Forward Head Posture and Anterior Thoracic Adjusting: New Case Report

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Forward head posture, or Cervical Forward Flexion, has emerged as a significant postural concern over recent years with many people attributing the increase (at least in part) to the uptick in smart phone and device usage, and the subsequent hours spent looking down. However, the increases appear to hark back as early as 2002-2009 during which time “cervical spine procedures increased” alongside associated costs.  A case report recently published in the Asia Pacific Chiropractic Journal has released details of a 24-person retrospective case series which casts light on the potential relationship between anterior thoracic adjusting and forward head posture.

The study, authored by Harvey Getzoff, cited work by the National Institute for Occupational Safety and Health which determined that “Cervical spine musculoskeletal disorders are an important factor with work related injuries.” The institute found that “high prevalence and incidence of neck and shoulder pain is present in the working population, especially sedentary workers.” Given that the data leading to that conclusion was collected well before the coronavirus pandemic and a massive move to work-from-home arrangements for many organizations, this postural concern remains a significant one.

Any work on forward head posture is noteworthy, as literature increasingly links subclinical neck pain to differences in function. Getzoff also remarked that “reduced active movement within the cervical region has been found to disturb functional activities and cause a lack of corrective and protective reactions along with loss of mobility in the neck area that is associated with changes in the passive structures of the cervical spine [1].” In the original study, referenced below and freely available, the author offers up more details on the concerns and potential comorbidities tied up with forward head posture, but it all lead to one action: the retrospective case report designed to give some indication as to whether or not a chiropractic intervention, namely the anterior thoracic adjustment, could assist with cervical forward flexion (CFF).

For the purpose of the case series, all 24 patients had neck pain and CFF. None had been adjusted within the previous two weeks and none were in acute pain. All data collection happened in just one visit (which is a limitation of this study and an opportunity for further research). They were considered a candidate for the study if they couldn’t touch their chin to their chest while sitting upright with their leg’s supine (down the length of the table). 

If they were considered appropriate for the study, the attending chiropractor then measured their range of motion using a goniometer, applied the anterior thoracic adjustment, and measured again. The chiropractor determined where to adjust (within the upper chest/back area of the spine) using standard palpation and orthopaedic tests. For chiropractors, full details of the adjustment used are provided at the link below [1].

Interestingly, 23 of the 24 participants showed improvements following the adjustment. The one who didn’t was the only patient in the study who had scoliosis (an abnormal curve of the spine).

While a full breakdown of the degrees of improvement are listed in the original article [1], it is encouraging to note that 15 of the 23 patients who reported an improvement had this improvement measured between 11 and 20 degrees, making it a significant difference after only one adjustment.

With every case report, or indeed a case series, there are limitations. We cannot generalise based on case reports because it is only randomised controlled trials or clinical trials of appropriate size that allow us to do that. However, in this case, 24 patients make for a larger sample than one stand-alone case report. Thus, we can see it isn’t an isolated case. However, it was only one chiropractor delivering the adjustments and the difference was measured after only one session. Further research would be required to show us if there was an effect over time and whether results differed from chiropractor to chiropractor. However, given the manoeuvre described by the chiropractor and the methods used to ascertain the need for an adjustment were not uncommon, it still remains an encouraging study.

Time will show us the impact of sedentary lifestyles and varying ergonomic arrangements in a long-term work-from-home economy created by coronavirus pandemic. But given the long-standing postural concern that is forward head posture (or CFF), this case report is certainly a good one to have on file.


  1. Getzoff H. Anterior Thoracic adjusting and the relationship to cervical Olexion: A retrospective case series of twenty-four patients. Asia-Pac Chiropr J. 2020;1.2:online only. URL thoracic-adjustment–getzoff/
  2. Bernard BP. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. U.S. Department of Health and Human Services. Public Health Service Centers for Disease Control and Prevention National Institute for Occupational Safety and Health. July 1997. 2-1, 2-21
  3. Oglesby M, Fineberg SJ, Patel AA, Pelton MA, Singh K. Epidemiological trends in cervical spine surgery for degenerative diseases between 2002 and 2009. Spine (Phila Pa 1976). 2013;38(14):1226-32.
  5. Haavik H, and Murphy B (2011), “Subclinical Neck Pain and the Effects of Cervical Manipulation on Elbow Joint Position Sense,” JMPT Vol 34, Iss 2, Feb 2011, pp. 88-97,
  6. Luke M (2016), “Subclinical neck pain impairs cognitive ability which can be improved by chiropractic treatment: a four week longitudinal study with a healthy control group comparison,” Journal of Pain and Relief, DOI: 10.4172/2167-0846.C1.012,
  7. Daligadu J, Haavik H, Yielder P, Baarbe J, and Murphy B (2013), “Alterations in Cortical and Cerebellar Motor Processing in Subclinical Neck Pain Patients Following Spinal Manipulation,” JMPT Vol 36, Iss 8, October 2013 pp. 527-537,
  8. Haavik H, Murphy B (2012), “The role of spinal manipaultion in addressing disordered sensorimotor integration and altered motor control,” J Electromyogr Kinesiol, 22(2012) pp.768-776).
  9. Baarbe J, Holmes M, Murphy H, Haavik H, Murphy B (2016), “Influence of Subclinical Neck Pain on the Ability to Perform a Mental Rotation Task: A 4-week Longitudinal Study with a Healthy Control Group Comparison,” JMPT  39, Iss. 1, Jan 2016 pp. 23-30,
  10. Kelly D, Murphy B, and Backhouse D (2000), “Use of a mental rotation reaction-time paradigm to measure the effects of upper cervical adjustments on cortical processing: a pilot study,” JMPT, 23(2000), pp.246-251, DOI:





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