This is the first study exploring the impact of different head and neck positions on respiratory function. Kim DH, Kim CJ, Son SM. You have 60 to 70 muscles in your neck, head, and face area. According to a small 2019 study, FHP can negatively affect a persons breathing. 16781683, 1994. nhs.uk/live-well/exercise/common-posture-mistakes-and-fixes/, ncbi.nlm.nih.gov/pmc/articles/PMC5889545/, ncbi.nlm.nih.gov/pmc/articles/PMC5551003/, bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2438-y, orthoinfo.aaos.org/en/diseases--conditions/introduction-to-scoliosis/, ncbi.nlm.nih.gov/pmc/articles/PMC2907357/, orthoinfo.aaos.org/en/diseases--conditions/kyphosis-roundback-of-the-spine/, ncbi.nlm.nih.gov/pmc/articles/PMC6348172/, spineuniverse.com/conditions/spinal-disorders/faqs-about-flatback-syndrome, acatoday.org/content/posture-power-how-to-correct-your-body-alignment, ncbi.nlm.nih.gov/pmc/articles/PMC5659804/, Want to Kick Your Slouching Habit? When they are rigidly tight in the forward head position, the scalenes can't counterbalance tension in the back of the neck. Fathollahnejad K, et al. These muscles are also accessory muscles of respiration, which are used in addition to the diaphragm [29]. 17, no. "Walk" your fingers downward to try to find to bottom tips of each blade and then release the hug. 1. This is a list of the main symptoms associated with this postural issue: Symptoms: Neck Pain at base of the Skull Headaches and Dizziness Cervical Radiculopathy Ineffective breathing technique Temporomandibular joint (TMJ) issues Impaired balance Forward Head Posture Exercises What's to know about upper crossed syndrome? 26, no. Adopting good posture has myriad benefits. Due to the increased compressive forces through the neck joints and increased muscle tension, pain is the common outcome. They then need to repeat the steps for the regular chin tucks. 27, no. Back decompression can help relieve some types of back pain. Patients with acute torticollis are usually unable to take a proper breathing and therefore this issue should be addressed when examining patients with acute torticollis. Lovitz adds that if you are experiencing health problems related to poor posture, one skill you can try is the " 20/20/20 rule ." Pain, pins & needles and numbness in the arms and hands. FHP can have a negative impact on static balance. 2. 1173185, Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. Effec. Hooper TL, Denton J, McGalliard MK, Brisme JM, Sizer PS Jr. Thoracic outlet syndrome: a controversial clinical condition. WebThe vagus nerve and glossopharyngeal nerve control the muscles of the throat. 591593, 2014. A small 2019 study of healthy college students found that a forward head posture decreases the lower thorax (mid-spine) mobility, leading to decreased respiratory function. With a forward head posture, the distance between the tongue base and posterior wall is increased. 28, no. All this shifting of the body causes strains, stress and ultimately pain for numerous parts of your body. Dont jut your butt backward or lean too far forward, cautions Dr. Bang. When youre severely hunched over, its harder to walk, and you have an increased risk of falls and injuries. Hold for five seconds, then release. The subjects were asked to rotate their head to the left side and side flex to the right side. J Child Neurol. A. G. Silva and M. I. Johnson, Does forward head posture affect postural control in human healthy volunteers? Gait & Posture, vol. How long does it take to fix forward head posture? Gently tilt your head to the side, attempting to touch your ear to your shoulder, until you feel a mild stretch. Best food forward: Are algae the future of sustainable nutrition? 507511, 1997. Swayback also increases your risk of developing back and hip injuries and other musculoskeletal injuries, such as disc degeneration. Levangie PK, Norkin CC. This is an open access article distributed under the. Learn about its symptoms, causes, Many people believe large breasts are a cause of upper back pain. A. Oldham, and N. Strimpakos, Respiratory dysfunction in chronic neck pain patients. The scalene triangle is important because the brachial plexus nerve complex branches pass through it. for a prolonged period of time can lead to development of FHP [19]. (2017). Other faulty postures like pelvic and lumber spine posture. 3, pp. The scalenes resemble this and are positioned on the neck and collarbone similarly. [1] Thoracic Kyphosis is a complication of the combination of slouched-forward shoulders and rounded upper back. We do not endorse non-Cleveland Clinic products or services. You may dismiss the discomfort for a while, but its your bodys way of getting your attention. The United Kingdoms National Health Service (NHS) provide the following instructions: If a person sits at a desk for long periods of time, they should focus on maintaining proper posture. A person with FHP also typically tilts their head back in order to look forward. C. F. Chen, I. N. Lien, and M. C. Wu, Respiratory function in patients with spinal cord injuries: Effects of posture, Paraplegia, vol. 3, pp. 94, no. Three other problems linked to poor posture may surprise you. J. Han, S. Park, Y. Kim, Y. Choi, and H. Lyu, Effects of forward head posture on forced vital capacity and respiratory muscles activity, Journal of Physical Therapy Science, vol. Additionally, it can impact the movement patterns for the scapula, or shoulder blade, and the humerus, which is the long arm bone, resulting in a condition called scapular dyskinesis. Relieve that neck pain with these exercises and tips. 6, pp. F. Manning et al., Effects of side lying on lung function in older individuals, Physical Therapy in Sport, vol. Without moving your feet, lean your torso toward the wall until you feel a gentle stretch across the entire front of your chest. It has more than one function. Hold for a count of 5 and slowly release. (2016). Journal of Bodywork and movement therapies. Laura Campedelli, PT, DPT, is a physical therapist with experience in hospital-based acute care and outpatient therapy with both children and adults. I have seen physiotherapists and they diagnosed me immediatelly with forward head posture (FHP), which seems to be quite a nasty condition, which can result in all sorts of pains and symptoms. Kim DH, Kim CJ, Son SM. Although usually considered cervical flexors (they bend the neck forward), once the neck is extended in this way the scalenes can become cervical extensors (they are used to bend the neck backward). Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion. In some cases, doctors can help identify potential causes and recommend new treatment options. 8186, 1990. 2015;28(3):951-5. Therapeutic Exercises. It is considered an accessory breathing muscle because it lifts the first rib during an inhale. In turn, tongue pressure may be reduced, limiting the patients ability to move the bolus into the oropharynx, pharynx, and esophagus. 38, no. M. A. Yoga may also help. Ignoring advice on goodposturecan affect your overall health and set you up for neck and shoulder strain,back painand even joint damage. Davis Company. Forward head posture (FHP) occurs when a person is leaning their head forward, out of neutral alignment with their spine. Alteration of cervicothoracic mobility impairs normal breathing mechanics by reducing diaphragm mobility and strength [8]. 2005-2023 Healthline Media a Red Ventures Company. 198200, 2013. Part 1: anatomy, and clinical examination/diagnosis. This could be a result of temporary entrapment of the phrenic nerve, which supplies the diaphragm, reduces it neural activity, and consequently weakens the diaphragm activity [22]. 4, pp. FHP strains for example your neck muscles which then pull back your jaw -> overbite -> possible TMJ symptoms. The consequences of chronic forward head posture can be significant. Katzman WB, et al. Studies have reported that symptoms including neck pain, headache, temporomandibular pain, and musculoskeletal disorders are related to FHP, FHP greatly influences respiratory function by weakening the respiratory muscles. https://www.physio-pedia.com/index.php?title=Forward_Head_Posture&oldid=321240. When you tilt your head to one side you will stretch your middle scalene on the other side. Hold for This also causes tension on the spine. Your lower back looks straight and you stoop forward. Position your monitor straight ahead at eye level. Advertising on our site helps support our mission. 3, pp. You may have pain in your neck and lower back. Gently tilt your head to the side, attempting to touch your ear to your shoulder, until you feel a mild stretch. When only one posterior scalene is contracting, it flexes and rotates the neck joints. Im B, Kim Y, Chung Y, Hwang S. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. (2020). 3, pp. As you stretch your middle scalene, looking up over the shoulder towards the opposite direction can stretch your anterior scalene. 2018;9(6):309313. Push your head forward until you feel the stretch through your throat. A 2014 study calculated the force in pounds of flexing the neck forward to different degrees. They all contract when you breathe in, opening space for the lungs to expand in the thorax by lifting the top ribs. 2013;28(3):365-78. doi:10.1177/0883073812469294. J Phys Ther Sci. 2011. p501-37. A person can also incorporate exercises and stretching into their daily routine to help loosen stiff muscles and joints. You should have. Change the position in which you look at your cell phone. Bad posture or Forward Head Posture has a negative effect on all the physiological systems of the body including breathing and production of hormones. When refering to evidence in academic writing, you should always try to reference the primary (original) source. With a forward head posture, the distance between the tongue base and posterior wall is increased. Journal of back and musculoskeletal rehabilitation. All this shifting of the body causes strains, stress and ultimately pain for numerous parts of your body. A small 2019 study of healthy college students found that a forward head posture decreases the lower thorax (mid-spine) mobility, leading to decreased respiratory function. With the increased use of hand held devices, everyone is prone to poor sitting postures like forward head posture. 539548, 1997. p384-404. C. Fernndez-De-Las-Peas, C. Alonso-Blanco, M. L. Cuadrado, and J. In one study, just four weeks of strengthening and shoulder stabilization exercises improved pain, discomfort, and quality of life in participants who trained for 30 minutes a day, three times a week. Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion. Havingpoorposturemay lead to aches and pains, but having it over the long term is when you get real damage, says chiropractorAndrew Bang, DC. (2017). If you have this condition, you may need to bring your head up so you can see whats in front of you. Normal respiration is a very intricate function that comprises mechanical as well as nonmechanical components. 2, pp. We avoid using tertiary references. This is supported by work of Hodges and colleagues who reported that the diaphragm mobility is altered by posture movements [7]. A physical therapist can help you develop a routine of stretches and exercises for strengthening the muscle groups that will help you stand or sit properly. Scalenes can be affected by a whiplash injury, especially when the trauma is on the side of the neck. This dull or achy pain may spread across the side or back of the neck, as well as into the upper back, shoulder, and/or WebWhen forward head posture causes muscle pain, it typically feels like one or more of the following: General soreness. Remember that the human body was simply not built to maintain one position all daytaking a quick break to stretch and move every half-hour or so should be an essential part of your daily routine if you work at a desk or perform repetitive motion of any kind. 98104, 2012. Bring both hands behind your head, lifting your elbows to bring your upper arms parallel to the floors. possible injury during exercise, work, or other activities. In some cases, a person may find that pain medications may be helpful in reducing pain. A. Like the anterior scalene, the medial scalene muscle is considered an accessory breathing muscle because it lifts the first rib during inhalation. When you have respiratory issues (for example, asthma) your scalenes may have to work extra hard. The National Academy of Sports Medicine (NASM) define FHP as holding the head out, in front of its natural position over the cervical spine. Individuals with FHP showed reduced diaphragmatic strength as a result of its reduced activity [20]. Effects of forward head posture on static and dynamic balance control. Or a shoe lift can help equalize your leg length to improve your gait and help you stand straighter. With your elbows bent 90 degrees and your upper arms parallel to the floor, place your palms and forearms against each adjacent wall. Lane, Spinal respiratory motoneurons and interneurons, Respiratory Physiology & Neurobiology, vol. Depending on the cause of your scalene muscle tension, getting regular massages might also help keep these muscles flexible. Pain and fatigue can increase the longer you keep standing. (2019). (2018). Its whats meant by the phrase standing up straight.. The authors are grateful to the Deanship of Scientific Research, King Saud University, for funding through Vice Deanship of Scientific Research Chairs. Does structural leg-length discrepancy affect postural control? This indicates the huge impact the head position can have on physio-mechanical function of the respiratory system. 3, pp. Your posture has a major impact on your health, but most people don't know how to sit with good posture. People may associate FHP with using electronic devices for a long time, such as cell phones or computers. DOI: Carini F (2017). B Bradley Corrective Exercise for Forward Head Posture and Upper Crossed Syndrome Available from: Fathollahnejad K, Letafatkar A, Hadadnezhad M. Hilla Sarig Bahat, Andrei Levy & Tomer Yona (2022) The association between forward head posture and non-specific neck pain: A cross-sectional study, Physiotherapy Theory and Practice, DOI: 10.1080/09593985.2022.2044420. Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert. In turn, tongue pressure may be reduced, limiting the patients ability to move the bolus into the oropharynx, pharynx, and esophagus. Lack of development of back muscle strength. R. La Touche, A. Pars-Alemany, H. von Piekartz, J. S. Mannheimer, J. Fernndez-Carnero, and M. Rocabado, The influence of cranio-cervical posture on maximal mouth opening and pressure pain threshold in patients with myofascial temporomandibular pain disorders, The Clinical Journal of Pain, vol. To compensate for your upper body shift, your hips tilt forward. Forward Head Posture can cause serious health problems if left untreated. By Anne Asher, CPT You may spend a long time leaning over a small screen, slouching in a chair, or carrying a heavy backpack when you walk. When your spine is in the swayback position, it may cause back pain that affects your ability to move. A pilot study, Cephalalgia, vol. Here's how to get started. The scalenes are implicated in a number of neck problems. WebForward head posture (FHP) is a poor habitual neck posture. You can also set an alarm on your phone or computer to ping every 15 minutes or so to remind yourself not to slouch (devices are also available especially for this purpose). USA: F.A. 2023 Dotdash Media, Inc. All rights reserved. This dull or achy pain may spread across the side or back of the neck, as well as into the upper back, shoulder, and/or All subjects performed spirometry (Vitalograph Alpha, Bucks, UK) to measure the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and FEV1/FVC ratio. The anterior scalene also lifts the first rib, but thats a pretty subtle action that you might not be aware of while its happening. Thank you, {{form.email}}, for signing up. WebForward head posture (FHP) is a poor habitual neck posture. Davis Company.2007. Learn more. This dull or achy pain may spread across the side or back of the neck, as well as into the upper back, shoulder, and/or 112, no. Discover how poor posture can lead to neck and back pain, and other health troubles, especially when you sit at a desk all day. Demographic characteristics of participants (n=15). This "humpback" position can lead to a painful shortening of the muscles of the back of the neck, as well as compression of the cervical vertebraethe uppermost portion of the spine that supports the head and protects the spinal cord. With temporomandibular joint symptoms, the muscles of mastication may have increased tension (Pterygoid, Masseter, temporalis muscles). 3, pp. [3] Turn your head side to side to roll over different areas. Bad postures all involve taking the spine out of its neutral alignment position. WebThe vagus nerve and glossopharyngeal nerve control the muscles of the throat. During torticollis, there is shortening of sternocleidomastoid, trapezius, and other neck muscles [26, 27]. However, this may not be enough. 374-375, 1996. As with any other exercise routine, it takes about four to six weeks to see real change. This also causes tension on the spine. The consequences of chronic forward head posture can be significant. These help to elevate rib cage especially during labored breathing [30, 31]. Stand up straight. It often co-exists with Upper Crossed Syndrome Defined by hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae. WebA 2017 extensive review in the Journal of Chiropractic Medicine, the authors indicated, FHP [Forward Head Posture] can lead to headache, shoulder pain, neck pain, craniofacial pain, radiating pain to the scalp, temporomandibular disorders, subacromial impingement syndrome, restricted range of motion at the cervical spine, and scapula and WebA 2017 extensive review in the Journal of Chiropractic Medicine, the authors indicated, FHP [Forward Head Posture] can lead to headache, shoulder pain, neck pain, craniofacial pain, radiating pain to the scalp, temporomandibular disorders, subacromial impingement syndrome, restricted range of motion at the cervical spine, and scapula and All rights reserved. WebWhen the sleeping posture involves a forward flexed neck it restricts the normal function of the airways. The scalene muscles are accessory breathing muscles that help you inhale. Neck muscle weakness associated with neck pain has been shown to decrease thoracic mobility affecting pulmonary function [33]. Strengthening exercises for scapular retractors (Rhomboids, middle Trapezius). Torticollis is characterized by a twisted neck position that is very difficult to release. Different postures such as forward head posture (FHP) and kyphosis have been shown to alter breathing mechanism including diaphragm mobility [37]. If pain or stiffness is disrupting everyday tasks and a persons quality of life, doctors may prescribe muscle relaxants or stronger pain medication in addition to other therapies. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. When you sit at your desk to work, hold your shoulders and arms at a 90-degree angle. 505, no. When only one side contracts, it elevates (lifts) the first rib to flex and laterally bend (move to the side) the neck. Hold for five seconds, then release. 144, no. It can be affected by various factors, including age, lifestyle, disease, and change in posture, that can interfere with its normal functioning [1, 2]. The aging process also can lead to bone loss and posture problems as you lose the capability of support in some muscle groups. Noll M, et al. Verywell Health's content is for informational and educational purposes only. So, how can you tweak your habits to remedy the problem? They were screened for any cardiopulmonary disease, sinusitis, or any type of pain or postural abnormality and were excluded if any positive sign or symptom was found. When the scalenes are healthy and working in a balanced way, they help support the upright posture of your cervical spine, which is the upper part of your spine. Radiographic techniques can be used to measure postural angles, but it is not always practical. Walking may also be difficult, giving you leg pain and a feeling of weakness. You spend 1/3 of your life in bed. Bad posture or Forward Head Posture can also cause changes in the mood, pulse, blood pressure and lung capacity. Age-related hyperkyphosis: Its causes, consequences, and management. De Troyer, Respiratory effects of the scalene and sternomastoid muscles in humans, Journal of Applied Physiology, vol. Forward Head Posture can cause serious health problems if left untreated. 2. Verywell Health's content is for informational and educational purposes only. Sway a bit, or step forward and backward for a while, throughout the day.. Sometimes the scalenes can give you problems because they're prone to a lot of tension. The posterior (back) scalene occupies the farthest back position of all the scalene muscle branches. Learn the strategies that can help. If your posture is out of alignment, it can lead to: Bad or out-of-alignment posture is common. Manual therapy and stabilizing exercises on forward head and rounded shoulder postures: A six-week intervention with a one-month follow-up study. This is a list of the main symptoms associated with this postural issue: Symptoms: Neck Pain at base of the Skull Headaches and Dizziness Cervical Radiculopathy Ineffective breathing technique Temporomandibular joint (TMJ) issues Impaired balance Forward Head Posture Exercises Policy. M. Appel, A. Childs, E. Healey, S. Markowitz, S. Wong, and J. Mead, Effect of posture on vital capacity, Journal of Applied Physiology, vol. KSU/RRC/72). Can forward head posture cause throat problems? A corner pec stretch is much like a push-up at the wall,exceptthat the emphasis is placed onstaying in the position that causes your chest muscles to lengthen. Healthline Media does not provide medical advice, diagnosis, or treatment. 10, no. Didnt listen when your mom nagged you to sit or stand up straight? Strength and flex exercise plan: How-to videos. They may diagnose an underlying condition that can be treated, such as osteoporosis or arthritis. Sitting at a desk every day can bring about similar results. There is newly evidance that there is no relation between FHP and neck pain, additionally individual with neck pain had lower ROM and slower neck movement. It does not contribute to thescalene triangle; only the anterior and medial branches do that. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Forward head posture (FHP) occurs when a person is leaning their head forward, out of neutral alignment with their spine. In this condition, the weight of the head places increased pressure on the neck and cervical spine, forcing the body out of balance. Stand up straight. deep neck flexors, including the longus capitis and longus colli, scapular stabilizers and retractors, such as the rhomboids, middle and lower trapezius, teres minor, and infraspinatus, deep upper cervical extensors, such as the longissimus capitis, splenius capitis, cervical multifidus, and upper trapezius, shoulder protractors and elevators, such as the pectoralis minor, pectoralis major, and levator scapula, weakness in the muscles of the upper back. Older women with hyperkyphosis have a 70 percent increased risk of fracture. This means ensuring that the ears are in line with the shoulders. B. Wirth, M. Amstalden, M. Perk, U. Boutellier, and B. K. Humphreys, Respiratory dysfunction in patients with chronic neck paininfluence of thoracic spine and chest mobility, Manual Therapy, vol. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. In our aging population, kyphosis is estimated to affect 20 to 40 percent of older men and women, and the angle of kyphosis continues to increase as you age. Forward Head Posture can cause serious health problems if left untreated. Standing in those positions can cause low back pain. WebWhen the sleeping posture involves a forward flexed neck it restricts the normal function of the airways. It can be affected by various factors, including age, lifestyle, disease, and change in posture, that can interfere with its normal functioning [1, 2]. They may also advise you to see a physical therapist. 2, pp. In most cases Physiopedia articles are a secondary source and so should not be used as references. Stand upright with the feet shoulder-width apart. Text neck tightens muscles and their supporting ligaments and tendons in the front of your neck, and at the same time lengthens the muscle structure at the back of your neck. Push your head forward until you feel the stretch through your throat. [8], Risk factors associated with forward head posture include female gender, older age, being an ex-smoker, high job demands, and low social or work support.[8]. For example, a posture brace and taping may help reduce hyperkyphosis. The assumed FHP and torticollis postures decreased the SNIP values compared to the normal upright sitting. 471479, 2011. Do 20 to 30 reps at once. Can Large Breasts Cause Pain in Your Upper Back? It decreased significantly during induced right torticollis position. These actions are similar to those of the anterior scalene because the attachment sites (origins and insertions) are located near one another. (2011). 29, no. However, other factors can also lead to FHP. This causes the soft tissues of the throat to be tightened, restricting the ability for air to pass. Decreased range of motion of cervical spine, Early disc degeneration and osteophyte formation, Temporomandibular joint pain and inflammation, Increase in dorsal kyphosis and decrease in height, Decrease in vital capacity and range of motion of shoulder and arm, Possible protrusion of nucleus pulposus and nerve compression, Mobility impairment in the muscles of the anterior thorax (intercostal muscles), muscles of the upper extremity, Impaired muscle performance due to stretched and weak lower cervical and upper thoracic erector spinae and scapular retractor muscles (. All Rights Reserved. Hold for Can poor sleep impact your weight loss goals? The syndrome is often a result of poor, Upper back pain between the shoulder blades has many potential causes, including stress, injury, muscle strain, and underlying conditions. 2023 Dotdash Media, Inc. All rights reserved. 2017 Jun;29(6):1043-1044. doi:10.1589/jpts.29.1043. But youll still need to be diligent about maintaining a goodposture. 2, pp. G. R. Melam, S. Buragadda, A. Alhusaini, M. A. Alghamdi, M. S. Alghamdi, and P. Kaushal, Effect of different positions on FVC and FEV1 measurements of asthmatic patients, Journal of Physical Therapy Science, vol. During upright sitting, SNIP was measured using MicroRPM device (MicroRPM, Micro Medical, Ltd., Kent, UK) [13]. 455-456, 2016. The overall prevalence of neck pain in the general population is high, reaching 86.8%. There was no association between the SNIP scores, age, or BMI. Axial Spondyloarthritis Exercises for Pain Management, Improving Posture With Ankylosing Spondylitis, At-Home Exercises and Physical Therapy for Calcific Tendonitis, Tilted Pelvis: Symptoms, Treatments, Causes, and Distinctions, Exercises You Should Avoid If You Have Neck Arthritis, 5 Posture Training Exercises to Reduce Pain and Sagging, Exercises for Foot and Ankle Injury Recovery, Causes of Neck Pain and Treatment Options, Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion, Effect of forward head posture on thoracic shape and respiratory function, Effects of forward head posture on static and dynamic balance control, Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial, Cervical exercise: the backbone of spine spine treatment, Effects of pulling direction on upper trapezius and rhomboid muscle activity, Chest stretches: 5 chest stretch variations, Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture, Exercise therapy for office workers with nonspecific neck pain: a systematic review, Nerve issues in the arms and hands (pins and needles, numbness), Tension neck syndrome (neck, shoulder, and joint pain, stiffness, and decreased range of motion, Reduced respiratory function and efficiency.
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