National Academy of Sports Medicine Exercises with Ergonomic Intervention on the Syndrome. J Res Health Sci. 2019;19(3):e00450.
• 18. Nitayarak H, Charntaraviroj P. Effects of scapular stabilization exercises on posture and muscle imbalances in women with upper crossed syndrome: A randomized controlled trial. J Back Musculoskelet Rehabil. 2021;34(6):1031–40.
• 19. Abd El-Azeim AS, Mahmoud AG, Mohamed MT, El-Khateeb YS. Impact of adding scapular stabilization to postural correctional exercises on symptomatic forward head posture: a randomized controlled trial. Eur J Phys Rehabil Med. 2022;58(5):757–66.
• 20. Yaghoubitajani Z, Gheitasi M, Bayattork M, Andersen LL. Corrective exercises administered online vs at the workplace for pain and function in the office workers with upper crossed syndrome: randomized controlled trial. Int Arch Occup Environ Health. 2022;95(8):1703–18.
• 21. Lee S-M, Lee C-H, O’sullivan D, Jung J-H, Park J-J. Clinical effectiveness of a Pilates treatment for forward head posture. J Phys Ther Sci. 2016;28(7):2009-13.
• 22. Ruivo RM, Carita AI, Pezarat-Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study. Man Ther. 2016;21:76–82.
• 23. Shih HS, Chen SS, Cheng SC, Chang HW, Wu PR, Yang JS, et al. Effects of Kinesio taping and exercise on forward head posture. J Back Musculoskelet Rehabil. 2017;30(4):725–33.
• 24. Park SH, Oh YJ, Lee MM. Improving Function and Quality of Life in Patients with Chronic Neck Pain, Tension-Type Headache, and Forward Head Posture: The Role of Eyeball Exercise and Cervical Stabilization Programs. Med Sci Monit. 2024;30:e944315.
• 25. Mulet M, Decker KL, Look JO, Lenton PA, Schiffman EL. A randomized clinical trial assessing the efficacy of adding 6 x 6 exercises to self-care for the treatment of masticatory myofascial pain. Volume 21, Issue 4, Pages 318 - 328. 2007;21(4):318–28.
• 26. Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC Musculoskelet Disord. 2017;18(1):525.
• 27. Gillani SN, Qurat-Ul-Ain, Rehman SU, Masood T. Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial. J Pak Med Assoc. 2020;70(3):394–8.
• 28. Aneis YM, El-Badrawy NM, El-Ganainy AEA, Atta HK. The effectiveness of a multimodal approach in the treatment of patients with upper crossed syndrome: A randomized controlled trial. J Bodyw Mov Ther. 2022;32:130–6.
• 29. Sasun AR, Jawade S, Chitale N. Measuring the Efficacy of Myofascial Rollers and Post-isometric Relaxation Technique in Relieving Pain Intensity and Postural Deviation Using Plumb Line Assessment for the Treatment of Upper Cross Syndrome in Dental Undergraduate (UG) Students. Cureus. 2022;14(10):e29831.
• 30. Chang MC, Choo YJ, Hong K, Boudier-Revéret M, Yang S. Treatment of Upper Crossed Syndrome: A Narrative Systematic Review. Healthcare (Basel). 2023;11(16):2328.
• 31. Chaudhuri S, Chawla JK, Phadke V. Physiotherapeutic Interventions for Upper Cross Syndrome: A Systematic Review and Meta-Analysis. Cureus. 2023;15(9):e45471.
• 32. Sheikhhoseini R, Shahrbanian S, Sayyadi P, O’Sullivan K. Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis. J Manipulative Physiol Ther. 2018;41(6):530–9.
• 33. Porto AB, Nascimento Guimarães A, Alves Okazaki VH. The effect of exercise on postural alignment: A systematic review. J Bodyw Mov Ther. 2024;40:99–108.
• 34. Titcomb DA, Melton BF, Miyashita T, Bland HW. Evidence-Based Corrective Exercise Intervention for Forward Head Posture in Adolescents and Young Adults Without Musculoskeletal Pathology: A Critically Appraised Topic. J Sport Rehabil. 2022;31(5):640–4.
• 35. Cools AMJ, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48(8):692–7.
• 36. Çobanoğlu G, Yusuf Demirkan M, Ecemiş ZB, Güzel NA, Üniversitesi G, Fakültesi SB, et al. Forward Head Posture and Its Effect on Muscle Activation. Gazi Sağlık Bilimleri Dergisi. 2024;9(1):85–93.
• 37. Arshadi R, Ghasemi GA, Samadi H. Effects of an 8-week selective corrective exercises program on electromyography activity of scapular and neck muscles in persons with upper crossed syndrome: Randomized controlled trial. Phys Ther Sport. 2019;37:113–9.
• 38. Sbardella S, La Russa C, Bernetti A, Mangone M, Guarnera A, Pezzi L, et al. Muscle Energy Technique in the Rehabilitative Treatment for Acute and Chronic Non-Specific Neck Pain: A Systematic Review. Healthcare (Basel). 2021;9(6):746.