Clinical Conversation: What is a Neutral Head Position? (January 2022)

 

This transcript includes highlights from the live, interactive session of our Clinical Conversation: What is a Neutral Head Position? 

If you missed the live webinar, you can read about neutral head position and how to integrate it into your clinical Pilates practice below. 

Please join our next live event, where you can participate in our Case Study discussion and Q&A session. 

Check out our upcoming Clinical Conversations here

 

WHAT DO WE MEAN BY NEUTRAL? 

  • The optimal alignment of a joint.
    • A position of efficiency.
  • The position of a joint where the bones that make up the joint are placed in the optimal position for maximal movement.
  • The midrange of a joint, where there is the least amount of load on the ligaments and non-muscular tissues around the joint.
    • Stabilizing muscles are working minimally to maintain the position of the joint.

 

NEUTRAL BODY POSTURE

  • The posture of the body in microgravity.
  • This minimizes the body’s need to support itself against the pull of gravity, and offloads musculoskeletal stress.
  • It also reduces pressure on the diaphragm and spine.

A diagram showing the neutral body posture, the posture the human body naturally assumes in microgravity. 
NASA, 1987

KEY POINTS: NEUTRAL HEAD POSITION

  • Assumption for measuring a neutral head position is that the head and subsequent cervical alignment is upright, relaxed and resting.
  •  Intervertebral ranges of motion vary between static and dynamic conditions.
  • There are differences in vertebral ranges of motion during dynamic movement of the head and neck:
    • This is due to hysteresis. 
    • The head and spine’s position depends on its prior movement.
    • The head’s posture depends on the direction of motion.

 

ANATOMY REVIEW OF THE HEAD AND SPINE

  • Head (C0) & seven cervical vertebrae (C1-C7). 
  • C1 forms the atlanto-occipital joint with the occipital condyles of the occiput of skull.
    • Bears the weight of the skull.
    • Primary movements: flexion/extension.
  • C2 forms the atlanto-axial joint via its superior projection from the vertebral body, the dens/odontoid process, and the atlas of C2.
    • Primary movements: lateral rotation.
  • C3-C7 are considered “typical” vertebrae.
    • Primary movement C2-C4 is lateral rotation.
    • Primary movement C4-C7 is lateral flexion.
  • Motion in lower cervical spine lags head motion.
  • Relative contributions of individual joints to overall neck range of motion change throughout active flexion and extension.

 

FUNCTION OF THE HEAD AND SPINE

  • To stabilize the head so that the eyes are parallel with the ground. 
  • Alignment of the vestibular apparatus, for balance.
  • Large range of motion to scan and interact with the environment.
  •  Mastication and swallowing, and therefore digestion.
  •  Elevation of the ribs during inhalation.
  •  Protection of the spinal cord, peripheral nerves and vertebral vasculature.

 

CLINICAL PILATES EMBODIED ANATOMY: EXPLORATION OF THE HEAD & NECK

  • Moving the Eyes: Notice that where the eyes move, the head will follow.
    • Explore how this works with the eyes open, and with the eyes closed. 
  • Moving Towards Sound: What do you notice about how sounds draw the ear, and thus the head? 
    • Experiment playing with different sounds in the room. How does the body respond as the head moves towards these sounds? 
  • Drawing Circles: Draw circles with the head, leading with different parts of the head, and notice the head and neck range of motion.
    • Forehead leading the movement.
    • Nose leading the movement.
    • Chin leading the movement.
    • Each ear (separately) leading the movement.
    • "Back" nose leading the movement.
    • Crown of the head leading the movement.
  • Moving the Spine: In sitting or standing, notice how the spine moves when the head leads the movement through flexion, extension, side flexion, and lateral rotation.
    • How does the range of motion change when maintaining a "neutral" head position? 

WHAT IS A NEUTRAL HEAD POSITION: CLINICAL REASONING QUESTIONS 

  • Clinical Reasoning Question One: Saw.
    • How can you teach Saw with an emphasis on head position?
    • And how will maintaining a neutral head position impact spinal range of motion through this exercise? 
  • Clinical Reasoning Question Two: Head Position and Shoulder Range of Motion.
    • How would you expect the position of the head to impact shoulder range of motion for Drawing the Sword on the Reformer, and why?

 

REFERENCES

1. Alahmari K, Reddy RS, Silvian P, Ahmad I, Nagaraj V, Mahtab M. Intra- and inter-rater reliability of neutral head position and target head position tests in patients with and without neck pain. Braz J Phys Ther. 2017 Jul-Aug;21(4):259-267. doi: 10.1016/j.bjpt.2017.05.003. Epub 2017 May 19. PMID: 28558952; PMCID: PMC5537472.

2. "ANTHROPOMETRY AND BIOMECHANICS." Man-Systems Integration Standards (MSIS). Last modified August 27, 2020. https://msis.jsc.nasa.gov/sections/section03.htm#3.3.4%20Neutral%20Body%20Posture.

3. Biely, Scott & Smith, Susan & Silfies, Sheri. (2006). Clinical Instability of the Lumbar Spine: Diagnosis and Intervention. Ortho Phys Ther Prac. 3. 

4. Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992 Dec;5(4):383-9; discussion 397.

5. Porwal A, Sasaki K. Current status of the neutral zone: a literature review. J Prosthet Dent. 2013 Feb;109(2):129-34. doi: 10.1016/S0022-3913(13)60030-X. PMID: 23395339.

6. Newell RS, Blouin JS, Street J, Cripton PA, Siegmund GP. The neutral posture of the cervical spine is not unique in human subjects. J Biomech. 2018 Oct 26;80:53-62. doi: 10.1016/j.jbiomech.2018.08.012. Epub 2018 Aug 22. PMID: 30170839.

 

 

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