360- Forward Head Posture, Gait, and Postural Control

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with more research. Another brand new study that came out in gait and posture. It is titled the relationship between Forward Head Posture, Postural control and Gait Systematic review. An important conversation for us to have as chiropractors. Why? Because we can make an impact in postural control. We can make an impact on gait, we can make an impact on on forward head posture. So how do all these things come together? What are the takeaway messages we need to be aware of for our patients? And where's the research going? We're gonna touch on all that and more on today's episode. Before we get started, I wanna say a few words about the smart chiropractor. The smart chiropractor can power your patient journey. More new patients, better retention, more consistent reactivations. How do we do it? You can check it all out@thesmartchiropractor.com Again, that is the smartchiropractor.com hit up the blog, check out the free tools and resources. We have literally hundreds of pieces of content that lay out the path. So if you would like your practice to be busier, if you'd like to improve new patient flow retention or more reactivations, head on over. We have the tools and systems and if you want our help, you can always sign up and become a member. We'd be happy to to work with you as we do over 300 practices around the world. But as I said at the top on today's episode, we're talking research the relationship between forward head posture, postural control and gait. This is a systematic review. I'm going to drop a link down in the episode notes, the show notes, so if you want to check it out, you can do so. Forward head posture, what is it? Well, it is only one of the most common postural deviations in the the sagittal plane. And we know that significant association exists between sagittal plane, sagittal spinal alignment, postural control and fall risks. And there's a radiographic study that demonstrates alteration in the sagittal cervical alignment is associated with decreased postural control. I think we highlighted that study not too long ago on this podcast, but that's why this is so important. Now, is a half inch of forward head posture going to lead to crazy imbalance that somebody's falling down and has an increased fall risk? I'm not too sure. Right. There's shades of gray here. But I can tell you if that's the terminal point I start to think about when you pull that back and you're not optimal. Anything off of optimal could cause potential issues. It doesn't mean you're falling down all over the place. But I instantly think of like athletes, high performance and just people trying to perform throughout the day if they are off of optimal. Now you notice I said optimal and not what I'm gonna say is normal, because normal off of an X ray. I think there's variability there. Now, optimal for each individual. Hard to assess because everybody is built a little bit different. But we can take cues and know what's going on in a meaningful way. That enables us to talk about gait, that enables us to talk about posture, that enables us to talk about forward head posture, specifically in this case. So current research does indicate that people with forward head posture have reduced vestibular and proprioceptive functions, which are crucial sensory inputs for postural control. If your vestibular system's off, I mean, this is vertigo 101, right people? It is, it is a life changer. There is no question about that. Additionally, if you have proprioceptive aberration, so to speak, if your proprioceptive system's not working, your spatial awareness stinks. So you have to have these two systems working in harmony and ideally optimally, so that you have great postural control. And this is again important in my opinion, for people, whether they sit at a desk all day or whether they're on a court playing in front of hundreds, thousands of people at night. Postural control matters. We live our lives in motion. We are a movement based healthcare profession and people don't move enough. So this is really important stuff. Postural control requires an accurate sensory integration of vestibular, visual and proprioceptive inputs and motor responses to the displacement of center of gravity. This is an interesting one, the displacement of center of gravity. And anytime we're off of that really pinpoint of the center of gravity, we need to have really, really good integrations between the vestibular system, visual and proprioceptive input to know what's going on. And that is really, really important. And I think about this, I bridge this almost immediately. I think of that instantaneous axis of rotation slightly different than center of gravity, but that is the pinpoint of motion within a spinal disc and that migrates posteriorly as we age. So center of gravity, not only is the migration of the at this pinpoint of motion at the disc migrating posteriorly, but in many ways, in many cases, we add on a little bit of weight as we age and we get some increased lumbar, lower doses. So our center of gravity is shifting. It is not static as we age and aging could be week to week. In some cases, as we go through life under gravity, our center of gravity is changing. So the integration of these systems needs to be a constant work in progress because it's a dynamic system. Now let's take a look at some previous research. There's a cohort study that indicated a increased risk of all cause cardiovascular disease and cancer mortality associated with balance disorders, including vestibular, visual and proprioceptive specific balance disorders. So there's a cohort study out there that literally showed an increased risk of all causes of death, cardiovascular disease and cancer death associated with balance disorder. So is this a big deal in lifestyle and performance? Absolutely. But if we really bring this all the way down the road, there's actually research out there that showcases this is even much more of a big deal than optimal performance. This is a, you know, not to overdo it here, but a life or death type thing, there is a opportunity that this is something that influences overall all cause mortality. Now some of that's due to falls. I'm sure that it's mostly in a very aged senior population, but it's still stuff to take really, really seriously. So with a systematic review, they looked back at a variety of other studies to create this study. So all the studies in this review were cross sectional studies published between 2006 and in 2020. So pretty new. They weren't digging deep into the archives of 100 years ago, 50 years ago, or even, or even 25 years ago. They were looking at pretty recent studies. So that's great because it gives us a good idea of what's going on now in terms of postural control. They broke this up in a few different ways. One of those was static balance. And they found two studies that supported no relationship between forward head posture and static balance. And one which concluded the opposite. Gotta love research, right? The research is point of research. One study is to ask 10 more questions. And in this case, is there conflicting research? Yes. Is that uncommon?

No.

There is very, very common that we see conflicting research. Why? For a few different reasons. The design of the study matters, the population of the study matters, and the execution of the study matters. That's not to say good, bad, better or worse. But what it is to say is you can end up asking the same question and getting a few different answers. Also, the best research studies are very linear. You're trying to answer like one super, super, super specific question and within a topic there might be hundreds of super specific questions. So you might have slightly different answers depending upon the question asked, even though it falls in the same arena of, of the overall topic, if that makes sense. So long story short, static balance. Two studies, no relationship between forward head posture and static balance. One study concluded that there was a relationship in the opposite in the limits of stability. Three studies identified showed significantly reduced limits of stability with people that have forward head posture. So unilateral there. Postural stability control. They found four studies reported contradictory findings related to postural stability. So a little bit all over the place there. Performance based balance. This is like, this is one that I think all of our ears should perk up for. Three studies revealed impaired performance based balance with forward head posture using physical performance tests and scales. So that's really important. Performance based balance like that is doing tasks, living life, doing stuff. So if you have performance based balance issues with forward head posture, that's a big deal. So let's dive into proprioception. Proprioception. Four studies demonstrating a consensus that forward head posture was significantly. They don't use that word lightly when they're doing research associated with head position. Sense error. You need to know where you are in space. If you do not know where you are in space. Let's extrapolate that a little bit. If you have a poor sense of proprioception, you don't know where you are in space. Number one, you, your movement patterns and biomechanics are very likely to be suboptimal. They're not gonna be good. And let's go one step farther. So let's say there's an injury due to gravity, due to sports, due to age, whatever it might be. People suffer with injuries throughout time. We all do. You have an injury now, you're going through a rehab process, but you have poor proprioception, you have fear, avoidance behavior, cause you don't wanna move. You have you and rightfully so. Because you don't really know where you're moving in space. You're trying to do rehab exercises that are maybe not counterproductive, but certainly not super productive because you don't know where you are in space. You got injured, now you're trying to rehab doing things where you don't know where you are in space. So all of these things tie together, in my opinion, in an important way. And with us as chiropractors being able to impact, as I've seen in previous research, I won't say cite it perfectly right now, but when we can affect proprioception with the spinal adjustments that we deliver, how meaningful is that? Especially if somebody's going through rehab exercises, Especially if somebody's trying to get over an injury. Especially if somebody's not moving enough and their system's not getting the dynamic input it needs enough to be optimized, which is 99% of people out there. So is what we do super important? Yes. Is it all about pain? In my opinion, absolutely no. This performance is lifestyle. We think of performance and we use performance, I do as like sports and pro athletes and things like that. But performance is life. Performance is about movement, getting through life under the weight of gravity, with the dynamics that we're under each day. So you want to have an optimized system to the best of your ability. Nobody's perfect, but you want to be as good as you can be. And this systematic review aimed to determine whether there was that relationship between forward head posture, postural control and gait. And what did they find? Well, the results suggest that individuals with forward head posture present with decreased stability, reduced performance based balance and impaired cervical proprioception. Now where does this tie to chiropractic? They have a couple things here that I want to highlight because they are so well said in this study. They cite the fact that consistent evidence supported impaired proprioception associated with cervical spine motion. That should get everybody's attention. The impaired proprioception is associated with muscle spindle function as a length sensor. Neck muscles have abundant muscle spindles as proprioceptors and are essential for postural control. In particular, a couple muscles here, rectus capitis, posterior major, minor, oblique capitis, superior and inferior, as well as longissimus capitis. The major changes in neck muscle length are shortening of occipital extensors and lengthening of cervical extensors during forward head posture, thus affecting normal proprioceptive inputs of muscle spindles. Alterations in muscular tension following changes in muscle length can affect golgi tendon organs, which are important proprioceptors as well. This is a big deal. Additionally, proprioceptive and vestibular inputs interact with each other and with postural control. So you gotta have this system fine tuning together. Cervical spine motion is a key one. Are you checking that cervical spine motion? Are you analyzing what's going on segmentally, regionally and whole body because that is critical to patients getting well, staying well, and certainly again, if you're prescribing any sort of rehab exercise, which I'm pretty sure everybody listening is so the conclusions in this study were, quote, this systematic review found consistent evidence supporting reductions in stability, performance based balance and cervical proprioception in populations with forward head posture. However, a lack of high quality studies weaken the evidence base. The current evidence for the relationship between forward head posture and static balance and postural stability remains conflicting and the evidence for the relationship between forward head posture and vestibular deficit and gait disorder are very limited. So what does this tell us? Tells us there's more research to be done. What do you know? So there are more questions to be answered. But based upon what we went through today, I think it is very safe to say does forward head posture affect our performance based balance? Yes. Does it affect our overall stability? Yes. And do we need to keep a keen eye on that as patients come in and out of our practice, as we prescribe exercise, as we check out what's going on? Absolutely. So, so great study. Lot of key take home messages. Brand new, hot off the presses. We'll drop a link to it down in the show notes so you can check it out. Before we wrap up today, if you have not taken advantage of the awesome offer from Power Step, they're going to give you a free pair of orthotics. Go over and do so. Use the code ebc evidence based chiropractor@pro.powerstep.com sample pro powerstep.com sample I will drop that link down in the show notes as well. Pick yourself up a pair of these insoles. See if you like them and if it'd be a great fit for your patients. They are what I use. They're what my father uses. I can't recommend them enough. They support this podcast. You should support them and and they're willing to give you a free sample pair, so check it out. Additionally, if you are looking to hire a new DC associate or CA in the coming six months, have a conversation now. The process takes time. Let us help you have a conversation. Schedule a free complimentary call@chiromatchmakers.com speak with one of our placement specialists. We're happy to hook you up with everything we know about how to do it correctly. If you want to work with us, wonderful. But we're happy to guide that process for you. Or if you're looking for that next career opportunity, we have literally 100 jobs available right now, $85,000 plus base pay. You can check out the map on Chiromatchmakers.com see where you want to practice, see what's available out there. There is a ton of great opportunity, so thank you so much for listening in. I hope you've had a great year so far as we're closing down on 2022. Believe it or not, if you have not left a rating or review for this podcast, that would be awesome if you would take a moment of your time and and do so. It helps more and more docs find out about our podcast. So if you're listening on your phone you can scroll on down, tap some stars, leave some feedback. I would greatly, greatly appreciate it. That would be so awesome. Thanks so much for tuning in. Have an awesome week in practice and I'll talk to you soon.

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