What is Habitual Posture?
Habitual posture is an unconsciously “learned” posture that is not thought to be due to alterations in nervous system function. It can result in “abnormal” head positioning (turning, tilting, and/or rotating) that can be voluntarily corrected. It is likely caused from how someone holds their head in different settings. It may also be caused by our normal muscle imbalances, eye dominance, arthritis, scoliosis, how we hold our bags, leg length discrepancies, and many other reasons. Forward head posture (eg, looking at phones, using a computer) increases the weight on the supporting structures of the neck from 10 to 30 lbs. Rounded shoulders cause the muscles in your upper back and neck to work harder to hold your head and arms up and eventually pinch the tendons in your shoulders. The more time spent in an abnormal posture, the more likely it is for it to become a “normal” posture.
As such, habitual postures are often associated with muscular pain. Biomechanical imbalances from areas distant from the neck, including leg length discrepancy, scoliosis, and decreased range of motion in the leg, can affect posture and spine curvature, leading to muscle overuse, constant firing patterns, and muscle fatigue in the neck and shoulder. The positioning of arms for typing leads to rounded shoulders that produce decreased subacromial space, cascading into shoulder joint problems such as impingement, rotator cuff tears, and frozen shoulder.
What is Cervical Dystonia?
Cervical dystonia is a condition where the muscles in your neck contract (tighten) involuntarily, causing your head to twist, turn, or tilt into abnormal positions. When you have Parkinson’s disease, you may develop this neck problem as part of your condition.
Unlikely cervical dystonia, habitual postures do not cause head tremors or have special sensory tricks. Habitual posture may be difficult to technically distinguish from cervical dystonia, but basic strategies used in treating cervical dystonia are very helpful for those with habitual posture.
How Common is This in Parkinson’s Disease?
Cervical dystonia affects about 9 out of every 100 people with Parkinson’s disease. This is much more common than in people without Parkinson’s Disease. Dystonia in general can occur in 30% or more of patients with Parkinson’s disease.
When Does It Develop?
In most cases (about 7 out of 10 people), cervical dystonia develops after Parkinson’s disease has already been diagnosed. However, sometimes neck dystonia can appear before other Parkinson’s symptoms become obvious.
What Makes It Different?
Cervical dystonia related to Parkinson’s Disease has some unique features compared to cervical dystonia that occurs on its own:
- It tends to be less severe overall
- It causes less head tremor and pain
- It affects more men than women (the opposite is true for cervical dystonia without Parkinson’s Disease)
- It typically occurs in people around age 70
How Do Parkinson’s Medications Affect It?
The relationship between cervical dystonia and Parkinson’s medications can be complex. Some people find that their dystonia improves when they take levodopa (a common Parkinson’s medication), while others may not notice much change. In some cases, dystonia can develop as a side effect of long-term Parkinson’s treatment.
Commonly Associated Symptoms
- Muscle tightness and muscle knots (myofascial trigger points)
- Neck pain (cervicalgia)
- Tension-type headaches
- Morning-predominant headaches
- Occipital neuralgia
- Migraines
- Temporomandibular joint (TMJ) and jaw pain
- Teeth grinding (bruxism)
- Shoulder pain
- Myofacial pain syndrome
- Zygapophyseal (facet) joint pain
- Tingling pain in the neck or arms
- Low back pain
What Other Treatment Options Are Available?
Basic approaches for neck pain or tightness:
- Pay attention to posture throughout the day. See if certain activities bring out bad posture. Try to limit the amount of time spent in a bad posture.
- Look for neck tightness when lying down to sleep. You may find that you tighten your neck in certain positions. See if different head/body positions make a difference.
- Explore the muscles of your head/scalp, jaw, and neck (front and back) to find tight muscles, knots, or asymmetries. The shower can be a great time to look.
- Try massage, gentle stretching, heating pads, and/or ice packs. If the muscle is sore, massage more!
- It is okay to use over-the-counter Tylenol or NSAIDs (eg, Advil) occasionally for pain.
- Physical therapy can help improve neck mobility and reduce pain. Exercises and stretching routines tailored to your specific needs may be beneficial.
Inova Health Talk: Types of Dystonia and Treatment Options
Drew Falconer, MD, Medical Director of the Inova Parkinson’s and Movement Disorders Center, gives an overview of types and causes of dystonia and available treatment options.
To learn more visit Inova.org/move.
How do I . . . manage my dystonia?
Dystonia is a frequent, often under-recognized part of Parkinson’s that is dynamic, coming and going through the day.
Join Parkinson’s specialists Josefa Domingos, PT, PhD and John Dean MA CCC-SLP for a practical session regarding dystonia in Parkinson — what to notice, what to write down, what to tell your clinician, and how families can help.
Reporting clearly, plus collaborative, adaptable exercise and therapy, makes the biggest difference over time.
Occasionally tight muscles in the neck can pull on the vocal cords to cause a sore or raspy voice (muscle tension dysphonia) or the sensation that something is stuck in your throat (globus sensation). YouTube has excellent stretches, exercises, and massage videos to help with either symptom.
- “Laryngeal Massage: De-Stress Your Voice – Professional Voice Care Center”
– www.youtube.com/watch?v=QUDNXLSrOXk - “Laryngeal Massage & Myofascial Release for a Tight Throat (6 Exercises)”
– www.youtube.com/watch?v=YSpn6rsrf_w
Ask your dentist if it looks like you are grinding your teeth (bruxism). This is a common cause of neck pain or tightness and can be treated with a night (bruxism) guard to protect your teeth. Bruxism also can lead to bothersome “TMJ” or jaw pain.
- The major muscles involved with bruxism include the temporalis muscles, masseter muscles, medial pterygoid muscles, and lateral pterygoid muscles.
- You can find great YouTube videos on how to relax those muscles. Try searching the muscle name followed by the word “release,” “stretch,” or “massage.”
- You can also simply search YouTube for “TMJ exercises” or “bruxism exercises.”
- Insurance often does not cover Botox injections to help treat bruxism.
Typical dystonia medications are generally poor options because they cannot relax specific muscles. They instead affect all the muscles in your body and even your brain. These medications often cause side effects, usually brain fog and poor balance.
- Anticholinergics (eg, trihexyphenidyl, benztropine)
- Benzodiazepines (eg, clonazepam, diazepam)
- Muscle Relaxants (eg, tizanidine, baclofen)
Botulinum Toxin (BoNT) injections:
These injections are effective in temporarily weakening the overactive muscles, thereby reducing spasms. The injections need to be administered by a healthcare professional and most often require repeated injections every three months. The benefit of these injections is that they only affect the muscles injected and do not cause systemic side effects.
Surgery:
In severe cases where other treatments are ineffective, surgical options such as deep brain stimulation (DBS) may be considered. This involves implanting a device that sends electrical impulses to specific brain regions to reduce symptoms.
Resources and Support
Living with cervical dystonia can be challenging, but various resources and support systems are available to help you manage your condition:
1. Dystonia Medical Research Foundation (DMRF):
Website: www.dystonia-foundation.org
2. Dystonia UK:
Website: www.dystonia.org.uk
3. National Institute of Neurological Disorders and Stroke (NINDS):
Website: www.ninds.nih.gov
Author Mick Reedy, MD, is a Movement Disorders Specialist with
Inova Parkinson’s and Movement Disorders Center (IPMDC)