Massage Therapy Journal Summer 2024

Summer 2024 • 51

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Late stage postures. As TNS progresses, the postures become more pronounced and detrimental. In later stages, the forward head posture intensifies, leading to a more significant compromise of the cervical spine. This posture is characterized by lower cervical spine flexion and upper cervical spine extension. This particular alignment is unconsciously adopted to ensure that the eyes remain at a horizontal level. The excessive extension in the upper cervical region, however, results in diminished space within the atlanto-occipital and atlantoaxial joints, and sometimes a flattening or reversal of the cervical curve in whole. 1 Together, these alterations cause additional stress on the vertebrae, discs and supporting tissues, and can affect more diverse structures like the cranial nerves and spinal cord if the atlanto-occipital joints become subluxated, resulting in on-and off, sometimes vague nervous system issues throughout the body. Individuals in this later stage may visibly demonstrate a more rounded thoracic spine (hyperkyphosis), and the shoulders may adopt a forward and downward position (internally rotated and protracted). This advanced stage is marked by chronic muscle tightness, spasms and a more fixed or structural alteration of the curvature

of the spine—another reason to catch these postural issues early and treat them daily with mindful re-education and body therapies. Anatomical Implications The early stages of TNS see anatomical changes via adaptive responses, where the body attempts to cope with the increased demand on the neck muscles and ligaments. And in the later stages, these adaptive mechanisms become strained, leading to structural changes that may or may not become permanent. The cervical spine may undergo flattening or even reversal of its natural curve, which contributes to degenerative disc diseases, osteoarthritis and nerve compression. Ligaments may become overstretched and unable to return to their supportive positions. Muscles, particularly those in the anterior neck (from superficial to deep), may also hypertrophy to support the weight of the head when the head is positioned forward. Understanding the anatomical progression of TNS postures is crucial for massage therapists to tailor their treatments effectively. Early identification and targeted interventions like guiding individuals toward adopting healthier ergonomic practices can help mitigate the risk of these long-term complications.

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