Assessing the Neck and Head

• In this Blog We have Discussed Following Topics.

1. Common Deviations
2. Assessment Process
3. How Head and Neck is Related To the Rest of Body

• Common Devotions

1. Forword Head Posture
2. Excessive Cervical Lordosis

• When in perfect alignment, the head should be naturally balanced atop the spine, torso, and lower body. A forward head refers to a projection of the head that places it too far forward of the body’s center.

• The cervical spine naturally contains a slight lordotic curve. Excessive cervical lordosis refers to an increased curvature of the neck that accompanies a forward head position. Excessive cervical lordosis is problematic because it can compress discs or nerves in the neck and cause pain or dysfunction in this area, as well as in the upper torso, head, and arms.

ASSESSMENT PROCESS

VERBAL ASSESSMENT

1. Ask if the client has ever experienced pain, headaches, or tension in the neck or head, and ask about the specific location and nature of the pain. For example, many people suffer headaches as a result of muscle tension that compresses nerves in the neck and shoulder.
2. Ask about the client’s past injuries or surgeries. For example, a fusion of two or more cervical vertebrae may affect movements and functions.
3. Ask about the client’s level of physical activity. Ask whether he plays sports, and if so, which ones? Someone who rides a bicycle for exercise may have significant stresses on his neck because he must round his shoulders over the handlebars while his neck arches backward to keep his eyes focused ahead.
4. Ask about the client’s occupation. Does the client sit for prolonged periods in front of a computer? If so, where is the monitor in relation to where he sits—for instance, must he look sideways to see it? Does the job require him to look down a lot, bend over a table, or look over his shoulder for sustained periods? Over time, repetitive work positions can lead to shoulder, back, and neck pain.
5. Ask whether neck or head pain ever prevents the client from engaging in an activity or limits what he can do. This will highlight the activities he feels he is missing out on, and it will help you to understand his underlying motivation for seeking your help.
6. Ask if the client’s pain coincides with any other pains or symptoms. This will ultimately progress both parties’ understanding of the body’s interconnectedness and will help you to identify causes and solutions for the person’s musculoskeletal issues. For example, a client who experiences headaches after standing for many hours may also notice that this pain coincides with lower back pain and her choice to wear high heeled shoes. You can then teach her about how her choice of footwear can affect the position of her lower back and neck and cause pain
7. Ask the client what aggravates his condition and what makes it feel better. For example, if a client tells you that sitting and watching television makes his neck pain worse, you can coach him on how to improve his posture when seated.

VISUAL AND HANDS-ON ASSESSMENTS

EVALUATE THE POSITION OF THE HEAD

• To evaluate whether a client’s head is forward of its optimal position in relation to the rest of the body, ask the person to sit on a gym ball or on the edge of a chair with the feet and head facing forward, then look at him from the side. From this position, locate the part of his cheekbone that protrudes outward the most, just below the eye. 
• Place one of your index fingers on this part of the client’s cheekbone and your other index finger directly below it on the client’s collarbone. With your index fingers positioned in this way, stand directly over your fingers and look down to assess the position of your index fingers in relation to each other (see figure).

• Ideally, they should be vertically aligned, that is, with one directly below the other. If the index finger on the client’s cheekbone is ahead of the one on his collarbone, the head is too far forward for optimal alignment.

• EVALUATE FOR EXCESSIVE CERVICAL LORDOSIS

• To evaluate whether the curve in a client’s neck is excessive, ask the client to stand with his back to a wall with his heels, buttocks, and shoulders touching the wall.

• While he is holding this position, ask him to touch the wall softly with the back of his head. 

Note - Make sure he does not arch his lower back as he pulls his head back; this is a common movement compensation.

• Next, with the back of the client’s head gently touching the wall, assess his line of sight by drawing an imaginary line from the corner of his eye through the center of his eyeball and out into the room. If the neck is arched backward and the eye socket is tilted upward, this imaginary line will not be parallel to the floor and indicates that the client has excessive cervical lordosis.

HOW THE HEAD AND NECK RELATE TO THE REST OF THE BODY..?

• When the head moves forward from its optimal position, the thoracic spine and shoulders round forward to accommodate this shift and the resulting effective increase in the weight of the head. As this happens, the neck typically arches backward excessively to keep the eyes level and in line with the horizon.

• This forward shift in the thoracic spine, shoulders, and head subsequently causes compensatory shifts in the pelvis and lower back. Specifically, the lower back arches excessively in an attempt to keep the body upright and balanced, and the pelvis rotates anteriorly.

• This shift in the pelvis and lower back causes the hip socket to move backward and the legs and hips to internally rotate, resulting in further compensations all the way down to the feet as the knees move toward the midline and the feet and ankles overpronate (see figure).