Forward Head Posture and Activation of Rectus Capitis Posterior Muscles

Abstract

Abstract Context: Rectus capitis posterior (RCP) muscles have physical attachments to the pain-sensitive spinal dura. Atrophy of these muscles is associated with chronic headache in some patients. The authors suspect that the significance of atrophy in the RCP muscles has been undervalued because the functional role of these muscles is not well defined. Objective: To determine whether a statistically significant change in normalized levels of electromyographic activity in RCP muscles occurs when the head is voluntarily moved from a self-selected neutral head position to a protruded head position. Methods: Fine wire, intramuscular electrodes were used to collect electromyographic data as asymptomatic participants moved their head from a neutral head position into a forward head position and back into the neutral head position. This sequence was repeated 4 times. Normalized levels of electromyographic activity were quantified using a 2-head position × 2 sides of the body repeated measures design that incorporated mixed-effects β regression models. Results: Twenty participants were studied. Electromyographic activity collected from RCP muscles was found to increase as the head was voluntarily moved from a self-selected neutral head position (11% of maximum voluntary isometric contraction [MVIC] in RCP minor, 14% of MVIC in RCP major) into a protruded head position (35% of MVIC in RCP minor, 39% of MVIC in RCP major) (P<.001). Conclusion: Rectus capitis posterior muscles may contribute to segmental stabilization of the occipitoatlantal and atlantoaxial joints by helping to maintain joint congruency during movement of the head.