Pillows for neck problems and keeping it simple when treating forward head posture and neck pain in patients
Perhaps you have heard of the K.I.S.S. method – Keep It Simple Stupid! It is credited to a design principle from the U.S. Navy back in the 1960s that emphasized that systems work best if they are kept simple rather than made complicated. After over 30 years in practice, I am seeing the importance of that principle when tackling the biomechanical problems with which patients present, including the chiropractic tools used and pillows for neck problems due to abnormal loading. Perhaps the ancillary principle for chiropractic should be F.A.L.S. — Fix Abnormal Loading Stupid!
Excessive disc loading
In a study from Spine in 2006, “What is Intervertebral Disc Degeneration, and What Causes It,”1 the authors Adams and Roughly state, “Plainly, excessive mechanical loading causes a disc to degenerate by disrupting its structure and precipitating a cascade of nonreversible cell-mediate responses leading to further disruption.”
My K.I.S.S. method question to patients is this: “If you have a wagon and you shift all of the weight to the back right hand side of the wagon, what is going to wear out?” The patient’s K.I.S.S. response: “The back right hand side!”
As our society becomes more and more engrained in technology with the everyday use of computers, laptops, tablets and cell phones, the effect of daily use of these devices is seen in the forward head posture that develops. There is a long list of cultural names given to this postural deformity: text neck, computer neck, iHunch and iPosture, just to name a few. In the professional jargon the literature talks about forward head posture, upper cross syndrome and dowager’s hump.
The effects of forward head posture
Forward head posture is seen every day in chiropractic offices when patients present with a host of different symptoms: headache, neck pain, mid-back pain, shoulder symptoms or a combination of these.
The forward head posture can cause issues beyond just pain. It can cause degenerative changes and increase the patient’s fall risk. It is seen upon physical exam with the chin jutting out over the sternum, the auditory canal anterior to the shoulder, and the classic upper cross syndrome of tight upper traps/suboccipital/pecs with stretched cervical flexors/lower traps.
In addition to these physical exam findings, one will also see changes on cervical X-ray. In my office we are seeing more cases with a loss of cervical lordosis and reversal of the cervical curve. Also noted consistently in the 40-year-old and up population is degenerative disc disease, specifically in the lower cervical spine. Forward head posture is the excessive mechanical loading talked about by Adams and Roughly that is contributing to the degenerative disc disease in the cervical spine.
What concerns me even more is we are seeing this forward head posture in younger ages. If we are seeing the forward head posture which is causing abnormal loading in the lower cervical spine of these younger age individuals, doesn’t it make sense that they are heading toward the same degenerative disc disease?
All this boils down to abnormal loading in the cervical spine.
Unless you change the loading, you will never change the destruction!
As chiropractors we have a toolbox full of useful resources that we can reach for to help change the loading on the patient’s musculoskeletal system. Here is just a partial list of tools chiropractors can use:
- Spinal manipulation
- Soft tissue adjusting
- Therapy modalities (IF, US, etc.)
- Low-level laser light therapy
- Spinal decompression
- Dry needling
- Kinesiology taping
- Cervical pillows for neck problems
Treating forward head posture
I use the “3 R’s” approach in my office: Reduce, Restore, Rehab.
You must reduce the subluxations and abnormal loading on the musculoskeletal system with tools such as pillows for neck problems. Of course, the main tool used is spinal manipulative therapy. This is key in helping to fix the abnormal loading (F.A.L.S.).
Restore is next and involves restoring the posture as well as the movement patterns. This is where the use of good cervical pillows for neck problems is important. Many are well-received by patients and very adaptable since they have multiple different options for use depending upon the patient. I have very limited time with a patient to make spinal adjustments, but cervical pillows for neck problems are with them 6-8 hours a night. Cervical pillows for neck problems support and fix abnormal loading (F.A.L.S.).
Rehab addresses the muscle imbalance that exists in the forward head posture. The primary exercise I teach is neck retraction. Think of the head on a rail and the patient is to slide their head backwards on the rail. A trick I use to help them with this is to have them lean their back against the wall with feet about a foot away from the wall. Put on some sunglasses and lower them on their nose so that they are looking over the top of the glasses. When properly performing this exercise, they should never be looking through the glasses. If they are looking through the glasses, then they are extending their head rather than retracting it. This, again, is another tool to help fix abnormal loading (F.A.L.S.).
Braces and retainers
There are many more options I am sure you can think of recommending. But, in my opinion, you need to K.I.S.S. in order to improve patient compliance. I explain it to my patients in this way: Think of the spinal adjustments as the braces that are moving the teeth. Cervical pillows for neck problems and exercise are the retainers that can help keep the new position.
As I try to find more and better ways to help my patients, I try to evaluate my treatment plans by asking if I am keeping it simple, and if I am changing the abnormal loading. If so, then there will be better patient compliance and improved posture outcomes.
JEFF MCKINLEY, DC, received his bachelor’s degree in biology from Lipscomb University in Nashville, Tenn., and his doctorate from Logan College of Chiropractic. He completed post-doctorate training in sports injuries and is a Certified Chiropractic Sport Physician (CCSP). He has been part of the Pioneer Sports Medicine Team at Warren County High School for over 25 years working with the athletic trainer, orthopedic surgeon, physical therapist and EMT to care for high school athletes. He has also served a two-week rotation at the U.S. Olympic Training Center in Colorado Springs, Colo. He is a member of the Foot Levelers Speaker’s Bureau, where he travels the country leading seminars on key chiropractic topics. See upcoming seminars at footlevelers.com/continuing-education-seminars, and visit his website at drmckinley.com.