Ideal alignment of the cervical region allows the head to be positioned with minimal muscular effort.  Ideal alignment is an inward lordotic curve with both the upper and lower cervical region in a position of slight extension.

The most common alignment impairment observed in the cervical spine is a forward head posture.  The forward head posture is characterized by a forward translation of the lower cervical region, and hyperextension of the cervical region with typicaly, an increased kyphotic curve in the thoracic region.

Normal                                             Forward Head

The muscular adaptations associated with a forward head position are shortening of the cervical spine extensors and a lengthening of the intrinsic cervical spine flexors.  The forward head position also requires increased activity of the extensor muscles of the cervical spine to counter balance the head against the effect of gravity.  The muscular adaptations that occur with a forward head position results in an increase in compressive forces acting on the articular facets.

Additional alignment faults may include an increase in the degree of upper cervical extension in comparison to that of the lower cervical spine, suggesting possible muscular adaptations in the suboccipital region.  These adaptations can include shortness of the suboccipital extensors, superior obliques, inferior obliques, and rectus capitus and lengthened position of the suboccipital flexors, rectus capitus lateralis and anterior muscles.