The<unk>  is a multi-factorial problem. * Thoracic<unk> ing requires flexing of the thoracic facet joints. After sufficient time and load, they can freeze and lock in this position. The collagen of the surrounding ligaments, fascia and joint capsules will shorten down around the immobile joints, reinforcing the<unk> ed hypomobile section of spine. * The middle back support muscles (erector spinae, rhomboids, middle and lower trapezius fibres, etc.) become stretched out and weak. * The cantilevered (poked forward) head position loads the spine up to several times more than erect posture, because of the increased moment arm. So the posterior neck muscles (especially the upper fibres of trapezius) holding the head in its forward position, often sustained for many hours, can strain, producing individual myofibril and cell damage. Repair of this microtrauma involves the laying down of adhesive fibrosis, as a normal part of the inflammatory response. Adhesive fibrosis is relatively non-elastic, so after sufficient repeated microtrauma from muscle strain, the posterior neck muscles become strained, shortened and less elastic. * In this same cantilevered head position, the longus colli muscles and other deep neck flexors around the front of the neck are hardly being used, so they become weak, allowing the chin to poke out. * The combined effect of all the above in the cantilevered head position, with the chin poked out, is to compress every facet joint in the cervical spine. This predisposes to acute locking episodes. At the top of the cervical spine, this often manifests as cervicogenic headache, with pain referring over the head from the C0/1, C1/2, and/or C2/3 joints, and from the insertion of the upper trapezius fibres onto the nuchal line of the occiput. In older patients, especially with osteophytes and/or where the intervertebral foramina are already diminished, this compression and further reduction of the foraminal spaces can result in irritation and impingement of the nerve roots, referring pain some distance down the arm(s).
IHunch
DICOM
OHVIRA
Ices
AURA
Pomp
Stimson line
DrawMD