Forward head posture (FHP), also known as anterior positioning of the cervical spine. FHP is a misalignment of the spine that is most prominent in the neck. There can be times when it is noticeable because the head will not be aligned to the spine and the neck will be pulling forward. The neck pulling forward can cause symptoms that includes headaches, muscle fatigue, weakened strength, lower back pain, limited motion, and more because of the way the body is all connected. However, there are treatments, which include stretches, that can be done at home.
The muscles involved in forward head posture includes mainly the back, neck, and shoulder muscles. The muscles involved are the cervical flexor muscle, midthoracic rhomboid muscle, middle and lower trapezius muscles, pectoralis major, and neck extension muscles^(3,7). However, because every part of the body is connected, forward head posture does affect other muscles and causes the pain to radiate to other areas.
Muscles involved specifically in the neck area
People who have flat feet have a greater chance of getting plantar fasciitis without proper prevention and care, such as wearing arch supports or wearing the correct shoes. Flat feet can cause the plantar fascia to do more work and so causing it to over pronate^(8). This would lead to the misalignment of the joints such as the knees and hip joints. When there is a misalignment, the muscles will adjust posture and so the muscles of the back will try to accommodate for the over pronation of the feet, leg muscles and lower back muscles not being able to pull the joints in its proper alignment, leading to forward head posture ^(9).
In “a 2013 study conducted at the University of Colorado showed that computer workers with a higher level of stress increased their neck extension and tightness in the upper trapezius more than those with a lower stress level^(6).” This shows that a cause of forward head posture is stress. Stress causes tension in the neck, shoulder, and the back causing the muscles to work more and can become stiff. The stiffness can cause muscles to be fixed in a certain posture, which can lead to forward head posture.
Sitting posture is a major cause of forward head posture because many people don’t have the correct posture. Sitting in the correct posture takes practice and time for the body to be conditioned to it. When people try to sit with upright posture, they can feel uncomfortable so are not able to hold it for a long period of time. However, the body was not made to sit hunched despite it feeling more uncomfortable to sit with proper posture.
This study showed that “thoracic upright sitting when compared to lumbo-pelvic sitting was associated with increased thoracic extension and decreased head/neck flexion with a trend towards posterior translation of the head^(2).” This means that the thoracic upright sitting can lessen the forward pulling of the neck, thus decreasing forward head posture.
Forward head posture affects and limits certain activities.
When the head is being pulled forward, there is a lot of strain the muscles have try to balance in order to not be overworked or overstretched. “For every inch that […] head protrudes, [there are] 10 additional pounds of force upon [the] neck^(6).” This really illustrates how much pressure is being put on the neck when the head is protruded out of proper alignment with the shoulders and spine. This is due to the muscles needing to support the head. Because of the imbalance, it makes it harder for the muscles to really pull back the head. The muscles want to pull back the head in order to minimize the pain that is felt, however, this causes the muscles to be weakened.
The weakening of the muscles is due to the shortening of the muscles. The muscles shorten in order to minimize the pulling of it from the head’s weight. Because the length is shortened, the muscles range in motion will decrease^(5).
There are other posture problems that forward head posture could lead to. It is found that “FHP, head-on-trunk misalignment, leads to increased lordosis of the lower cervical spine as well as rounded shoulders accompanied by increased kyphosis of the thoracic spine^(5).” Lordosis is when the lower spine is curved inwards while kyphosis of the thoracic spine is when the upper back becomes curved.
The different conditions of the back
Forward head posture can also lead to a decrease in proper functioning of the respiratory system due to the slouching, which encloses the lungs. The muscles that are involved with proper respiratory system are the sternocleidomastoid muscle, scalene muscles, pectoralis major, and the thorocolumbar ES muscle. Due to slouching and the muscles trying to support other areas of the body, such as the head, the muscles collapse into the respiratory system preventing full capacity of breath intake of the lungs ^(7). So, leading to shortness of breath and feeling breathless faster.
Forward head posture is “associated with muscle imbalance, pain, fatigue, and limited motion of the cervical spine. FHP may cause herniated cervical intervertebral discs and other adverse effects, such as chronic low back pain and temporomandibular disorder^(1).” Forward head posture is the number one cause for temporomandibular disorder. This is a disorder that involves the jaw and is caused by forward head posture because the way the joints are attached to the skill that is in front of each ear^(11). This causes the jaw to not be able to function correctly.
Pilates is an exercise that is designed to improve physical strength, flexibility, and posture. “Pilates exercise […should result] in a subsequent decrease in neck and shoulder pain, which may inhibit potential headaches ^(1).”
At Home Exercises
The reliability of at home exercises are proven by a study that shows the “[significant statistical] difference between pre-test and post-test measurements for neck angel, shoulder distance, head distance and HScal distance,” of easy to do at home exercises that were tested. This shows how these exercises were effective in realigning the head to a normal position. These exercises, if continued frequently can treat forward head posture.
The overhead thumb press^(6) will work out the shoulders and back.
Chin Tucks will help practice the neck muscles to readjust to neutral position and prevent the muscles being stuck.
Shoulder blade touches will help open up the respiratory system and open up the lungs for better breath intake.
For people who work all day in front of the computer, to prevent forward head posture, “correct posture and breaks of at least 20 minutes are [recommended]^(3).” This also applies when using smartphones. Take the 20-minute break to stretch the neck, shoulder, and back muscles while not slouching to prevent the muscles to be conditioned to the same hunched posture. It can be difficult in the beginning if the body has been trained so long to sit in a slumping position, however, if this is practiced frequently, it will get easier and posture can be improved.
1. Sun-Myung Lee, et al. “Clinical effectiveness of a Pilates Treatment for Forward Head Posture.” Journal of Physical Therapy Science, vol. 28, no. 7, July 2016, pp.2009-2013. EBSCOhost. Accessed 20 April 2016.
2. Joao Paulo Caneiro, et al. “The Influence of Different Sitting Postures on Head/Neck Posture and Muscle Activity.” Manual Therapy, vol. 15, no.1, Feb 2010, pp.54-60. ScienceDirect. Accessed 20 April 2017
3. Kim, Seong Yeol, and Sung-Ja Koo. “Effect of Duration of Smartphone Use on Muscle Fatigue and Pain Caused by Forward Head Posture in Adults.” Journal of Physical Therapy Science, vol. 28, no. 6, 28 Jun 2016, pp. 1669-1672. National Center for Biotechnology. Accessed 20 April 2017.
4. Katherine Harman, et al. “Effectiveness of an Exercise Program to Improve Forward Head Posture in Normal Adults: A Randomized, Controlled 10-Week Trial.” Journal of Manual & Manipulative Therapy, vol. 13, no. 3, 18 Jul 2013, pp. 163-176. Taylor & Francis Online. Accessed 23 April 2017.
5. Kyeong-Jin Lee, et al. “The Effect of Forward Head Posture on Muscle Activity During Neck Protraction and Retraction.” Journal of Physical Therapy Science, vol. 23, no. 3, Mar 2015, pp. 977-979. National Center for Biotechnology Information. Accessed 23 April 2017.
6. NG, Nick. “How to Fix Forward Head Posture with Exercise.” Livestrong.com, Livestrong, 4 Aug 2010. Accessed 23 April 2017.
7. Jintae han, PT, et al. “Effects of Forward Head Posture on Forced Vital Capacity and Respiratory Muscles Activity.” Journal of Physical Therapy Science, vol. 28, no,1 30 Jan 2016, pp. 128-131. National Center for Biotechnology Information. Accessed 4 May 2017.
8. “Plantar Fasciitis-Topic Overview.” WebMD, WebMD, Accessed 9 May 2017.
9. Patterson, James. “Flat Feet & Back Pain. “LIVESTRONG.COM, Leaf Group, 15 November 2010. Accessed 9 May 2017.
10. Mark. “Forward Head Posture Correction.” Posture Direct, 2 Feb 2017. Accessed 9 May 2017.
11. Salmeri, Jeff. “Bad Posture Can Cause Temporomandibular Disorder.” Dynamic Dental. 7 Jun 2012. Accessed 23 April, 2017.