Forward Head Posture Overview

Neck pain is often accompanied by misalignment in the area between your shoulders and head. If you sit at a computer for hours on end, or you drive for a living, you may well be fostering a long-term problem known as forward head posture. Maintaining forward head posture can strain muscles of the neck, leading to pain and even worse neck posture.

Theoretically, your head is in a good alignment with your neck when your ear lines up exactly with the gravity line. The gravity line (also called plumb line) is an imaginary straight line representing the downward pull of gravity. It is used in posture assessments as a reference for noting the positions of body parts and determining the presence of any postural misalignment or deviation. A forward head posture occurs when the head is positioned forward of this gravity line, looking at the body from the side. Forward head posture is considered a deviation because the head varies from that reference line.

Here is a slightly more technical description of forward head posture. This is forward head posture from a clinician’s perspective: "Certain daily activities such as prolonged computer use may increase neck flexion (flexion means bending forward). Usually, the lower part of your neck (called the cervical spine, or c-spine for short) is the area that flexes most. The upper c-spine extends (bends backward) as you lift your head to be able to see."

Forward head posture often results in a strength imbalance between muscles that support and move your neck, shoulders, and head. The muscles in front of your neck may become weak while the ones in the back may become short, tight and strained.

Forward head posture often results from yet another posture issue called kyphosis. Kyphosis is a clinical term for a posture in which your shoulders and upper back round forward. (There are several types of kyphosis.) You may know kyphosis by its less flattering nickname, hunchback.

When the shoulders round forward, as they tend to do after many consecutive hours sitting at a desk, computer or at the wheel, the head is also brought forward. This occurs because the upper back area (called thoracic spine) supports the neck and head. When the thoracic spine moves or changes its position, under most circumstances, your head and neck will follow. Most of the head’s weight is in the front, and this contributes to the forward movement as well. To be able to see, you then lift your head.

Standing and sitting with good posture along with exercises to strengthen your neck may help get you back in alignment. Stretching may also help as neck muscles, in general, can get extremely tight and prevent you from doing your exercises fully. Stretching your neck may also relieve pain.

If your neck gives you a lot of pain, or if you are not sure how to get started with a neck exercise program, consult with your doctor. Your doctor will include a postural assessment as part of your diagnosis because it will likely inform your treatment plan.

You should only work with a qualified practitioner when addressing your forward head posture. Examples are an MD such as a physiatrist, a physical therapist or an athletic trainer or body worker with experience and advanced education in posture and neck issues. Be sure any allied or holistic health provider you work with is in communication with your MD.

Almost all of us are at risk for forward head posture. Computer use strongly encourages rounded shoulders and upper back, and therefore forward head posture; it is a significant risk factor. Driving for a living (or for many hours at a stretch) is another risk factor. Habits such as reading in bed with a pillow propped under your head may also contribute to forward head posture. Doing close work requiring manual dexterity and eyesight acuity can raise your risk, too. If you are a seamstress, an electronic technician, or you have an occupation in which you are positioned similarly, this means you.

And if you regularly carry a significant amount weight in front of your body you may be developing kyphosis which, as we've seen often leads to forward head posture. An example of this is if you tend to carry your child or another load in front of your body. Possessing very large breasts may also increase your risk for kyphosis and forward head posture.