A question of great philosophical debate!

The same could be asked about body pain - 

Does the knee problem create the hip pain, or does the hip problem cause the knee pain?  Is your headache caused by a neck problem, or your lower back?

Janda's Theory -' The Domino Effect of Forward Head Posture 

Professor Vladimir Janda is one of the biggest contributors to our understanding of nervous systems influence over muscle control. Through his observations he provided original theories that scientists, via improved experimental methods are now able to confirm.


One prominent area of his studies was the development of three stereotypical patterns associated with distinct chronic pain syndromes;

  •         upper-crossed syndrome(UCS)
  •         lower-crossed syndrome (LCS)
  •         layered syndrome (a combination of UCS and LCS)

These syndromes are characterized by specific patterns of muscle weakness (inhibited) and tightness (facilitated) that cross the body (as shown in the diagram above).


Specific postural changes seen in UCS, include forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and winging of the scapulae. Specific postural changes are also seen in LCS including anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, lateral leg rotation, and knee hyperextension.


We know that when our centre  of gravity changes the rest of our body shifts its balance to compensate, below explains how UCS can lead to Layered Syndrome.


An example of the domino effect can be seen below:


Janda found that the UCS pattern of imbalance caused spinal joint dysfunction, particularly at the atlanto-occipital joints, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment.


He also found that LCS created joint dysfunction, particularly at the L4-L5 and L5-S1 segments, SI joints, and hip joints.


Correcting these muscle imbalances through stretching and strengthening can help reduce stress on your joints and muscles and in turn reduce pain.


For further details of Janda’s life and contributions, read the paper by Morris and colleagues, Vladimir Janda, MD, DSc: tribute to a master of rehabilitation. (Spine. 2006 Apr 20;31(9):1060-4.)


Text adapted, and image taken from http://www.jandaapproach.com/ cited 11/2/2013