The splenius capitis and cervicis have an important role and a hard one at that when clients have the forward head posture. Like some of the erector muscles that run parallel with the spine these splenius muscles travel in an oblique direction or in a diagonal zone. Unilaterally they can sidebend and rotate the head to the same side but when bilaterally contracted they extend the head. What else extends the head that we just discussed in part 1? Sub-occipitals. Hopefully as we travel down this path you will start to see some correlation and the importance of treating these muscles with the forward head posture and neck pain. These splenius muscles with the attachment down at T6 can rotate and sidebend the atlas and other cervical vertebrae. This in turn combined with the levator scapula can lock the upper cervical facets open or closed. In turn this creates a loss of movement and more pain.
Now let’s discuss the SCM, and anterior scalene which are big contributors to the forward head posture. The SCM can create increased cervical lordosis just like we explained earlier and the anterior scalene often lead to nerve root irritation resulting from closure of the intervertebral foramen. This nerve root irritation causes the SCM and scalene to go even further in to hypercontraction. It’s almost a protective muscle spasm. Here is another way to look at this dysfunction. The scalenes and SCM pull the head forward which creates closure of the foramen which causes nerve root irritation since the nerve root travels through the foramen and this irritation creates more contraction which in turn leads to more forward head posture. Usually when working the scalenes you will feel they are hard and stuck which is usually caused by fibrosis. The scalenes attach onto the ribs which is in the thoracic outlet. When contracted on both sides the ribs are to elevate. Due to this consistent contraction the first and second rib tend to stay in a state of elevation. This is one of the causes you may have heard the outcome of an elevated first rib. Because of this we have compressed space between the clavicle and the top ribs which in turn can lead to nerve trunk irritation. As we know scalene work can be pretty painful so use caution and try not to plow through them.
So now when you see a client with the forward head posture and complaining of neck pain you have a very good understanding of what is going on and the structures to look at and treat.