As mentioned earlier force causes fluids to move. Gravity is a force and it comes into play with poor standing and sitting postures. One obvious example is the forward head carriage. If you think about it for a minute it becomes quite clear. The force of gravity acting on the forward head causes fluid to move in the upper thoracic and lower cervical spines. The pressure is now greater in the anterior aspects of these structures and fluid therefore moves to the posterior. This movement causes sagittal wedging in the discs and vertebral bodies. The head now stays forward and the scenario may worsen over time. Muscles adapt to this and an upper crossed syndrome develops as well as an associated cranial nerve involvement. Only by reversing the fluid shift within these parts of the spine will the condition be corrected. The therapeutic direction of force has to be opposite of that of gravity.

Just because a patient looks as though they have a forward head carriage it doesn’t mean theirs is symptomatic, that is why we test for it. Likewise a patient presenting with a seemingly good posture doesn’t mean they don’t have a forward head posture for their particular case. That’s why we test for it.

Several techniques can be used to test and treat this condition. Remember always look for red flags.

A second example is the misshaped lower lumbar vertebral bodies and discs due to sitting slouched or standing stooped for long periods. Again, the testing would involve introducing a force into the lumbar spine opposite that of gravity.

General considerations:

• Without re-shifting the fluid in these areas of the spine any treatment would only have limited and short lived results.
• The patient should be educated to what has happened and given a few simple home exercises in order to self correct.
• Best practices state the patient should become independent of care as soon as possible.

Now that the head is back is the time for muscle lengthening procedures to be applied to hypertonic groups followed by strengthening exercises for the inhibited groups. The same applies for the lumbar spine.