What is a Forward Head Posture?
Forward Head Posture (FHP) is a condition where the skull protrudes forward more than an inch over the vertebra (atlas) in the neck on which the head rests. In forward head posture, there is anterior tilting of the cervical spine. For every inch where the head moves forward on the shoulders, the weight of the head increases by at least 10 pounds. Which means that if the weight of the head is 12 pounds, and if the head is titled past the shoulders by about 3 inches, then it puts about 42 pounds of pressure on the cervical extensors and the neck! Such increase in the load/weight to the neck leads to Forward Head Posture (FHP). This causes many problems for the body, such as pain in the neck and shoulders, migraine, jaw pain and cervical spine arthritis… to name a few. The cause of the Forward Head Posture is excessive sitting and misalignment in the pelvis or it can also occur from injuries, such as neck strain or sprain. This leads to a chain reaction in the muscles along with tissue imbalances resulting in forward protrusion or forward tilting of the head.
Causes of Forward Head Posture
Some of the causes of Forward Head Posture include:
- Weakness in the neck muscles can lead to forward head posture.
- Injuries, such as neck sprains and strains.
- Poor or bad sleeping position.
- Incorrect breathing habits.
- Driver's-neck is also one of the causes of forward head posture.
- Repetitive use of/or indulging in TV, computer, video games, texting, gardening and carrying heavy backpacks can also cause forward head posture.
- Rotational athletics where there is dominant use of one side of the body, such as golf, tennis, baseball and hockey can also cause forward head posture.
- Certain movements during work, such as seen in some professions where the risk of developing forward head posture is more, e.g. massage therapists, hair stylists, painters, writers and computer developers.
Signs & Symptoms of Forward Head Posture
When there is increased pressure on the shoulders and neck, this means that the shoulders and neck have to carry the additional burden the whole day leading to isometric contraction of the neck and shoulder muscles. This results in the straining of neck muscles along with decreased blood circulation, pain and fatigue in the neck muscles.
Some of the common symptoms of forward head posture include:
- Forward tilting of the head.
- Chronic pain in the neck, shoulders, upper, lower and middle back.
- Rounded shoulders.
- Temporo-mandibular joint (TMJ) dysfunction.
- Teeth clenching.
- Decreased appetite.
- Pinched nerves.
- Decrease in overall height.
- Decrease in the range of motion.
- Headaches and migraines.
- Myofascial pain syndrome.
- Muscle spasms.
- Numbness or tingling in the hands and arms.
- Tightness and soreness in the neck and chest muscles.
- Insomnia or poor sleep.
- Decrease in the athletic performance.
- Disc degeneration.
- Sleep apnea/mouth breathing.
- Facial pain (Trigeminal neuralgia).
Physical Consequences of Forward Head Posture
- Forward head posture results in lot of physical problems due to the extra pressure on the neck from the altered or weak posture.
- This results in flattening of the normal curve of the cervical spine putting undue strain on the muscles, ligaments, joints and bones of the neck.
- All these factors also cause acceleration in the degeneration of the joints resulting in neck arthritis/degenerative joint disease.
- Additionally, forward head posture is one of the most common causes of tension and pain in the neck, head, shoulders, and spine.
- Chronic or persistent forward head posture also can contribute to disc herniation, myospasm, nerve impingement and osteoporosis.
Physiological Consequences of Forward Head Posture
- Bad posture or Forward Head Posture has a negative effect on all the physiological systems of the body including breathing and production of hormones.
- Bad posture or Forward Head Posture can also cause changes in the mood, pulse, blood pressure and lung capacity.
- There are some cases where there has been decrease in the vital lung capacity by about 30% due to Forward Head Posture.
Muscle Imbalances Associated with Forward Head Posture
Weak and Inhibited Muscles:
- Longus colli muscle.
- Longus capitis muscle.
- Suprayoid and infrahyoid muscle.
- Rhomboids muscle.
- Serratus anterior muscle.
- Lower trapezius muscle.
- Posterior rotator cuff.
- Arm extensors.
Tight and Facilitated Muscles:
- Pectorals (major & minor).
- Levator scapulae.
- Upper trapezius.
- Suboccipital muscles.
- Sternocleidomastoid muscle.
- Latissimus dorsi muscle.
- Subscapularis muscle.
- Arm flexors.
Treatment & Ways to Correct Forward Head Posture
It is important to correct the forward head posture as soon as possible; because if this problem is ignored, then it can cause serious health problems, such as myofascial pain syndrome and degenerative joint disease. Treatment comprises of correcting the imbalances in the muscles by stretching and strengthening the neck muscles, which are causing the forward head posture.
To Correct Forward Head Posture, the muscles which need to be stretched comprise of:
- Upper cervical (capital) extensors: Semispinalis capitis, splenius capitis, longissimus capitis and suboccipital muscles
- Lower cervical flexors. Sternocleidomastoid muscle, medial and anterior scalene muscles.
- Stretching the muscles present in front of the torso, which include pectoralis minor and pectoralis major.
The muscles which need to be strengthened in order to correct forward head posture comprise of:
- Upper cervical (capital) flexors: Rectus capitis anterior muscle, longus capitis muscle and suprahyoid muscles
- Lower cervical extensors: Semispinalis cervicis, splenius cervicis and longissimus cervicis.
- Strengthening of the muscles present in the back of the torso, which include the rhomboid muscle.
Other than this, Treatment for Forward Head Posture also comprises of:
- Stretching and strengthening exercises should also be implemented for the muscles present in the upper body, from the hips to all the way up to the back, chest, neck and head.
- Deep breathing exercises should be practiced as these also help in correcting the forward head posture by relaxing the tense muscles.
- Strengthening of the core muscles should be done.
- The setup of the desk at the office and home should be ergonomically correct to prevent of to help get rid of forward head posture.
- Make sure that correct posture is maintained while working at a desk, driving a car, sitting on the sofa, talking on the phone, reading, texting and when sleeping.
- It is important to avoid the additional stress/load on the neck.
- Focusing on deep breathing, practicing optimal posture and mindfulness is greatly beneficial for the musculoskeletal system thus helps in correcting the forward head posture.
- Corrective exercises combined with myofascial release program also help in reversing the forward head posture and its pain.
Exercises to Correct Forward Head Posture
Given below are some gentle exercises, which will help in correcting the forward head posture. However, it is always better to seek medical consult before commencing any type of exercise.
The following exercises need to be done at least twice a day and should be done for about 15 minutes for each time to achieve maximum benefit.
Forward Head Posture Exercise #1- Neck Release Using Tennis Ball
The following exercise helps in releasing or loosening the tension in the group of muscles, which are located under base of the skull. This particular muscle group is often overactive in individuals who have a forward head posture and can cause symptoms such as headache and dizziness. When these muscles are loosened then the position of the head can be corrected. If there is pain in the neck, then there is a tendency to have tenderness or heaviness in this particular region.
Tennis ball neck release is an exercise done with the use of tennis balls or something of similar shape. It makes a great tool to release the tension in the muscles of this area.
- The ball should be placed under the head such that it presses into the areas under the base of the skull.
- Rotate your head from side to side to so as to put pressure on certain areas.
- If it starts to hurt, then you are doing it on the right area and try to get a solid 5 minutes on this region.
- Repeat on the other side.
- If tennis balls are not available then pressure to the same region can be applied by gently pressing with your thumbs.
- In case there is dizziness or worsening of the pain, then decrease the pressure on the neck.
Forward Head Posture Exercise #2: Neck Stretch
This is another stretching exercise for the neck muscles which can be done by placing the hands at the back of the head and gently pulling the head forwards.
- A stretch can be felt at the back of the neck.
- Hold this for at least 30 seconds.
- Repeat 3 times.
Forward Head Posture Exercise #3: Chin Tucks
After the tight and stiff neck muscles are loosened, then strengthening exercises for the neck muscles should be done for achieving correct position of the head.
- Sit straight and gently tuck your chin in so that it looks like a double chin.
- A gentle lengthening sensation can be felt at the back of the neck.
- Do not move your head up/down.
- Make sure that your eyes and jaw stay level.
- Move the head slowly and horizontally backwards.
- Hold this position 5 seconds and repeat it at least 25 times.
Forward Head Posture Exercise #4: Chin Tuck Against Gravity
- Lie down on your stomach and keep your head off the edge of the bed.
- Gently keep on tucking your chin as mentioned above.
- As the movement is done against the gravity, it puts a greater effort on the neck muscles.
- Hold it for at least for 5 seconds and repeat at least 25 times.
Forward Head Posture Exercise #5: Chin Tuck with Thera-Band
This exercise is similar to chin tuck against gravity, but it is done against a thera-band resistance. Hold the position for 5 seconds and repeat it 25 times.
All the above mentioned exercises if done using proper technique greatly help in developing strong muscles of the neck.
Forward Head Posture Exercise #6 Chin Nods
- These exercises help in strengthening the muscles present at the front of the neck, which are known as deep neck flexors and which work along with the muscles in the back.
- Lie down on your back on a thin pillow which supports the neck and slowly perform the above mentioned chin tuck and follow this with a chin nod as if you are saying 'yes'.
- You can feel a slight stretch at the posterior side of the neck, but there is also a sensation of movement in the front muscles of the neck.
- The important thing to do while doing this exercise is to remain relaxed. There should not be any strain felt in the muscles present in the front of the neck as you do a chin nod. Hold this position for 5 seconds and repeat at least 25 times.
Expanding the Front of the Chest & Shoulders
Forward head posture can cause tightness in the front of the chest and shoulders due to hunching up of the shoulders. The following exercises help in expanding the front of the chest and shoulders.
Front Shoulder Stretch to Correct Forward Head Posture
- Place your hands behind you on a chair.
- Squat down slowly till there is a stretch felt at the front of the shoulder.
- Make sure to keep an upright posture.
- Avoid flaring your elbows out.
- Hold this position for at least 30 seconds.
- Repeat 3 times.
Chest Stretch to Correct Forward Head Posture
- Spread out both of your arms and lean on the door frame when doing forward lunges.
- Repeat this exercise at different angles, which will give you different areas of tightness.
- Hold for at least 30 seconds.
- Repeat 3 times.
Strengthening of Scapula Muscles to Correct Forward Head Posture
- The muscles of the scapula need to be strengthened for preventing the front of the shoulders into rounding forward and becoming tight.
- This can be done by pulling the shoulder blades backwards and downwards.
- Hold this position for at least 30 seconds.
- Repeat three times.
Prevention of Forward Head Posture
- Do not use very thick pillows when sleeping at night. This disturbs the neck alignment when lying down.
- Always ensure that you are maintaining a good posture throughout the day
- When you are walking, walk as if there is a steel bar connected to the back of the head and spine. This helps in keeping the chin tucked in and ensures that you do not lead with your chin.
- Persist in doing the necessary exercises for correcting the forward head posture. Do not be discouraged if you don't see immediate results, as it takes time for this problem to be corrected.