Sunday, October 25, 2015

Head Forward Posture: Part 3: Relationship to Zangfu Disharmony

Fig. 1: Upper Cross Syndrome
In the last blog post, I wrote about a common postural disparity called Upper Cross Syndrome (UCS) which involves a head-forward posture and scapular protraction. Upper Cross Syndrome is a muscle imbalance which includes a combination of overactive, shortened muscles and inhibited, lengthened muscles. We can visualize this by looking at a person from the side and picturing an X overlaying the body as illustrated in Fig. 1; one leg of the X indicates the overactive muscles (the posterior cervical extensors and pectoralis muscles) and another indicates the inhibited muscles (the lower and middle trapezius and rhomboids and the anterior cervical flexors).

Also discussed in this post was the sinew channels (jingjin) involved in UCS. Specifically, the Lung and Large Intestine sinew channels were seen to work in a coordinated fashion to balance the scapula and were involved with imbalance as seen in scapular protraction. In protraction, the muscles of the Lung sinew channel (pectoralis minor) were short and overactive while the muscles of the Large Intestine sinew channel (the middle and lower trapezius) were inhibited.

The Kidney and Urinary Bladder sinew channels work together to balance the cervical spine in relationship to flexion and extension. In a head forward posture, the muscles of the Urinary Bladder sinew channel (comprising the cervical extensors such as the splenius cervicis and capitis) were overactive while the muscles of the Kidney sinew channel (comprising the deep cervical flexors such as the longus colli and capitis) were inhibited.

So, in terms of the sinew channels, the structures involved with UCS are Lung/Large Intestine and Kidney/Urinary Bladder. Interestingly, the zangfu pattern commonly seen with UCS parallels this, as seen in a study done by Matt Callison, M.S., L.Ac. Callison presented the finding of this study at the Pacific Symposium in November of 2011. He took a sample size of 150 (this has now grown to over 250) and had them fill out a questionnaire which included common questions asked as part of the examination methods in TCM. In addition, postural assessment was performed revealing five basic postural patterns. These are seen in Fig 2 below.

Fig 2: Image courtesy of Matt Callison and used with permission. Type I indicates the Zang pattern associated with UCS. Other postures and their respective sinew channel relationships will be explored in other posts. 

Matching the results from the questionnaire revealed trends that allowed a comparison between these five common postural disparities and common Zangfu diagnoses. Relevant to this discussion, respondents with UCS as seen in the first image in Fig 2 gave answers that would be consistent with Spleen, Lung and Kidney deficiency. Observing this posture, one can see the compression of the lungs which affects breathing, but also the middle jiao is compressed and there is a bowing of the abdomen. Kidney deficiency manifests with a reduction in tone of the stabilizing muscles of the spine, especially the cervical spine in UCS. Note: UCS involves the Lung and Kidney sinew channels and their respective internally and externally related channels. UCS describes a Western muscle imbalance, first discussed by Vladamir Janda. It is only describing the relationship of the shoulder girdle and the head/cervical balance. In practice, I see the Spleen sinew channel involved, as it incorporates the deep abdominal fascia which, when restricted, can contribute to a bowing of the abdomen.

The question that often arises is that of chronology. Which came first: the posture or the pattern? In my opinion, this is a somewhat unimportant question; it is more useful simply to understand that structure and function are related. One affects the other. Possibly there is no answer to this question, as dysfunction occurs differently for everyone. Some may have zangfu dysfunction, which affects the channels and collaterals and leads to a change in the posture. Others may have a job or other circumstance that affects the posture and, due to the strain on the internal organs, leads to zangfu disharmony.

What is more important to consider is that addressing the posture can impact the health of the zangfu. This will reinforce and broaden treatment with distal points in an acupuncture session, and with herbs, diet, and lifestyle changes.

Facebook icon Google Search icon LinkedIn icon Instagram icon YouTube icon


  1. Replies
    1. Hi Yentl, I will be putting together some ideas for the next post. These will be acupuncture, tuina, and corrective exercise based. Check back in the next week for more specific information. In Sports Medicine Acupuncture, we needle the motor points of the rhomboids, middle and lower trapezius with a tonifying technique and the pectoralis minor motor point with a more sedating technique. This is part of the comprehensive treatment (zangfu disharmony, qi, blood, yin or yang deficiency, other imbalances, etc.). After acu, we perform tuina and then prescribe corrective exercises. I might describe the motor point techniques, but am concerned because we assess for depth and needle perpendicular over the ribcage. This is something that I think is tricky to discuss in writing and is better in class. I might focus more on the tuina and corrective exercises for safety reasons. Thanks for the interest.