Master Class: Kyphosis and Forward Head

Kyphosis is hyper-curvature of the thoracic spine. 

Forward head is a natural consequence of kyphosis since the eyes must look straight ahead.  A forward head posture involves increased flexion of lower cervical vertebrae and the upper thoracic regions, increased extensions of upper cervical vertebrae, and extension of the occiput on C1.

Strategies for Kyphosis and Forward Head

1. Open the chest and abdomen, release posterior neck muscles and sub occipitals.

2. Re-train neck and sub occipitals.

3. Passive thoracic extension over a prop (ball, arc).

4. Axial lengthening, prone neutral.

5. Posterior shoulder strengthening: Rhomboids, mid traps, external rotators, lats.

6. Active thoracic extension: End-stage rehab. This should be tried only after the spine can move into extension. This may take weeks to months to achieve! If you try this too soon you will just be working extension through the cervical and lumbar spine.

Strategies for Forward Head

• Release posterior neck muscles, especially at the occiput.

  • Exercises: Use roller behind the neck to release sub occipitals, upper traps

• Strengthen sub occipitals and retrain neck flexion first isometrically and then concentrically.

  • Exercises:

    • Mat: Supine Head nods, chin tuck, and press skull into Mat. Progress to squeezing a tangerine to lift the head off the mat. You can assist the skull oh the way up and have them control eccentrically down to the mat. 

    • When cueing any supine abdominal exercises have client press skull back into the hand with chin tucked in.

    • Prone put theraband behind the skull and lift skull into it.

    • Wall: Keep chin tucked in and press the skull against the wall. Add arm circles, chicken wings.

Strategies for Kyphosis

• Eccentric Work on Thoracic Spine: Passive Extension

  • Open and stretch the chest muscles (pectorals) and rectus abdominis / abdominals.

  • Work on Passive Extension of the spine by putting something under the spine in a supine position.

  • Exercises:

    • To stretch Pectorals: Lie on roller supine and do basic shoulder set: Shoulder Slaps, Arm Reaches, Chicken Wings, Arm Circles.

    • For passive thoracic extension: Lie on arc supine and do Arm Circles. Add Extension to Neutral Ab Curls.

    • Lie on Gertie Ball under thoracic spine or Franklin Balls on either side of thoracic spine Supine and do eccentric ab curls.

• Isometric Work with Thoracic Spine: Holding Prone Neutral

  • Axial lengthening, prone neutral spine. Give imagery to lengthen through the skull especially in a prone position.

  • Exercises:

    • Mat/Arc/Long Box: Lie prone on mat, arc, long box and lift the skull by the scruff of the neck (mama cat), keep the chin tucked in to lengthen cervical curve. When the skull is held in line with the spine, in neutral spine,  this should fire the thoracic extensors.

    • Reformer: Long Box Prone Series is great when cued properly. 

• Concentric Work with Thoracic Spine: Active Thoracic Extension.

  • Exercises:

    • Mat: Swan with Gertie Ball under sternum

    • Reformer: Long Box Prone Series

    • Cadillac: Swan with Push-thru bar, Gertie Ball under sternum

    • Chair: Swan

• Address the Shoulder Misalignment: Strengthen Rhomboids, Mid Traps, Lats, Rotator Cuff.

  • Exercises:

    • Reformer Supine: Lat Pulls, Chicken Wings

    • Reformer Long Box Seated: Chest Expansion, Rhomboids, Rotator

    • Cadillac: One arm lat pull, double lat pull with push-thru bar