How To Fix Forward Head Posture (FHP) & Thoracic Outlet Syndrome (TOS)

forward head posture is the mother of all neck pains and headaches and sometimes it can even result in very very serious conditions such as thoracic outlet syndrome in tos thoracic outlet syndrome you have compressions nervous and cardiovascular compressions that happen here in the scalene triangle which will impair completely impair the blood circulation in the arms i have treated people who had arm pain and being not even able to turn the pages of the book for months due to thoracic outlet syndrome so in this video i want to share with you the detailed protocol that i use with my patients to deal with this condition of course it's a standard protocol and whenever you deal with individual patients well you will adapt the protocol to their living conditions to their habits to their medical status but that will give you a strong basis for say treating your issues related to forward head posture this is a protocol that i use over a six-month period this means that you should not believe the videos of the people who tell you i'm gonna give you three magic exercises to deal with forward head posture that doesn't exist as you will see forward head posture is intimately related to your daily activities and to your habits and habits are not changed overnight thanks to three exercises that's a blatant lie number two forward head posture is complex because it's a vicious cycle i have a video on the channel which is dedicated to explaining the mechanism behind forward head posture the link is in the description to cut a long story short bear in mind that forward head posture is the consequence of a vicious cycle this vicious cycle has three components one your mid-back is round two your shoulders are forward three your head is forward and each one of these three will cause the two others so whatever you do which creates one will automatically generate the two others for example if you stand with your pelvis forward you see that your mid back is round therefore your shoulders are forward and your head is forward etc etc hence we need to deal with all these aspects that are connected to your daily activities and we need to fix the muscle length toens and relaxation in the areas after each session we want to define one exercise and one goal the goal is related to your daily activities and it's something that should keep you busy all day long the exercise is the subject matter of dedicated exercising sessions morning evening afternoon or more but it's something that doesn't have so so much to do with your daily activities so you see one is correcting your habits the other one is more symptomatic approach step one of the protocol is related to patient empowerment it's related to explaining to people what they suffer from and why we're gonna treat forward head posture the reason why we need to do that is that forward head posture is in all your daily activities and if you see people say one hour every two weeks well how do you want to be able to follow them for the rest of the two weeks they have to do it by themselves to do so they need to have understood how the body works and this is called the three rules of posture again there's a video which i also link in the description but let me summarize it rule number one speaks about the shape of your spine it states that when your back is slouched that means round and compressed you increase the chance of a disc hernia you push the head and the shoulders forward which is what we're trying to fix and you shrink the lungs 1b that's not a reason to get a hollow back here excessive hollow curvature will strain the lower back muscles or the spinal muscles in the areas which are hollow can be your neck will increase the pressure on the intervertebral cartilage and in the lower back hollow back plus effort physical effort such as crossfit for example will create incontinence one c now speaks about twisted back and either family of scoliosis can be twisted from below twisted from the middle twisted from above or twisted because of a rotation this is a bit like a hollow back except that it leads to asymmetric strain so muscle shortening and contraction on one side plus pressure on the cartilage on the same side furthermore one c states that when you have repetitive torsions in your spine you will wear off the outer part of the disc and therefore increase the likelihood of um discopathy and hernia because the outer wall of the disc is weaker hence the inside will have an easier time leaking out that's for rule one hence according to rule one whenever you do something which is either prolonged or frequent or hazardous hazardous means physical effect your back should be neither hollow nor round nor twisted what's in the middle is what i'm going to do here this is called flat yeah it doesn't mean your back is rigid and stiff as a plank but it means that you control the curvature because you control the pelvis okay we're gonna come back to that later in the protocol posture rule number two states that you will never have issues because your neck would be too relaxed a too relaxed neck is a concept that does not exist what will not strain the neck is what you do with your head your neck can be too flexed that is more than 20 degrees can be forward that's what we're talking about can be in extension or can be rotated or tilted which is also covered by rule number one okay so these are five head factors that result in neck strain next to that we have four elbow factors arms forward more than 20 degrees arm sideways more than 20 degrees elbows pulled back or upwards so five head factors four elbow factors we need to minimize these nine factors to lower next string and posture rule number three is the rule of the architect the role of the architect observes that your body starts on the ground and goes against gravity exactly like a baobab or like a cathedral and what makes these able to stand for century is the fact that they have strong foundations hence the rule of the architect states that posture education or posture therapy always should start in the feet and move upwards one floor after the other this is the reason why the protocol or the program or any posture program does not take only three exercises but takes weeks or months we have to do a full reconstruction of your body if you want to take an example of that or a metaphor of that imagine that you buy a countryside house and you observe that the roof is weak well you can't change the roof of course but two years later you'll need to change it again if you haven't checked the stability of the walls or the foundations so if you want to spare money spare energy you start in the foundations and you build upwards the protocol foresees that after explaining the basics of posture to the client or the patient session one is also dedicated to how do we apply this when we sit there's a long version to how to sit which is linked in the description that's the video on how to fine tune your sitting posture and the short version is the one that i'm gonna give you now the short version is look mother gravity will always bring you in this direction and this is your big enemy because it pushes your head forward it will be aggravated by the fact that you have your feet forward it will also be aggravated by the fact that you lean back because when you lean back something needs to go to your keyboard and to your screen and that means even more slumping okay so what we're trying to fight against is this backward rotation of your pelvis to do so we need to find something that will stabilize the pelvis hence the short version of how to sit is look you need to get a push from the ground so that this push can throw you at the back of your chair where your pelvis ie your belt will meet the lower part of the chair which is called the lumbar support and this lumbar support will help you prevent the pelvis backwards rotation and therefore the slouching however you should be careful that your shoulder blades are not against the backrest because if they are against the backrest either you hollow your back which is a violation of rule 1b or you will slide forward which is a violation of rule 1 a and which is going back into a forward head posture so step one is to explain the sitting posture and to see how this sitting posture can be improved on the couch on the office chair on the kitchen chair etc you'll be perfectly careful when people or you have this kind of semi lying down position on their bed this is a typical situation in which you push your head forward as far as the office is concerned you always adjust the office chair away from the desk and then you go to the desk and there what you have to do is actually quite simple is observe that you know when your neck is relaxed which is the application of rule number two while your arms do little and your head neck do little so there should be my keyboard in my mouse that's minimum effort in my arm shoulder system and here should be my screen i.e slightly below my line of sight and you see the problem of a laptop this isn't the size of the laptop so whenever you use a laptop you should always have a split keyboard and a split mouse and if you work on software that take a lot of visual attention such as excel or video editing or things like this well it's much better to get also a split screen in session one we will therefore be particularly attentive to what you do with mobile devices and we'll try to find techniques so that you use them much less every time you have a small screen your head is projected forward and the smaller the screen the more this phenomenon one last thing we do in session one is emphasize that you need to check your eyes if your visual equity is not good you will always put your head forward after session one the goal is on pelvic support so you make sure that people or you always sit on the sitting bones against the lumbar support whatever be the seat that they use car plane couch office kitchen chair no matter the exercise for session one is the upper body reset cf the description or the demo that i'm now gonna do it can happen that people have so much pain that uh it's difficult to have this as the first goal but generally speaking it's still okay so let's do for go for the upper body reset make sure that your feet are pointing forward that your knees are relaxed and that your pelvis is pushed back step one is we relax the wrists so flexion extension step two you through your thumbs step three your elbows always very gently never causing pain then we go with the shoulders so you hit your buttocks and then we'll add the neck gently looking down not too quick and then we go with the whole spine so you look far to the left far to the right i always look downwards to make sure that my back doesn't go hollow and what i'm now gonna do is i'm now gonna flex my chin in between my collar bones and add a spinal flexion but no point to go too low you stop when your hands are at knee level so the exercise prescription after session one is this upper body reset your aim is to reset your upper body at least 15 times a day that means once per hour frequency matters much more than duration so 50 times a day upper body reset and we see each other in two weeks for session two in session two both the goal and the exercise may seem a bit remote from the reason why you came to posture therapy because we'll be dealing with your feet and will be dealing with your spine as a whole not directly with your neck but remember rule number three rule number three was stating that we need to reconstruct the body as a whole starting in the feet and therefore we will need to work on your balance so let's go for the goal and then we switch to the exercise the first thing i always do is make people aware of the fact that their weight can be in direction of their toes which will make them do like an eagle you know the toes will cramp or their weight can be in direction of their heels in which case they will see their toes get off the ground what's neither one nor the other is when your weight feels like it's right under the arch of the foot there your toes are on the ground but they're relaxed next to that they can also be a sideway movement yeah you can have your weight more on the left foot or more on the right foot and what's neutral for avoiding a twisted back which you would have here yeah is when your weight is 50 50 between the two feet therefore what's neutral in terms of weight distribution is when your weight is under the arch of the two feet distributed 50 between left and right and the initial goal will be this will be well monitor what you do with your weight distribution during the day and whenever you feel like you're going on one leg or you feel like your weight is on your heels etc go back to under the arch 50 50 between the two feet and that will help us have strong foundations that will then be used to build the body upwards knee pelvis and spine it can happen when people have standing jobs that i add a secondary goal which is a bit of an exception to the salami technique with according to which i should have only one goal per session because if you tell people who were extending that they should always be with their weight under the arch disputed 50 50 it makes them extremely static and this will be difficult to keep for prolonged periods of time in this case i showed them the military technique the military technique is a technique that is used to stand for pro-launch periods of time whilst avoiding this sideway deviation what you'll do is put one foot slightly in front of its normal position say one to two inches and you let your whole body move back and forth and here two things will happen number one as you create this back fourth movement while you're unable to shift sideways and twist your back number two you're reactivating the muscle contraction relaxation especially if in addition you play with your knees and therefore this will say bring the blood back to the heart avoid accumulation of metabolic waste in the legs and therefore reduce leg directness so when you're static assess how your weight distribution is and if you need to stand for very long instead of shifting your weight to one leg well just use the military technique create back and forth movement and therefore you will avoid twisting your back then comes the exercise the exercise is actually the causing of the upper body reset that we saw in session one why the cousin because there are two exercises that should belong to everybody's daily hygiene number one is the upper body reset number two is the modified cat cow happy dog exercise that we're gonna do now and which helps mobilize the spine in every region and every direction therefore preserve spinal mobility and as the neck is part of and built on your spine the fact that your spine is both flexible and under control without blockages will avoid that the neck pays the price for things that go wrong underneath so here is how cat cow happy dog works it seems at first like a non-exercise but i will show you six variants that ensure that you have really fully mobilized your spine or almost fully actually and you will see that you actually don't know the exercise that well so you start on force and i like to train on my fists because it avoids wrist extension which is a source of increased pressure in the carpal tunnel and for people with thoracic outlet syndrome this may be quite critical if the fist directly on the ground is painful well you put a yoga mat a towel or anything you start version one with your elbows and your fists right under your shoulders and your knees right under your hips and the first part of the exercise is hollow back but be careful that you start the movement in the pelvis and that your neck follows then you go back to a flat back and then you move to a round back in which you're looking at what's happening behind you and then you shift to flat back if you want to be perfectionist whenever you go from flat to hollow or round too flat you should inhale and whenever you round your back you should exhale because this folds your lungs and pushes the air out so version one is this say standard known version of the cat cow but that you do precisely version two we're gonna move with the knees more open than 90 degrees and this will help mobilize the lower back always train slowly version three we go with the knees bent around 45 degrees and this helps mobilize the upper back including the upper ribs and in thoracic outlet syndrome this is very critical because the first and the second trips are often kind of out of place or say blocked at least each one of these movements you will do three to five times this is for catkal then we move to happy dog which is the sideway rotation happy dog is always with a flat back and it's about bringing the right hip to the right shoulder and then the left hip to the left shoulder and what you observe it does this is a pure pelvic movement there's no lateral unbalance of my weight the weight distribution remains absolutely constant under the fists and the knees so this was version 4 in which i was at 90 degree in the shoulders and in the hip joints and obviously you got the same you got the low happy dog for the lower back which is like this in which you should make sure that your back doesn't go hollow and then you get the happy dog for the upper back and upper ribs which is like this in which the movement amplitude is very small but that's normal so for a session two your exercise is to at least three times a day practice this happy dog cat cow six variants insisting where you feel that it's the most helpful to you the exercise is almost complete because you see that there's one movement that we haven't done which is a torsion of your back yeah that will come a bit later i mean i show an exercise for this to some patients not to all it depends a bit on the context but we will see that in the very last session when the discussion will be on okay now how do we say implement this on the long term how do we change your daily posture hygiene around two weeks after session two comes session three i should get a nobel prize for that and as in session two we have dealt with static balance i.e how do you preserve your balance on the spot well in session three we're gonna make things a bit more complex and discuss how to preserve your balance when there's movement but the movement that we will create is very specific movement is movement that happens either in your knees or in your pelvis so we will of course make sure that you have achieved what you had to achieve after session two i.e that you master they say this idea that your weight should be under the arch of the feet and then i will ask you to preserve this balance under the arch 5050 absolutely unchanged once you bend your knees so this is a very slow exercise with your eyes open or even closed which is even more ideal and it is a millimetric exercise i.e is your only goal you only aim at keeping your balance absolutely perfect it's not a matter of reps it's not a matter of all that this is the first movement the second movement becomes extremely relevant in terms of forward head posture because we discussed in the introduction that when your pelvis is forward your head goes forward so what we're now going to do is make sure that people can preserve or that you can preserve your weight balanced whereas you shift your pelvis back and forth yeah so this is a wrong posture but at least i'm balanced under my feet and this is what we will discover as being a better posture and i'm still balanced so you see that something had to bala to to compensate as my pelvis was forward here my upper body was backwards and as my pelvis is shifting backwards my upper body is more forward this is particularly interesting in terms of neck strain when i'm here my arms are actually behind me in other words i will have to do a lot of effort in my neck to reach my keyboard or to reach anything that i do forward eg when i use peel potatoes for example or when i cook okay so this posture is a direct source of neck strain violation of rule number two and of course violation of rule number one because my back is hollow now observe what happens if my pelvis is shifted backwards well here my arms can cross freely in front of my hip joints and therefore typing or peeling potatoes does not require any effort in my neck anymore hence in this session i already introduced the idea that the best posture for your pelvis is slightly backwards exactly like monkeys exactly like children and that if we want this to happen properly well the weight balance should be super well under control because if you do this and go on your heels you'll never be able to sustain such posture what we have just done falls as a goal how do we make it a goal well we make it a goal by explaining to people that they should monitor what they do with their feet in daily activities eg for example when they cook and whenever they catch themselves not on their two feet under the arch well number one they go back under the arch under their feet and number two when they do what i call the penguin test this is the penguin test and observe that they hit their thighs well they use this movement to bring their pelvis backwards again without altering the weight balance exercise now now we're really targeting the vicious cycle that i mentioned in the introduction one of the components of this vicious cycle i would say the first one by order of gravity i.e from bottom to top is the fact that your mid-back goes round so what we will do is introduce in your day an exercise that aims at reinforcing the mid-back extensor muscles there are two variants to this exercise one is the variant on force which i call the prayer exercise and the other one is on a chair which is quite handy because you can practice it at work here comes the prayer on falls what's cool with this prayer on fours is that you can say add it to the exercise that we were doing last session which was your daily hygiene exercise of the cat cow and the happy dog so after you did the happy dog then you go on your forearms make sure that your lower back is flat make sure that your chin is brought backwards push your mid back slightly downwards and then you kind of exert the pressure of your elbows on the ground in direction of your knees and that should create tension in your mid-back which is a sign that you're strengthening the mid-back extensors the sitting down version is exactly the same you sit with your heels under your knees and you bring your forearms on the inner side of your knees and then you make sure that your lower back is flat that your neck is brought back and you move your mid back slightly forward that means a centimeter or two max you know it's a micro movement and then i press my forearms on the inner side of my knees in direction of my belly making sure that my fingers are super relaxed and you see that my back is flat as a plank and that i feel tension in the mid back muscles well that's exactly what i wanted and therefore this will be the new exercise this new exercise should be also practice at least three times a day for 40 to 60 seconds at a time ideally i recommend this exercise in the morning and in the early afternoon so that you kind of wake up the the muscles in your mid-back and therefore they will be ready for use for the half day to come it's not harmful to do the exercise in the evening but waking up these muscles which help and say support and erect posture just before you go lying down is less useful yeah so no harm but less usefulness if you do it just before going to bed hence do it before you're gonna sit for a while let's go for session four which happens two to three weeks after the previous one now we're gonna touch at a very very critical issue which is pelvic rotation pelvic tilt and this is something that may have striked you in the previous session which is when i told you to push the pelvis back whilst keeping your weight balance you could have said but wait olivia when i do that it can happen that my back is super hollow correct this was wrong and this would have been correct but the thing is i didn't want to make things too complex so i always tell my patients yeah look for now it could be when you push your pelvis back that it happens to be a bit hollow but we're gonna take it easy and fix this in two weeks so just be a bit patient and we'll get there so now is the time to learn how to tilt the pelvis so as to flatten the lower back once the pelvis is in place it's super important that we do things in this order because in many yoga classes or pilates classes you will learn pelvic tilt but without discussing about this backward forward position of the pelvis and as a result many people tell me yeah i learned in the yoga how to do pelvic tilt look now i stand well really do you no so pelvic tilt will be dramatic if the pelvis has not been put at the right place before and that was the goal of session three the thing is when people are there if you teach them how to turn their pelvis right away standing many of them will push the pelvis forward when they're tilted hence we need to go step by step first kneeling then using a chair then using the wall and then freestanding kneeling is the first step because when you kneel the pelvis can't move backward forward so after last week where we learned pelvic tilt on force while with kneeling we slowly move to a more upright position so what you will do is make sure that your torso is very much forward and you're going to do a hollow back and then a flat back you may even be able to do a round back and you sit on your heels and flat and hollow and flat and once you master this we can switch to the next step which is using the chair the chair is just here for helping you keep this distance between the pelvis and the backrest and the idea is the same once more we go hollow flat and maybe you can go round and flat yeah when you go hollow you should feel strain in your lower back muscles because they are in charge of hollowing your back together with the iliopsoas muscle and when you go flat yeah there you will feel your lower abs and your glutes when you do this as you now stand it is essential that you integrate the teaching of the previous sessions in particular the fact that your weight is under the arch 50 50. it's very important that you don't shift your weight backwards in direction of your heels after the chair we use a wall or a shelf or something and the idea is again the same you lean with your forehead on the wall go hollow and flat and make sure that the pelvis doesn't go any further or any closer to the shelf when you do the hollow back and the flat back this distance should remain always the same and once you know how to do this well you can use one or two fingers on the wall yeah and go hollow flat it also helps to keep your thumbs right here on the hip crest to make sure that the pelvis doesn't shift back and forth this four-step process takes a bit of time so usually i let people train for say two to three weeks preferably three weeks so that they really have the time to integrate this and how does the goal definition look like well it looks like look interrupt yourself in all kinds of standing activities and whenever you do the penguin test and find yourself with your pelvis too far forward instead of just pushing it back you will now push it back and tilt it inwards and yes you may feel some discomfort in your abs because they're usually not used to work that much but they will get used to it in other words they will get reconditioned in terms of exercises we will really keep focusing on the pathology and in thoracic outlet syndrome the strain in the scalene muscles pulls on both their attachments i.e your cervicals are usually blocked and your first and second ribs are tilted upwards as previously previously mentioned therefore the exercise for this session will be about mobilizing the upper ribs mobilizing means make them move so as to restore their mobility this is an exercise that i've never showed on on youtube it's based on carol euit's excellent book which is manipulative therapy in the rehabilitation of the locometer system this book is kind of a bible of manual therapy the only thing is it's super difficult to find it took me three years or so so let's go what we're going to do is if we want to mobilize the upper ribs on the right side we're going to bend forward with the right arm in between your legs meaning that the left arm is um outside and we're going to turn the head to the left which creates a pull here in the scaling triangle and the only thing with this exercise is whilst looking upwards you will inhale deeply and exhale inhale and exhale and you do this a few times the exercise is adjusted or fine-tuned by finding the right flexion angle so you really need to explore this space to see what's the the back position that helps you most in respect with feeling what happens in the scading triangle this exercise can be practiced say two times a day so you still at this stage of this treatment do the upper reset 10 to 15 times a day do the happy dog cat cow thingy at least three times a day reinforce your back muscles and now you add this and probably you start worrying because the exercise list is growing but you still need to be patient until session eight in which we're gonna discuss the three box system to clarify this so for now you're in intensive care you're just exercising don't count the time later i will deal with this issue now come session five if you remember session three we were doing the mid-back strengthening and the goal of it was to avoid this say slumping in the upper half of your back which would project your shoulders forward and as a result push your head forward now we're going to deal with the second component of the vicious cycle which is precisely the round shoulder posture which is another cause of forward head posture or slumping in the upper back and to do that dealing with shoulders forward we will both strengthen the back muscles here especially the lower trapezius and the latissimus dorsi that's the goal and the exercise will be about stretching your pecs so your daily goal is to be able to stabilize your collarbones i.e your shoulder blades when doing something with your arms forward so you see instead of letting my shoulder blades glide sideways and my collarbones shift forward when i do something with my arms forward i should be able to bring them back yeah and this is the job of the lower trapezius in particular there are different ways to mobilize the uh the the lower trapezius and latissimus dorsi which together form an m in your back so i always name it the m so there are different ways to strengthen your emma and we'll review these different ways of mobilizing the m so that you can choose the one that you prefer possibility number one is to move the ac joint here yeah so you will push your ic joint forward whilst keeping it forward you'll move it upwards whilst keeping it upwards you're gonna bring it as far back as you can and now you should really hate me yeah make sure that your pelvis is back and in and now you lower your shoulder blades release a bit the tension in between the two shoulder blades and go further a bit and you should feel tension here yeah which is the aim so that's possibility number one possibility number two is kind of a shortcut to do the same is you slump in your upper back a bit like a depressed guy or girl and you're gonna bring your collarbones straight into your mid-back where you would attach your bra brand so it looks like this it looks like crack collar bones go into my mid-back again make sure that your back doesn't go hollow you should stabilize the pelvis and you see why we're doing things in this sequence possibility number three hold your arms like you would be holding say kind of the steering of a motorbike and imagine that you have a big inflatable ball in between your elbows and what you're going to do is press your elbows inwards so as to create some strain under the armpit okay and of course in the mid back so that is the movement because there's no movement fourth and final possibility you bring your arms at 90 degrees from your body with the palms facing upwards your goal is to stick your elbows to your side and to open your arms like this whilst keeping your elbows as close as you can to your torso you should already start feeling something in your mid-back and now you will reopen your elbows and there the tension starts to really really increase make sure that your pelvis is back and in and when you feel this tension well you keep the tension whilst relaxing your arms okay again this only works if your pelvis is back and in so what's your daily goal your daily goal is whenever you perceive that your collarbones are forward you use one of these four methods to bring them back in place ie to let your shoulder blades slide downwards and together and thereby you also contribute to strengthening the lower trapezius which will help it really keep your shoulder blades together and by the way you see here why posture characters don't work is that most of them will bring those shoulder blades horizontally together and not diagonally downwards and as they bring them together they contract the rhomboids and the upper trapezius create next strain whereas when you mobilize the m you see that there's no next strain there's strength here in the foundations of the neck and this mobilization of the next foundation is what helps the neck stay relaxed because it's on solid ground now let's switch to the exercise the exercise is the complementary part of what we've just done it's about opening here so one was about strengthening here the other one is about removing the resistance the resistance that can for example be fed by the fact that your keyboard is too far forward instead of being here as we have discussed in session one to stretch the pecs we have different possibilities but you know i'd like to show you the lying down on the floor exercises because the cool thing about them is that you don't need any bed you don't need any couch okay plus we will adapt this is say the 2.0 version of the protocol the exercise so as to also stretch the serratus anterior which is often responsible for armpit pain and side pain that lasts for very long that doesn't want to be removed and which is often kind of coming together with this thoracic outlet syndrome so let's just lie down on the ground you use a yoga mat if you feel like it and we see what we can do without any accessory i'm gonna use a pillow just for comfort and what i'm gonna do is lie on the side or some inside so as to be able to let my arm hang outside of my body so see when i lie down here at a sufficient distance from the wall stretching the pexy symbol is just about letting my arm hang down at 90 degrees from my body that's one branch of the pectoralis and make sure that the cola bone is not forward but is pulled back second part of the exercise is when the arm is down and third part of the exercise is when it's up each one of these three stretching positions should be held for 40 to 60 seconds without causing any pain if you feel anything which does not feel right correct your posture until you feel no pain the idea is that if you feel pain you will automatically generate contraction and contraction is the very opposite of what we're trying to reach what we'll also do is add a version in which my fist is on my sacrum and that will help stretching this ratio center that i mentioned earlier so you see the exercise looks exactly the same except that now my fist is on my very very lower spine and i let my elbow hang downwards so this is your daily exercise for this session and you should practice say twice a day morning and evening if you have the time to do one more and three times in total well great for session six the goal is to learn how to mobilize the cervical spine throughout the day and that is to prevent neck blockages the exercise will be a bit um strange maybe for you which is stretching the piriformis and you may ask hey what the link between thoracic outlet syndrome and previous hermes well no there's no direct link it's more an opportunity thing in the sense that i see many office workers with thoracic outlet syndrome and the other pathology that office workers do have often due to prolonged setting and due to sitting for too long in too bad postures is contraction of the piriformis leading to sciatic pain and therefore as i see them now for neck issues and i may not see them later well this is a golden opportunity to teach them how to avoid this sciatic pain but let's start with the goal the goal is around three exercises and then we will see how we can integrate them in daily life the three exercises can of course be done standing but sitting is safer there's less mobility when you sit i.e more posture safety the first exercise is a generic neck mobilization exercise we're gonna mobilize all the cervical smile so we start with the nose that will always remain vertical that means the ear is not tilting in direction of the shoulder and with the nose vertical we rotate the head to the right say for example and then we're going to draw a semicircle to the other shoulder once we're there we go horizontally to the other side and again not too quick and at some point you you turn and you go the other way around the reason why we do only a semicircle is that if we would go the other way around we would have a combination of hollow neck and twisted neck which is a violation a massive violation of rule one and rule two so we don't do that second exercise aims at the lower cervical spine the lower cervical spine is typically strained when you're on your mobile phone or on your laptop because your head is too flexed this is another exercise by carol hewitt as we saw when we were mobilizing the upper ribs so we will move the arms at 45 degrees to the side and one hand will have its palm facing in direction of the ceiling and what we're going to do is nose vertical always look at the palm facing the ground the fingers are spread outwards and as we turn our head we turn the arms so that we always look at the hand that is facing the ground and you do three four five ways and backs third exercise is this time about mobilizing the upper cervical spine which is where the scalding muscles attach and actually this exercise is also used for the scalene cramp test ie to see if the scalene are blocked when do you mess up your upper cervical spine well typically when you slump and look horribly forward you see your upper neck is now under tension the exercise goes like this nose vertical turn your head to one side and when you exhale you bring your chin down and same to the other side so these are three neck mobilization exercises and at this stage you may be completely confused and wondering how can this be a goal well simply because these exercises are extremely compatible with a number of daily situations in which you sit but you actually don't do much i mean when you're at the traffic light when you watch tv even when you sit on the toilets or when you have a zoom meeting so you see the idea is okay we're gonna mobilize the neck extremely frequently and this will avoid that the strain goes exponentially high okay and we will connect this to the daily activities therefore it is a daily goal so now the key is your ability to identify these dead micro moments which are actually available for your neck even if your brains are busy let's now switch to the exercise which as i said earlier is the stretch of the peripheries there are two reasons for a sciatic pain number one is a compression of the sciatic nerve in the lower spine because of a disc hernia and reason number two which is in my opinion but i have no exact statistics on this quite more common is strain in the piriformis so you need to learn how to stretch the purifical evening stretch you know when you're lying down in bed before you fall asleep do this you're going to bring one foot in direction on your buttocks and then the other one and then if i stretch the left pivots the idea is that my left lower leg is both horizontal and as perpendicular as it can be to my body therefore i will grab the foot with my arm or with the belt if my arm is too short and create the stretch by pressing either with the other knee or with my fist yeah and i'm bringing the left knee in direction of the opposite shoulder this is an exercise that i even do every day especially on days where i've been sitting a lot either at the office or because i drove a lot let's now switch to session number seven which is say the last session in which we officially learn something session number eight will be more about organizing the future so in session seven we are going to stretch the neck at last will you think why did we not do this earlier because these stretches are extremely precise that's reason number one so you need good body awareness and good body control to do them and reason number two is well i don't want to stretch things that are super tense muscles that are super tense so first we had relaxation which you still have and then we worked on the m to reduce the strain on the neck and the aperture pieces in particular and then we learned how to mobilize the neck the goal being to remove the blockages so now everything is in place to stretch safely this time we're not going to use a pillow because we need the head to hang in direction of the ground i'm going to lie down of course you will find sitting and standing version of these stretches but one they are much less safe because it's more difficult to be precise when you sit or stand then when you lie down and number two when you sit or stand the weight of your head is on the muscles that you're trying to stretch i act as a resistance to the stretch when i lie down there's no weight of my head on the tissues and in the country the weight of my head will assist the stretch so you know this version is much more effective than the other ones as you can read from the comments of the videos that are related to these muscles which i'll link in the description so let's go i'm gonna lie down on the side what's important is two things number one is you don't lie on your shoulder blade but rather in direction of your chest number two you don't collapse with your shoulders one in direction of the other this would be ranch all the posture but you use your m to keep your hole with erect effect may say okay you grab your foot or your ankle so that you can stabilize the shoulder blade down on the direction on the side that you're trying to stretch and we have two stretches for a trapezius and levator scapulae stretch number one is ear in direction of the shoulder like this yeah to maximize the effectiveness of the stretch i will combine with something that's called post isometric relaxation when inhaling i will go against gravity i.e upwards and when exhaling i let go and again and you see the more i do that the further the stretch goes okay so you usually need to do this like three times and that will be enough so this is stretching position number one which you have to do on two sides hold the stretch for 40 to 60 seconds stretching position number two now still the same basic position in direction of your chest keep your with bring your shoulder blade low turn your head and bring your chin on your collarbone and the stretch is more central more in direction of your spine and of course you can also combine with post-isomatic relaxation and again you observe the same the more i do the further i go and the rule is always the same you don't want to create pain so these are stretches for the posterior neck muscles now we at last gonna stretch the scalene muscles which are the problem that we have been trying to tackle since the beginning so let's go we lie down on the back bring one foot back the other one make sure that your back is flat on the ground that your pumps are facing upwards and use your m to stick your collarbones to the ground and then i'll put the left ear in direction of the left shoulder turn my head to the right and have a slight extension and now i'm actually stretching the right side on the other side right here to the right shoulder turn to the left slide extension now we're at session eight session eight is the last session at least in the standard protocol and it is not foreseen that you learn anything new here unless we have discovered on the way that you have something else that needs to be fixed such as forearm pain or something yeah the goal of session eight will be to develop a system that allows you to say keep training and keep changing your behavior so that the new behavior becomes a habit for this i use a three box system box number one is about exercises that you need to do all the time every day several times a day this includes upper body reset and the cat cow happy dog thing one more exercise is up to you depending on what you have noticed to be your weak spot max three exercises is i think realistic for mr misses everybody to do every day box number two is about exercises that are say to be done a few times per week and these are for maintenance typically that could be the upper ribs mobilization or the cervical mobilization box number three is about escalation is when you feel that things go off track what do you do calling your physio or your osteopath can be a very good alternative but it may take two three weeks until they can see you therefore there are things that you do need to do in between and during the course of the treatment well we may have had to have this discussion in the sense that okay do we prefer heat or cold anywhere how do we do trigger point massage and how do we use a tents or ems units etc so box number three is about escalation and well this one will depend on you on your conditions on your means i hope that you find this video useful it took me really long time to shoot and to edit there are things that i needed to shoot again because i messed up the first time so i hope you appreciate the effort and if so well be aware that you can find even more in my book the posture manual if you need personal assistance or personal advice the best is that you check out the page of the online poster programs which are the app-based programs that i have developed for people like you who work in an office who don't have a great posture and who have back pain neck pain shoulder pain both programs will give you access to the posture academy which is the private facebook group on which i give weekly exercise sessions and the long program will also give you the opportunity to have three one-on-one sessions so have a look at that if you want to discuss about it while you fill in the the contact form and we will set up a zoom goal together if you're a physiotherapist or another paramedical colleague well i hope that this video could give you some insight into how i treat people with forward head posture and the consequences thereof i'm very happy to have interdisciplinary exchange on your best practice how you do things how you could make this protocol evolve and grow so please feel free to contact me as well [Music] you

Channel: Olivier Girard - the Posture Guy

Views: 46,395

Keywords: fix your posture, fhp, forward head posture, scalene triangle, thoracic outlet syndrome, tos, posture therapy, posture correction, posture exercises, arm pain, shoulder pain, armpit pain, shoulder blade pain, trapezius stretch, serratus anterior stretch, serratus anterior pain, neck pain chiropractor, thoracic outlet syndrome exercises, serratus anterior pain relief, forward head posture fix, forward head posture exercises, migraines relief, posture correction exercises

Id: 9a5wkLnd54I

Length: 63min 20sec (3800 seconds)

Published: Sun Sep 05 2021