Posts Tagged ‘Range Of Motion’


Thursday, January 31st, 2013


It’s been a while since I have done a review of research relevant to good and bad posture. And in that time some things have changed – the most noticeable is that if you look closely in the following papers you should notice that digital photography and the objective measurements possible as a result are a key feature. Now I don’t hate to tell you that “I told you so” – but I have been pushing the use of digital postural analysis since about 1996!

The other clear point from the following abbreviated abstracts is just how powerful postural analysis is as an outcome tool, and a predictor of morbidity. If you are not incorporating objective postural analysis and including corrective strategies that work in your practice – then WHY NOT?

Check out the world’s best postural analysis software at this link:


1) Sensitivity of clinical assessments of sagittal head posture.

J Eval Clin Pract. 2010 Feb;16(1):141-4. Gadotti IC, Biasotto-Gonzalez DA.

Historically, clinicians visually evaluate posture using anatomical landmarks. Advances in technology made digital photographs now feasible to use in clinical practice. Photogrammetry may increase the reliability of the assessment of postural changes. However, differences between visually estimated and photogrammetric recorded changes in posture need to be tested. The objective of this study was to evaluate the sensitivity of visual assessments of changes in head posture in the sagittal plane in relation to photogrammetric recorded data… Visual assessments of sagittal head posture were sensitive to detect differences between no FHP and FHP groups, but were not sensitive to detect differences between no FHP and slight FHP groups. Head posture photogrammetry is recommended to quantitatively detect less evident differences in head posture.


2) Differences in Standing and Sitting Postures of Youth with Idiopathic Scoliosis from Quantitative Analysis of Digital Photographs.

Phys Occup Ther Pediatr. 2013 Jan 8. Fortin C, Ehrmann Feldman D, Cheriet F, Labelle H.

The objective of this study was to explore whether differences in standing and sitting postures of youth with idiopathic scoliosis could be detected from quantitative analysis of digital photographs. Standing and sitting postures of 50 participants aged 10-20-years-old with idiopathic scoliosis (Cobb angle: 15° to 60°) were assessed from digital photographs using a posture evaluation software program… Significant differences between standing and sitting positions (p < 0.05) were found for head protraction, shoulder elevation, scapula asymmetry, trunk list, scoliosis angle, waist angles, and frontal and sagittal plane pelvic tilt. Quantitative analysis of digital photographs is a clinically feasible method to measure standing and sitting postures among youth with scoliosis and to assist in decisions on therapeutic interventions.


3) Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people.

Osteoporos Int. 2005 Mar;16(3):273-9. Takahashi T, Ishida K, Hirose D, Nagano Y, Okumiya K, Nishinaga M, Matsubayashi K, Doi Y, Tani T, Yamamoto H.

We have evaluated the association between trunk deformities of the sagittal plane and functional impairment of daily living in community-dwelling elderly subjects. The analysis involved a detailed assessment of indoor and outdoor activities of daily living, satisfaction with life, and mental status. The participants in this study were 236 community-dwelling older adults, aged 65 years and older, living in Kahoku district of Kochi in Japan. The participants were classified based on their posture, which was assessed using photographs of the subjects, and interviewed to assess their basic activities of daily living (BADL), instrumental ADL (IADL), and cognitive well-being in the cross-sectional study… The lumbar kyphosis group received significantly lower BADL and IADL scores than the normal group. The trunk deformity group which were defined as kyphosis, flat back, and lumbar lordosis groups exhibited decreases in activities that included going out, shopping, depositing and withdrawing money, and visiting friends in the hospital. These activities require going outdoors; thus, this study showed that the trunk deformity group had limitations in outdoor activities… The abnormal trunk deformity groups tended to score lower than the normal group with regard to subjective healthiness and life satisfaction measures, including subjective health condition, everyday feeling, satisfaction with human relationships, satisfaction with economic condition, and satisfaction with present life.


4) Video analysis of sagittal spinal posture in healthy and young adults

Journal of Manipulative and Physiological Therapeutics. Volume 32, Number 3, 2009;32:210-215. Yi-Liang Kuo, Elizabeth A. Tully, PhD, and Mary P. Galea, PhD

Changes in posture are of concern because of their association with pain or impaired physical function… Compared to young adults, healthy older adults demonstrated a forward head posture, with increased lower cervical spine flexion and increased upper cervical extension in both positions. Older adults also sat with significantly increased thoracic kyphosis and decreased lumbar spine flexion… The angular relationship between adjacent spinal regions in the sagittal plane can be objectively quantified using image-based analysis. The concept that the anteroposterior tilt of the pelvis in standing dictates the lumbar and thoracic curves was supported by the correlations between these adjacent regions in both age groups. The model of skin marker placement used in this study can have a broader application as a clinical tool for image-based postural assessment.


5) Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis.

Physiotherapy. 2012 Mar;98(1):64-75. Fortin C, Feldman DE, Cheriet F, Gravel D, Gauthier F, Labelle H.

Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic… Based on the XY co-ordinates of natural reference points (e.g., eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program… Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.


6) Postural compensations and subjective complaints due to backpack loads and wear time in schoolchildren.

Pediatr Phys Ther. 2013 Spring;25(1):15-24. Kistner F, Fiebert I, Roach K, Moore J.

This study investigated the effects of carrying weighted backpacks of up to 20% of body weight on the posture and pain complaints of elementary-school children. Craniovertebral, forward trunk lean and pelvic tilt angles were measured from sagittal photographs of 62 children (8-11 years old) before and after walking while carrying backpacks containing 10%, 15%, or 20% of body weight. Pain severity after a 6-minute walk with the loaded backpack was recorded. Subjective complaints of pain were assessed using a visual analog scale after walking. Repeated-measures ANOVA revealed statistically significant differences in postural angles and increased complaints of pain after walking with increased backpack loads. These results indicate that typical backpack loads create worsening postural changes due to backpack loads and time spent carrying those loads, putting children at increased risk for injury and pain, the latter of which is a strong predictor for back pain in adulthood.


7) Effect of backpack load carriage on cervical posture in primary schoolchildren.

Work. 2012;41(1):99-108. Kistner F, Fiebert I, Roach K.

This study examined the effects of various backpack loads on elementary schoolchildren’s posture and postural compensations as demonstrated by a change in forward head position. Sagittal digital photographs were taken of each subject standing without a backpack, and then with the loaded backpack before and after walking 6 minutes (6MWT) at free walking speed. This was repeated over three consecutive weeks using backpacks containing randomly assigned weights of 10%, 15%, or 20% body weight of each respective subject. The craniovertebral angle (CVA) was measured using digitizing software, recorded and analyzed. Subjects demonstrated immediate and statistically significant changes in CVA, indicating increased forward head positions upon donning the backpacks containing 15% and 20% body weight. Following the 6MWT, the CVA demonstrated further statistically significant changes for all backpack loads indicating increased forward head postures. For the 15 & 20%BW conditions, more than 50% of the subjects reported discomfort after walking, with the neck as the primary location of reported pain.


8) Effect of backpack weight on postural angles in preadolescent children.

Indian Pediatr. 2010 Jul;47(7):575-80. Ramprasad M, Alias J, Raghuveer AK.

Carrying heavy backpacks could cause a wide spectrum of pain related musculoskeletal disorders and postural dysfunctions. To determine the changes in various postural angles with different backpack weights in preadolescent children… digitizing software was used for analyzing photographs to determine craniovertebral (CV), head on neck (HON), head and neck on trunk (HNOT), trunk and lower limb angles. Postural angles were compared with no backpack and with backpacks weighing 5% to 25% of the subject’s bodyweight. The CV angle changed significantly after 15% of backpack load (P <0.05). The HON and HNOT angles changed significantly after 10% of backpack load (P <0.05). The trunk and lower limb angle also changed significantly after 5% of backpack load (P <0.05). Carrying a backpack weighing 15% of body weight change all the postural angles in preadolescent children.


9) Spinal Posture in the Sagittal Plane Is Associated With Future Dependence in Activities of Daily Living: A Community-Based Cohort Study of Older Adults in Japan.

J Gerontol A Biol Sci Med Sci. 2013 Jan 28. Kamitani K, Michikawa T, Iwasawa S, Eto N, Tanaka T, Takebayashi T, Nishiwaki Y.

Accumulated evidence shows how important spinal posture is for aged populations in maintaining independence in everyday life. However, the cross-sectional designs of most previous studies prevent elucidation of the relationship between spinal posture and future dependence in activities of daily living (ADL). We tried to clarify the association by measuring spinal posture noninvasively in a community-based prospective cohort study of older adults, paying particular attention to thoracic curvature, lumbar curvature, sacral hip angle, and inclination to determine which parameter is most strongly associated with dependence in ADL… This study indicates that spinal inclination is associated with future dependence in ADL among older adults.


10) Association of spinal inclination with physical performance measures among community-dwelling Japanese women aged 40 years and older.

Geriatr Gerontol Int. 2012 Dec 26. Abe Y, Aoyagi K, Tsurumoto T, Chen CY, Kanagae M, Mizukami S, Ye Z, Kusano Y.

Spinal inclination assesses spinal posture as a whole. However, the association between spinal inclination and physical performance has not yet been fully elucidated. Therefore, this study aimed to explore the association of spinal inclination with physical performance measures. The participants were 107 Japanese women aged 40-84 years. Spinal posture was assessed as inclination to a perpendicular line by using a computer-assisted device. Increased inclination value means forward inclination of the spine. Physical performance was measured by using the following methods: 6-m walking time, chair stand time, functional reach, Timed Up & Go Test, and grip strength. Information on participants’ comorbidities, osteoporosis, knee joint pain, back pain, falls in the previous year, regular exercise and usage of non-steroidal anti-inflammatory drugs (NSAIDs), was also collected. Pearson’s correlation analysis showed significant associations between spinal inclination and all of the physical performance measures. Pearson’s partial correlation analysis adjusted for age showed significant associations of increased inclination with poor physical functioning in 6-m walking time, chair stand time, functional reach, and Timed Up & Go Test, but not in grip strength. Linear regression analysis adjusted for age, grip strength, number of comorbidities, osteoporosis, knee joint pain, back pain, falls in previous year, regular activity and taking NSAIDs showed that spinal inclination was associated with poor function in 6-m walking time, chair stand time, functional reach and Timed Up & Go Test. Forward spinal inclination was associated with impairment in various physical performance measures. Proper prevention and treatment of underlying disorders should be prompted.


11) Importance of posture assessment in ankylosing spondylitis. Preliminary study.

Rev Med Chir Soc Med Nat Iasi. 2012 Jul-Sep;116(3):780-4. Roşu MO, Ancuţa C, Iordache C, Chirieac R.

The aim of this study is to perform a screening of patients diagnosed with ankylosing spondylitis (AS) in order to evaluate the static spinal disorders and correlate the results with the main clinical and functional parameters that characterize this disease… The assessment of lumbosacral pain in the morning and daytime lumbosacral pain showed a higher scores in patients suffering from kyphoscoliosis than in those with scoliosis, or kyphosis. Ott and modified Schöber index, and chest expansion, had higher mean values in patients with scoliosis compared with the other postural disorders. Statistically higher mean BASFI values were recorded in patients with kyphoscoliosis, while the mean BASMI values were lower in scoliosis patients. As to the quality of life of AS patients, HAQ-DI index recorded significantly lower mean values for kyphoscoliosis compared with other postural disorders. Our study suggests that posture assessment and implicitly the correction of possible misalignments should be part of the kinetic physical therapy program. Rigorous observing of postural recommendations can prevent the respiratory system complications.


12) Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults.

Man Ther. 2013 Feb;18(1):65-71. Quek J, Pua YH, Clark RA, Bryant AL.

It is unclear how age-related postural changes such as thoracic spine kyphosis influence cervical range-of-motion (ROM) in patients with cervical spine dysfunction. The purpose of this study was to explore the mediating effects of forward head posture (FHP) on the relationship between thoracic kyphosis and cervical mobility in older adults with cervical spine dysfunction. Fifty-one older adults… with cervical spine dysfunction – that is, cervical pain with or without referred pain, numbness or paraesthesia – participated. Pain-related disability was measured using the neck disability index (NDI). Thoracic kyphosis was measured using a flexicurve. FHP was assessed via the craniovertebral angle (CVA) measured from a digitized, lateral-view photograph of each subject. Cervical ROM - namely, upper and general cervical rotation and cervical flexion – was measured by the Cervical Range-of-Motion (CROM) device. Greater thoracic kyphosis was significantly associated with lesser CVA whereas greater CVA was significantly associated with greater cervical flexion and general rotation ROM, but not with upper cervical rotation ROM… Our results show that FHP mediated the relationship between thoracic kyphosis and cervical ROM, specifically general cervical rotation and flexion. These results not only support the justifiable attention given to addressing FHP to improve cervical impairments, but they also suggest that addressing thoracic kyphosis impairments may constitute an “upstream” approach.


13) Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome.

J Orthop Sports Phys Ther. 2009 Sep;39(9):658-64. De-la-Llave-Rincón AI, Fernández-de-las-Peñas C, Palacios-Ceña D, Cleland JA.

To compare the amount of forward head posture (FHP) and cervical range of motion between patients with moderate carpal tunnel syndrome (CTS) and healthy controls. We also sought to assess the relationships among FHP, cervical range of motion, and clinical variables related to the intensity and temporal profile of pain due to CTS… FHP and cervical range of motion were assessed in 25 women with CTS and 25 matched healthy women. Side-view pictures were taken in both relaxed-sitting and standing positions to measure the craniovertebral angle. A CROM device was used to assess cervical range of motion. Posture and mobility measurements were performed by an experienced therapist blinded to the subjects’ condition… Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion…


14) The role of forward head correction in management of adolescent idiopathic scoliotic patients: a randomized controlled trial.

Clin Rehabil. 2012 Dec;26(12):1123-32. Diab AA.

To investigate the effectiveness of forward head correction on three-dimensional posture parameters and functional level in adolescent idiopathic scoliotic patients… All the patients (n = 76) received traditional treatment in the form of stretching and strengthening exercises. In addition, patients in the study group (n = 38) received a forward head posture corrective exercise programme… Craniovertebral angle, Functional Rating Index and posture parameters, including: lumbar lordosis, thoracic kyphosis, trunk inclination, trunk imbalance, lateral deviation, surface rotation and pelvis torsion were measured before treatment, after 10 weeks, and at three-month follow-up… A forward head corrective exercise programme combined with conventional rehabilitation improved three-dimensional scoliotic posture and functional status in patients with adolescent idiopathic scoliosis.


15) The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial.

Clin Rehabil. 2012 Apr;26(4):351-61. Diab AA, Moustafa IM.

To investigate the effect of forward head posture correction on pain and nerve root function in cases of cervical spondylotic radiculopathy… Ninety-six patients with unilateral lower cervical spondylotic radiculopathy (C5-C6 and C6-C7) and craniovertebral angle measured less than or equal to 50° were randomly assigned to an exercise or a control group… The control group (n = 48) received ultrasound and infrared radiation, whereas the exercise group (n = 48) received a posture corrective exercise programme in addition to ultrasound and infrared radiation… Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.


16) The effect of the forward head posture on postural balance in long time computer based worker.

Ann Rehabil Med. 2012 Feb;36(1):98-104. Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI.

To estimate the effects of a relatively protruded head and neck posture on postural balance, in computer based worker… Thirty participants, who work with computers for over 6 hrs per day (Group I), and thirty participants, who rarely work with computers (Group II), were enrolled. The head and neck posture was measured by estimating angles A and B. A being the angle between the tragus of the ear, the lateral canthus of the eye, and horizontal line and B the angle between the C7 spinous process, the tragus of the ear, and the horizontal line. The severity of head protrusion with neck extension was assessed by the subtraction of angle A from angle B. We also measured the center of gravity (COG) and postural balance by using computerized dynamic posturography to determine the effect of computer-based work on postural balance… The results of this study suggest that forward head postures during computer-based work may contribute to some disturbance in the balance of healthy adults. These results could be applied to education programs regarding correct postures when working at a computer for extended periods of time.


17) Musculoskeletal dysfunction and pain in adults with asthma.

J Asthma. 2011 Feb;48(1):105-10. Lunardi AC, Marques da Silva CC, Rodrigues Mendes FA, Marques AP, Stelmach R, Fernandes Carvalho CR.

The mechanical alterations related to the overload of respiratory muscles observed in adults with persistent asthma might lead to the development of chronic alterations in posture, musculoskeletal dysfunction and pain; however, these changes remain poorly understood… This study aimed to assess postural alignment, muscle shortening and chronic pain in adults with persistent asthma… In comparison with non-asthmatic subjects, patients with mild or severe persistent asthma held their head and shoulders more forward and had lower chest wall expansion, decreased shoulder internal rotation, and decreased thoracic spine flexibility. Chronic lower thoracic, cervical, and shoulder pain was significantly increased in patients with mild or severe asthma compared with non-asthmatic subjects…


18) Head and shoulder alignment among patients with unilateral vestibular hypofunction.

Rev Bras Fisioter. 2010 Jul-Aug;14(4):330-6. Coelho Júnior AN, Gazzola JM, Gabilan YP, Mazzetti KR, Perracini MR, Ganança FF.

To investigate head and shoulder alignment among patients with unilateral vestibular hypofunction (UVH), using computerized biophotogrammetry (CB) and to correlate these measurements with gender, age, duration of clinical evolution, self-perception of intensity of dizziness and occurrences of falls… The patients with UVH had greater forward and lateral head deviation angles than did the normal individuals, with a statistically significant difference… Forward head was associated with the duration of clinical symptoms of the vestibular disease, age, intensity of dizziness and occurrence of falls.


19) Influence of forward head posture on scapular upward rotators during isometric shoulder flexion.

J Bodyw Mov Ther. 2010 Oct;14(4):367-74. Weon JH, Oh JS, Cynn HS, Kim YW, Kwon OY, Yi CH.

We assessed the effects of forward head posture in the sitting position on the activity of the scapular upward rotators during loaded isometric shoulder flexion in the sagittal plane. Healthy volunteers (n = 21; 11 men, 10 women) with no history of pathology participated in the study. Subjects were instructed to perform isometric shoulder flexion with the right upper extremity in both the forward head posture (FHP) and neutral head posture (NHP) while sitting. Surface electromyography (EMG) was recorded from the upper trapezius, lower trapezius, and serratus anterior muscles… Significantly increased EMG activity in the upper trapezius and lower trapezius and significantly decreased EMG activity in the serratus anterior were found during loaded isometric shoulder flexion with FHP. Thus, FHP may contribute to work-related neck and shoulder pain during loaded shoulder flexion while sitting. These results suggest that maintaining NHP is advantageous in reducing sustained upper and lower trapezius activity and enhancing serratus anterior activity as compared with FHP during loaded shoulder flexion.


20) Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks.

J Electromyogr Kinesiol. 2010 Aug;20(4):701-9. Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N.

Forward head and rounded shoulder posture (FHRSP) is theorized to contribute to alterations in scapular kinematics and muscle activity leading to the development of shoulder pain. However, reported differences in scapular kinematics and muscle activity in those with forward head and rounded shoulder posture are confounded by the presence of shoulder pain. Therefore, the purpose of this study was to compare scapular kinematics and muscle activity in individuals free from shoulder pain, with and without FHRSP. Eighty volunteers were classified as having FHRSP or ideal posture. Scapular kinematics were collected concurrently with muscle activity from the upper and lower trapezius as well as the serratus anterior muscles during a loaded flexion and overhead reaching task using an electromagnetic tracking system and surface electromyography. Separate mixed model analyses of variance were used to compare three-dimensional scapular kinematics and muscle activity during the ascending phases of both tasks. Individuals with FHRSP displayed significantly greater scapular internal rotation with less serratus anterior activity, during both tasks as well as greater scapular upward rotation, anterior tilting during the flexion task when compared with the ideal posture group. These results provide support for the clinical hypothesis that FHRSP impacts shoulder mechanics independent of shoulder pain.


21) The influence of cranio-cervical posture on maximal mouth opening and pressure pain threshold in patients with myofascial temporomandibular pain disorders.

Clin J Pain. 2011 Jan;27(1):48-55. La Touche R, París-Alemany A, von Piekartz H, Mannheimer JS, Fernández-Carnero J, Rocabado M.

The aim of this study was to assess the influence of cranio-cervical posture on the maximal mouth opening (MMO) and pressure pain threshold (PPT) in patients with myofascial temporomandibular pain disorders… The results of this study shows that the experimental induction of different cranio-cervical postures influences the MMO and PPT values of the temporomandibular joint and muscles of mastication that receive motor and sensory innervation by the trigeminal nerve. Our results provide data that supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures.


22) Body posture evaluations in subjects with internal temporomandibular joint derangement.

Cranio. 2009 Oct;27(4):231-42. Munhoz WC, Marques AP.

The aim of this study was to verify possible relationships between global body posture and temporomandibular joint internal derangement (TMJ-id), by comparing 30 subjects presenting typical TMJ-id signs to 20 healthy subjects. Body posture was assessed using the analysis of muscle chains on several photographs… There was a trend noticed in the group with the most severe dysfunction, to present a forward head and shoulders posture…


23) Global body posture evaluation in patients with temporomandibular joint disorder.

Clinics (Sao Paulo). 2009;64(1):35-9. Saito ET, Akashi PM, Sacco Ide C.

To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified… Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint… Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.


24) Respiratory dysfunction in chronic neck pain patients. A pilot study.

Cephalalgia. 2009 Jul;29(7):701-10. Kapreli E, Vourazanis E, Billis E, Oldham JA, Strimpakos N.

The aim of this pilot study was to add weight to a hypothesis according to which patients presenting with chronic neck pain could have a predisposition towards respiratory dysfunction. Twelve patients with chronic neck pain and 12 matched controls participated in this study. Spirometric values, maximal static pressures, forward head posture and functional tests were examined in all subjects. According to the results, chronic neck patients presented with a statistically significant decreased maximal voluntary ventilation and respiratory muscle strength. Furthermore, the current study demonstrated a strong association between an increased forward head posture and decreased respiratory muscle strength in neck patients. The connection of neck pain and respiratory function could be an important consideration in relation to patient assessment, rehabilitation and consumption of pharmacological agents.


25) Influence of forward head posture on condylar position.

J Oral Rehabil. 2008 Nov;35(11):795-800. Ohmure H, Miyawaki S, Nagata J, Ikeda K, Yamasaki K, Al-Kalaly A.

There are several reports suggesting that forward head posture is associated with temporomandibular disorders and restraint of mandibular growth, possibly due to mandibular displacement posteriorly. However, there have been few reports in which the condylar position was examined in forward head posture. The purpose of this study was to test the hypothesis that the condyle moves posteriorly in the forward head posture. The condylar position and electromyography from the masseter, temporal and digastric muscles were recorded on 15 healthy male adults at mandibular rest position in the natural head posture and deliberate forward head posture. The condylar position in the deliberate forward head posture was significantly more posterior than that in the natural head posture. The activity of the masseter and digastric muscles in the deliberate forward head posture was slightly increased. These results suggest that the condyle moves posteriorly in subjects with forward head posture.


Check out the world’s best postural analysis software at this link:


Yours for better health and better chiropractic

Nick Hodgson


Friday, July 18th, 2008


Within our chiropractic training and culture is a diverse range of physical indicators that we observe, measure and monitor to help us to diagnose our patients’ physical state: The history is used to narrow down our list of disorders or even diseases which may be causing the problem; Posture tells us how misaligned someone’s body and spine is; Radiographs show us how much decay and degeneration has developed; Range of motion tests measure how stiff they have become; SEMG assesses how tight muscles are; our palpation skills feel where there is contraction, restriction, fixation and misalignment.

And then we apply a physical therapy to try and intervene on the physical disorder that we have isolated.

It has almost become a cliché that there is a mind/body connection. But have we tended to minimise this relationship? Or have we even missed the point of this revelation? Are we persisting with the convenient separation and compartmentalisation of these two dimensions? We say, “oh yes the mind can affect the body, and the body can affect the mind” – but in saying this do we miss the paradigm of the mind/body relationship?

In other words the mind IS the body, and the body IS the mind.

When you are feeling certain emotions like anger, resentment, guilt, frustration – your physical body is different to how it is when you are feeling emotions like love, acceptance, peace, joy, reward. And if your physical body is different, then your thoughts, feelings and emotions are different. One doesn’t lead to the other – one is the other.

Let’s take another look at our list of “physical indicators” from another point of view, to see if we can see what they might really mean in terms of the mind/body:

The History is really someone’s story about the suffering they currently feel. And we are very good at asking questions about how the suffering feels: Where it hurts, how much it hurts, how big an area does the hurt cover, when does it feel a bit better and when does it feel a bit worse? But do we miss the most important question? What does the hurt mean – to them? Here’s another way of asking this question to help those who can’t make a connection – “if this hurt didn’t go away what would it mean you couldn’t do?”, or “if this hurt didn’t go away what aspect of your life do you think would be most affected?” Do you know that if something in your therapeutic relationship and encounter doesn’t allay or release this connection between their pain and suffering, that their mind/body will resist healing?

Postural Assessment: Why does anyone have bad posture? Because they don’t know they have it! Why would anyone carry their head too far forwards when that skull and its contents are as heavy as a bowling ball? Because they don’t recognise that it is where it is – they have poor somatic awareness. Here’s a thought – they will also have a proportionately poor psychic awareness. In other words they will actually have poor somatopsychic awareness. Check it out next time you examine someone with really bad posture: Ask them how they are feeling emotionally, ask them how aware they are of each of their internal bodily functions: More often than not the same disconnect will exist.

What about those protective buttresses that are being layered down inside their body – the ones you see growing around their skeleton on their Radiographs? Ask yourself this question: How strong, thick and solid are the protective mechanisms that this person has built around their emotions and memories? What will it take to chip away this person’s emotional fortress? The resistance, slowness of their recovery and the common poor prognosis could be reflective of their hardened interaction with the world in a more general sense.

And that stiffness that has built up in their Spinal Range of Movement, that you prescribe stretching exercises to reverse. Here is my observation: Range of motion is directly proportionate to range of emotion. My saying goes like this – “concrete body – concrete mind”. Observe how flexible these people are to suggested changes in their state of mind or lifestyle, and you may see a mirror image of their body’s flexibility.

What about that tension that you see on their SEMG? You may interpret it as physical tension: And you might ask; “maybe you are working too hard”, “maybe you did too much gardening on the weekend”, “maybe you aren’t sitting up straight”? How about this one – muscle tension is proportionate to neurological tone, which is dependent on emotional state. Maybe their body hasn’t been working overtime – maybe their mind has.

And all those things you “feel” while you are Palpating: Stiffness, resistance, swelling, and misalignment. Have you ever taken a moment to ask yourself while you have a direct connection with this person’s field of intelligence: “What am I feeling as I palpate this person?” You may be great at palpating, but, if you get good at feeling, then you will get even better at FEELING. You may even glean more insight into that person’s state of wellbeing in thirty seconds of palpation than sixty minutes of talk…

How does any of this help you to become a better healer, or a more profitable businessman? When you GET IT, that you are a body/mind and that your practice members are body/minds – Then you will experience greater quality and wholeness in your life, and your customers will receive greater quality and wholeness from you as a healer – and people pay for quality

(ps. If you think that this is suggesting that you have to become more of a psychologist or counsellor to be a better chiropractor – then you have missed the point – this has nothing to do with analysing and identifying the past hurts and experiences and helping someone to cognitively overcome the related dysfunctional thoughts and feelings. What this is about is that there is a whole new dimension awaiting you when you become more conscious of the mind/body synergy – what you are doing right now therapeutically will offer a much deeper meaning for both you and your practice members. In other words I am not talking about a change in procedure – but a change in consciousness.)

Find Out More About Training To Help You Make This Transition at


Tuesday, January 8th, 2008

A Case Study

A 55 year old female patient presented to the office with a history of two automobile accidents which had both caused a number of physical symptoms including whiplash, loss of range of motion in her right arm, SI joint pain, shoulder pain, hand pain, parasthesias in the upper and lower extremities, and loss of balance. Complicating the healing process was the onset of depression and suicide attempt after the death of her husband, six years after the second automobile accident.

Torque Release Technique protocols were used to evaluate and adjust spinal subluxations as it provides a low force adjustment. Adjustments were performed twice weekly over the documented seven months of care. Within one month of care, the patient noted a decrease in symptoms and an improvement in her quality of life. Periodic re-evaluations demonstrated an improvement in physical findings as well as improvement in the function of her autonomic and motor systems as documented by thermal and SEMG scanning.

The results of this case study indicate that patients with traumatic brain injury may benefit from including chiropractic care while healing from their physical and emotional stresses.

Click Here To Read The Abstract At The Journal Of Vertebral Subuxation Research…


Tuesday, July 24th, 2007

What are the secret ingredients which define a chiropractic adjustment? What are the features that separate an adjustment from other therapeutic modalities? What are the factors that differentiate a good adjustment from a bad adjustment?

Most definitions of “Adjustment” are very mechanistic in nature: “Moving the joints of the spine beyond a person’s usual physiological range of motion using a fast low-amplitude thrust”; “low-amplitude, high-velocity thrusts in which vertebrae are carried beyond the normal physiological range of movement without exceeding the boundaries of anatomic integrity”. The glaring pitfalls of such predominant definitions are that not all chiropractic adjustments carry the joints into their para-physiological range: Does this mean that SOT Blocks are not an adjustment, and that all instrument-based adjusting protocols are not chiropractic?

Perhaps it is time that we re-define the core components that describe a chiropractic adjustment?

Early chiropractic concepts spoke of universal and innate intelligence, the mental impulse, and proposed that a chiropractic adjustment doesn’t correct anything, but innate utilises the forces transmitted to the body following an adjustment to correct itself: In other words, the body is intelligent, but sometimes needs information from an external source to be able to make better perceptions, decisions and choices.

So, an adjustment is not so much an imposition of our will upon another person’s physiology; as it is the delivery of a new and enlightening piece of information which attempts to facilitate neurological change.

Torque Release Technique defines an Adjustment as “communication through touch”. What are the fundamental factors of this healing touch?

Perhaps we could define these in a physics-like formula…

A = F × CV × I2

In long-hand this translates to: Adjustment equals Force times Correctional Vector times Intent (squared).

Let’s explore this formula in greater detail:

The times signs indicate that each factor has a more significant impact on the other and on the total result than if instead the addition symbol was present; and that if all factors are present the resulting answer will be huge:

For example, in mathematical terms if each factor = 10, then A = 10 × 10 × 100 = 10,000

If the symbols had been additive the answer would be A = 10 + 10 + 100 = 120

If you minimise one of the factors then the answer is minimized:

To alter the above example slightly, if F = 1, then A = 1 × 10 × 100 = 1,000

The square symbol shows the “I” factor has the potential for greater impact: If this factor is small then the formula will not change much. Increase this factor and its impact becomes greater and greater at an exponential rate:

For example if we alter our original formula so that I = 1, then A = 10 × 10 × 1 = 100

Whereas if I = 100, then A = 10 × 10 × 10,000 = 1,000,000!!

Now let’s define the factors in more detail:

Force = Mass × Acceleration:

This is an old Newtonian formula. Every adjustment has force – an adjustment with no force at all is just a good intention. To increase force we either increase the mass or the acceleration, and if you increase both then the force greatly increases. In terms of a chiropractic adjustment, any experienced chiropractor knows the importance of speed over mass: The quicker you are the less the mass you have to use, and the more easily an adjustment is accepted. I guarantee that an adjustment will appear “heavy-handed” to a client due to excessive mass, and not due to excessive speed

Correctional Vector = Contact Point + Three-Dimensional Vector:

The force of an adjustment must have a point of contact and a direction: Specificity is what separates chiropractic adjustment from so many other therapeutic modalities, and without correctional vector I doubt that chiropractic would have attained separate and distinct status. Firstly we are more discerning in where we place our hands; for example, we don’t just stretch the lumbar spine, we adjust an L5.

Also integral in most chiropractic adjustment protocols is the direction in which we apply our force: Our predominant “listing” systems incorporate three letters to define the direction and combination of vectors in three dimensions, which we utilised in our adjustment. And we may even add a fourth letter to further define our contact point… For example: C2 PLI-S – we contacted C2 and our vector was in a direction to reduce the left and inferior vectors of the subluxation, and we used the spinous process as the contact point.

Intent = Become One + Visualisation + See Whole

R.W. Stephenson described the essential components of intent. Intent could be simply explained as what we are thinking about as we deliver an adjustment. But it can also mean much more than this as it may include our own emotional, physiological and even spiritual states.

“Become One” encompasses an almost spiritual connection that occurs when we as a practitioner enter into another’s “energy” or “intelligence” field. The insinuation is that when we come so close there is an influence between the two fields of intelligence. This has ramifications at a diagnostic level in the sense that we can potentially gather much deeper levels of information if we are perceptive to the other person’s “field”; and at a therapeutic level we potentially enter into a deep level for the transaction of information taking place.

“Visualisation” defines the need to see what we are doing: Can we imagine the structures and tissues that we are examining; can we envisage the impact that our testing and corrective vectors are having on the person’s physiology; can we see the effects of our adjustment before they actually occur?

“See whole” describes our intent: Wholeness. After our practice member is adjusted their mind/body is able to better perceive itself, the communications between mind and body are restored, and their physiology becomes more efficient and effective. Do you expect this? Do you actually SEE this occurring in your mind’s eye?

What separates an adjustment from other therapeutic modalities? The size of each factor illustrates its relative importance in the formula:

Massage = f ( m × a ) × CV × I2

Therapeutic massage is separated from relaxation massage by how deep the practitioner penetrates; that is by how much mass they use: Mass is probably the most dominant vector in the therapeutic formula. Acceleration is extremely small as most massage involves slow strokes. The vectors are usually unfocussed and very mixed, sometimes the more directions you sweep across a muscle the better. Intent is somewhat diminished due to poor visualization (most masseurs have inferior anatomical and physiological knowledge) but will have a high degree of connection and a desire to see whole.

Manipulation = f ( m × a ) × CV × I2

Manipulation is usually a mechanistic attempt to produce separation and preferably cavitation of joint surfaces: The Mass is increased and Acceleration is relatively high to achieve this end. Correctional vectors are minimised usually only involving two dimensions and are not seen as so important many times both directions/sides being manipulated to maximise the stretch effect. The intent is small, the need to become one being irrelevant, visualization being for the purpose of finding the structure to be manipulated and the outcome seen being no bigger than to cavitate a joint or to increase flexibility.

Acupuncture = f ( m × a ) × CV × I2

An acupuncture needle delivers minimal mass with no acceleration, so force is almost absent. The correctional vectors are so important, much care being taken in the location of the needles and in the precision of their insertion. The contact points are very different to a chiropractic adjustment relying on a totally different bodily system. The vitalistic intent of the acupuncturist must be considered equal to that of the principled chiropractor as they too expect great things from their therapeutic modality and it could even be argued that they are bolder in their therapeutic claims.

What differentiates a great adjustment from a bad adjustment? The adjustment with “that something extra” requires a precise combination of the secret ingredients…

Great Adjustment = f ( m × a ) × CV × I2

Bad Adjustment = f ( m × a ) × CV × I2

Keys to the adjustment with “that something extra”…

  • Maximise acceleration and minimise Mass.
  • Utilise a precise system to determine the most effective combination of contact point and correctional vectors.
  • Maximise Intent by respecting and perceiving the connection between you and your practice member, visualizing every aspect of your analysis and correction, and having a clear picture of the intended outcomes.

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