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Forward Head Posture and Obstructive Sleep Apnea

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Natick Massage | Weston Massage | Turtle Dance BodyworkA client recently came in complaining of pain and tension in his head, neck and shoulders. At our initial conversation, he mentioned that he spends long hours on the computer. As with many who work with computers, he had the classic signs of Forward Head Posture (FHP). These include a rounding of the upper back, forward rotation of the shoulders, head pulled down and forward, and chin jutting out. Our main goal for the session was to relieve these issues.

We started the session with him lying face down on the table. As he relaxed, he began to doze off. His breathing became heavier, then turned to snoring. Within minutes, the snoring became sporadic, interrupted by a few seconds of choking, then starting up again. During those seconds, while the air wasn’t getting to his lungs, it was clear that his whole upper torso began working hard, trying to get that needed air. Although I had heard of sleep apnea before, this was the first time I had witnessed it first hand. Watching how difficult it was for him to breathe, it was easy to understand how this challenging symptom could make it very difficult to get a good nights sleep, which might account for the speed at which he was out during the session. It also occurred to me while watching his body tense up and struggle for its needed sustenance, that the apnea might well contribute to some of his postural issues.

I proceeded to work on his spine, rib cage, shoulders and neck, then had him roll onto his back. As he settled, I mentioned the breathing pattern. He informed me that he had been diagnosed with Obstructive Sleep Apnea (OSA), and had been using a ventilator at night for some time. After a minute or two of work on his chest, he was back to the snoring and choking pattern. But I noticed that as the musculature in his pectorals and rib cage released, his breathing became more even, and the choking lessened. Moving to the neck, again the muscle tension released, and there was a noticeable change in the breathing for the better. At one point I was working the occipital ridge at the base of his skull, with his head lifted off the table, and felt the neck muscles completely let go. The snoring and choking went away, and he breathed normally for several minutes.

This experience prompted me to do a bit of research on the relationship between Forward Head Posture and Obstructive Sleep Apnea. Logic indicated that this type of posture must adversely affect the airway, since the neck is in such a compromised position. Studies have proven this out.

One such study, sited here, clearly indicates that within a group of 252 male participants (this condition is typically found in males), a definite connection is shown between Forward Head Posture and Obstructive Sleep Apnea in all levels of severity. Other factors, such as size and shape of the airway and tongue, and Body Mass Index (weight compared to height) are significant as well. Carrying extra weight is a challenge to the body on several levels.

While the contours of the airway passage and tongue may well be affected by the other factors, there is a fair amount of genetics that determine their size and shape, rendering them beyond our control. The postural and weight concerns, however, are well within our means to influence positively. A regular program of massage, stretching and awareness can without doubt improve posture, and a consciousness about diet and exercise are the best, most enduring approaches in controlling body weight.

Unfortunately, the handful of sessions we had together did not provide enough opportunity to see whether these changes would hold over an extended period of time. None the less, the glimpse of positive change was inspiring.

Study sited:

Natural Head Posture, Upper Airway Morphology and
Obstructive Sleep Apnoea Severity in Adults
M. Murat Özbek*, Keisuke Miyamoto*, Alan A. Lowe* and
John A. Fleetham**
*Department of Oral Health Sciences, University of British Columbia and **Department of
Medicine, Division of Respiratory Medicine, Vancouver Hospital and Health Sciences Centre,
University of British Columbia,


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  7. Kelsey O'Dea on July 30, 2014 at 5:24 pm said:

    I have OSA and forward head posture. I am thin and don’t have a large tongue or any other mouth issues. I know that there is connection between the two (OSA and my posture) and I wonder why the sleep specialists haven’t addressed this issue. The tighter I am in my neck and the more rounded my shoulders (after say, swimming), The worse I breath at night. I wish that this would be a topic further explored and communicated to patients.

    • There is certainly research to back the assertion. Have you been involved in any sleep studies? If so, this might be a good question to pose to the docs there.

  8. Better yet, get yourself to a good manual therapist who understands the relationship between the two. You may not get insurance to cover the work, but what is a good night’s sleep worth?

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