Forward head posture

    Last updated date: 25-Aug-2023

    Originally Written in English

    Forward head posture

    Head posture

    What is Forward head posture?

    Forward Head Posture (FHP) is a frequent condition in which your head is positioned with your ears in front of your body's vertical midline. Your ears should line up with your shoulders and midline in normal or neutral head position. Because it is caused by prolonged bending toward a computer screen or hunching over a laptop or mobile phone, FHP is also known as "text neck" or "nerd neck." It is also linked to the ageing process's decrease of muscular strength.

    FHP can result in neck pain, stiffness, an uneven stride, and other adverse symptoms. It is also frequently accompanied with rounded shoulders, sometimes known as kyphosis. The good news is that it is typically fixable: stretching and strengthening exercises, together with excellent posture, reduce adverse effects and restore improved posture.


    What causes Forward head posture?

    FHP causes

    Forward head posture (FHP) is frequently caused by hunching over an electronic device or slumping at your desk to stare at a computer screen for extended periods of time. Specific stretching and strengthening exercises, as well as manual therapy by a chiropractor or physical therapist, have been shown in studies to help restore proper alignment of your head and neck and decrease adverse effects. 

    FHP can also be caused by the following factors:

    • Driving bent over the wheel for extended periods of time
    • Occupations that demand you to lean forward, such as stitching
    • Carrying a large backpack
    • Long-term poor posture, such as slouching
    • Sleeping with your head up too high or reading in bed
    • Upper back muscle weakness 
    • Diseases such as arthritis and bone degradation
    • Congenital deformity


    What is the effect of Forward head posture on the muscles?

    Head erect

    Forward head position puts more strain on many of the muscles related to the cervical spine, which is responsible for holding the head erect. Forward head posture can cause muscular imbalances over time as the body attempts to adjust and discover effective ways to hold the head erect for straight-ahead vision. Some muscles grow longer and weaker, while others become shorter and tighter.


    Muscles that become long and weakened:

    The following muscles commonly elongate and weaken as a result of long-term forward head posture:

    • Deep cervical flexors. These muscles, also known as the longus capitus and longus colli, are found at the front of the cervical spine and aid in neck stabilization. When the deep cervical flexors are weaker, the chin tilts away from the neck, a condition known as "chin poking." 
    • Erector spinae. (Upper thoracic and lower cervical) These are extensor muscles that connect to the lower cervical and upper thoracic spines. The erector spinae are responsible for spinning and straightening the spine. The erector spinae muscles become less capable of maintaining the neck and upper back from hunching forward as they lengthen and lose strength. 
    • Shoulder blade retractors. The rhomboid and middle trapezius muscles in the upper back assist in bringing the scapulae (shoulder blades) rearward to maintain the shoulders back and chest open in proper posture. Weakening of the trapezius and rhomboid muscles causes the shoulder blades to slant forward, resulting to hunched shoulders and forward head posture.

    These are the muscles that may need to be addressed for and reduce neck discomfort. Depending on the patient's unique demands, different muscles may need to be developed to assist minimize forward head and rounded shoulder posture.


    Muscles that become short and tightened:

    These are the muscles that frequently shorten and stiffen as a result of prolonged forward head posture:

    • Suboccipital muscles. These four tiny muscles that link the bottom back of the skull to the top of the cervical spine aid in head rotation and extension. During forward head posture, these muscles work extremely hard and constantly contract to maintain the head inclined up and facing straight ahead.
    • Chest muscles.  And the upper back muscles lengthen as the shoulders curve forward, the chest muscles may shorten and tighten. The pectoralis minor muscles, which are a pair of tiny triangle muscles in the top region of the chest, are one example.
    • Levator scapulae muscles. This set of muscles runs along the back and side of the neck, from the top cervical spine to the shoulder blade (scapula). The levator scapulae muscle is important for raising or elevating the scapula, as well as assisting with other neck motions. The levator scapulae muscles may get shortened if the shoulder blade begins to tilt forward and rotate up with rounded shoulders.

    Stretches to relieve neck pain and improve forward head posture frequently target these muscles. Many more muscles may be shortened or lengthened as a result of forward head position, and the precise muscle imbalances may vary depending on the circumstance.


    How Forward head posture affects your health?

    Neck traction

    FHP can alter the muscles that support your head in your upper back, neck, and shoulder. When your posture is off, these muscles and connective tissue might get overworked. Muscle length and strength are altered as a result of this. The muscles at the front of your neck get shorter and weaker, while those in the rear lengthen and tighten. FHP also has an impact on the nerves, tendons, and ligaments that connect to those muscles.

    A healthy cervical spine has a natural lordotic curvature that softly bends forward from the base of the head to the top of the chest/upper back. When the head sags forward due to bad posture:

    • The lordosis curve flattens out when the lower cervical spine hyperflexes.
    • The upper cervical spine hyperextends, with the lordosis curve becoming more prominent.

    This unusual forward placement of the head and cervical spine puts additional strain on the intervertebral discs, vertebrae, and facet joints, thereby exacerbating or hastening spinal degeneration. Furthermore, when the cervical spine's bottom hyperflexes forward and the top hyperextends in the opposite direction, the spinal canal lengthens through the neck, increasing strain and tension on the spinal cord and adjacent nerve roots.


    Effect of forward head posture on lower neck vertebrae:

    Forward head position is most painful in the bottom section of the neck, directly above the shoulders. The lower cervical vertebrae, which include C5, C6, and C7, already bear the majority of the strain from the weight of the head. This weight rises when the head is held more forward.

    According to several research, the compressive pressures rise the highest at the C4-C5 and C5-6 spinal levels with forward head position. The intervertebral discs and facet joints at these levels of the spine may be subjected to extra shearing pressures when the vertebrae are moved in different directions relative to one another, as well as recurrent injuries that can produce pain and other symptoms.

    While forward head position places more strain on the lower cervical spine, it should also be remembered that compressive forces are raised on all discs and joints throughout the cervical spine. Furthermore, the precise cervical levels that suffer the greatest rise in compressive stresses might differ between individuals.


    Forward head posture and degenerative spinal changes:

    It is common for certain degenerative spinal changes to develop as the body ages. However, prolonged forward head position may raise the risk of accelerated degenerative spinal changes, such as:

    • Disc degeneration.  Intervertebral discs are vital in cushioning neighboring vertebral bones and allowing for spinal motion. Discs must perform more work and may degrade sooner when subjected to increased loads and shearing stresses between neighboring vertebrae. In certain situations, the disc's outer layer (annulus fibrosus) wears away, allowing the inner layer (nucleus pulposus) to seep out, containing inflammatory proteins that can cause pain and swelling if they come into touch with nerve roots or other surrounding tissues (called a cervical herniated disc).
    • Wearing down of facet joints. Small facet joints at the rear of each spinal level allow for limited movement between neighboring vertebrae. When these joints are subjected to larger pressures and repeated injuries, the protective cartilage that allows these bones to move smoothly might wear down. Cervical osteoarthritis occurs when cartilage within a cervical facet joint begins to deteriorate. 
    • Bone grinding against bone. As the discs and/or facet joints deteriorate, the spinal bones are more prone to scrape against each other, resulting in bony overgrowths known as bone spurs (osteophytes). Nerves, ligaments, muscles, and other tissues can be irritated by bone spurs.

    Degeneration of the cervical intervertebral discs is frequently accompanied with degeneration of the cervical facet joints. Typically, when a disc degenerates, the adjacent facet joints get overloaded and degenerate as well. Similarly, when a facet joint degenerates, the discs neighboring may be subjected to greater pressures.


    Pain and stiffness:

    Excess tension and pressure on the neck muscles might result from the extra pressure. This, in turn, can cause neck muscular pain and stiffness. People may encounter:

    • Anterior neck pain: Increased tension in the muscle above the hyoid bone can cause pain or stiffness at the front of the neck.
    • Myofascial trigger points and headaches: FHP puts more strain on the higher cervical spine muscles. Cervicogenic headaches can result from this.
    • Temporomandibular joint disorders: FHP causes muscular tension above the hyoid bone. As a result, the muscles near the mouth are put under more strain.


    Rounded shoulders and upper back:

    According to the National Academy of Sports Medicine (NASM), FHP can induce rounded shoulders and upper back. Furthermore, it can affect the movement patterns of the scapula, or shoulder blade, and the humerus, or long arm bone, resulting in a condition known as scapular dyskinesis.

    Upper crossed syndrome is a condition that occurs when a person has FHP with rounding of the shoulders. The rounding of the shoulders also puts additional strain on the lower back, increasing the likelihood of ruptured discs. These consequences culminate in "tension neck syndrome," characterized by pain that is frequently indistinguishable from tension headache.


    Respiratory issues:

    A 2019 study found that FHP can impair a person's breathing. According to the study, FHP can cause the upper chest to grow while the lower chest contracts. This shape shift may interfere with normal breathing. The above study, however, has limitations because it only included 15 male volunteers from one university.


    Balance issues:

    FHP may interfere with equilibrium. Participants in one research worked on computers for more than 6 hours each day. According to the study, individuals who had FHP, as a result, were more off balance than others. According to the researchers, the findings may assist give future advise on avoiding or curing FHP.


    Other effects:

    Other short-term consequences of forward head position are:

    • Kyphosis (excessively rounded shoulders)
    • Muscle spasms 
    • Chronic weariness
    • Restricted breathing
    • Temporal mandibular joint (TMJ) dysfunction
    • Insomnia
    • Sleep apnea 
    • Arm and hand numbness and tingling

    Long-term consequences of "nerd neck" include:

    • Reduced shoulder mobility
    • Osteoporosis (and related fractures)
    • Cervical spine arthritis
    • Bulging Discs


    How Forward head posture is diagnosed?

    Head diagnose chart

    When bad posture causes neck pain, a doctor or other health professional may make a diagnosis based on a physical exam and the patient's medical history. Forward head position may be assessed as part of the physical exam to quantify the severity of the disease and to provide a baseline for monitoring future improvement.

    The following are two of the most prevalent methods for evaluating forward head posture:

    • Ruler measurement. The patient stands with his or her back to a wall, and the practitioner uses a ruler to measure how far the back of the head is from the wall. There is no forward head posture if the head hits the wall when standing up straight. The larger the distance between the head and the wall, the higher the degree of forward head position.
    • Craniovertebral angle measurement.  This method includes measuring the forward-facing angle generated by a horizontal line and a line that travels up to the ear at the base of the neck. While more difficult to measure, several studies have discovered that the craniovertebral angle is a particularly valuable parameter that more closely correlates to neck pain and other symptoms associated with forward head position.

    There are other more metrics for assessing forward head position that is less widely utilized.


    How Craniovertebral angle is measured?

    From a person's side, the craniovertebral angle can be seen as follows:

    1. The doctor draws a fictitious horizontal line through the C7 spinous process, which is the rear of the vertebra at the base of the neck.
    2. The doctor then draws a second imaginary line from the C7 spinous process to the tragus, the pointed area in front of the earhole.
    3. The craniovertebral angle is formed when these two lines intersect at the C7 vertebra.

    A photogrammetry is a prominent approach in clinical practice for measuring the craniovertebral angle. This procedure entails taking a lateral shot of the patient (from the side) and then analyzing the photo using software to compute the craniovertebral angle. Small adhesive markers are often put on the patient in a few crucial places, such as the tragus and the C7 spinous process, before utilizing photogrammetry to quantify the craniovertebral angle.

    There are also different ways for determining the craniovertebral angle, such as utilizing a lateral radiograph (x-ray). Photogrammetry does not use radiation, making it better to radiography in terms of reducing radiation exposure.


    Craniovertebral angle interpretation:

    The craniovertebral angle measures the tragus of the ear relative to the base of the cervical spine (C7 spinous process) as the head moves forward. The more extreme the forward head position, the lower the craniovertebral angle.

    There is still no agreement on what constitutes a normal vs pathological craniovertebral angle. According to a study of the medical literature, forward head position is defined as a craniovertebral angle of fewer than 50 degrees while standing.

    While the patient is seated or standing, the craniovertebral angle can be assessed. According to some studies, measuring the craniovertebral angle when standing may yield a more relevant result since genuine forward head position is less evident when sitting.


    How Forward head posture is treated?

    Body flexibility

    It is important to note that what is considered normal head posture for one person may be significantly different for another person. Unless pain or other symptoms are present, it is typically not advisable to diagnose or treat a perceived forward head posture. In cases where forward head posture and pain have developed due to poor postural habits, a combination of the following may help to correct it.

    Exercise regularly. Exercises that focus on strengthening weak muscles and extending tight muscles in the neck, chest, and core help educate the body to retain a more upright position. In the beginning, it may be beneficial to consult with a physiatrist, physical therapist, chiropractor, or other skilled health practitioners who can build an exercise program tailored to the patient's unique needs.

    Maintain good posture. Remembering to exercise proper posture throughout the day, whether eating, commuting, performing at work, or watching a performance, can help alleviate stress on the cervical spine over time.


    Useful Neck Exercises:

    Neck exercises are a typical component of practically any neck pain therapy strategy. A normal neck exercise program will include stretching and strengthening exercises, cardiovascular conditioning, and maybe trigger point activities.

    Neck stretches

    Flexibility and stretching exercises can help to increase or maintain range of motion and suppleness in afflicted cervical (neck) joints, relieving stiffness that comes with pain. Neck stretching is best done every day, and some stretches can be done many times each day.

    Neck strengthening

    Specific strengthening activities can assist maintain good posture, which can reduce or eliminate pain flare-ups. Neck strengthening exercises should be performed every other day as a general rule to allow muscles to heal themselves.

    Aerobic conditioning

    Aerobic exercise, sometimes known as "cardio," is driven by a constant intake of oxygen and maintains the heart rate and breathing levels up throughout the session. Aerobic workouts enhance blood flow to the muscles and soft tissues of the neck and upper back, which can aid in muscular relaxation and range of motion. Furthermore, after 30 minutes or more of aerobic activity, the body's natural painkillers, known as endorphins, are released, which can help relieve neck pain.

    Aerobic exercise may be done on a daily basis. A treadmill, stationary cycle, or elliptical machine, as well as an upper body ergometer or arm bike, are all terrific possibilities. Going for a brisk stroll might be a nice place to start for someone who hasn't done any cardiovascular fitness in a while.


    Modify your workplace ergonomics:

    It is frequently necessary to consider workplace ergonomics as part of the treatment and prevention of neck pain. Perhaps the arrangement of the desk, computer display, and/or keyboard can be altered to promote better upper back and neck posture.

    Looking straight ahead when sitting erect at a computer workstation:

    • Direct your gaze to the upper third of the computer screen.
    • When typing, keep your forearms horizontal to the floor.
    • Keep your elbows to the side.
    • Feet should lie level on the floor, with thighs parallel to it.

    If any of these positions are impossible to attain owing to the workstation configuration, a modification must be made. For example, if the eyes do not naturally glance at the top third of the computer screen while facing straight ahead, the display may need to be elevated or lowered, or the chair's height may need to be adjusted.

    If a person works at a standing desk or does various types of sitting or driving, be sure that one side of the body is not continually rotated more than the other. In both static and repeated jobs, having as much symmetry as feasible is advantageous.

    Consistent movement to one side, as well as persistent rotation of the neck and back to the same side, can irritate joints and soft tissues, resulting in neck and back pain. Bad posture of the head, neck, and shoulders can also be developed as a result of repeated occupational duties and/or poor seating habits.

    It might be difficult to break long-held bad posture habits. Setting automated reminders to check posture, such as with a phone or computer app, may be helpful when first starting off. People in sedentary professions may benefit from setting reminders to get up and walk about at least once an hour rather than keeping the neck stationary for lengthy periods of time.



    Forward head posture

    When a person has good posture, their head is vertically aligned with their spine. Forward head posture (FHP) is when a person leans forward, out of neutral alignment with their spine. When the head is misaligned, it can create a range of concerns, including neck discomfort, pain, and balance disorders.

    Because of the increasing popularity of media devices such as cellphones and laptops, regular users frequently demonstrate poor posture. Forward head posture (FHP) is a bad habit of the neck. Upper Crossed Syndrome frequently coexists with it.

    The following are possible side effects of forward head posture:

    • Chronic neck pain 
    • Tight neck muscles 
    • Decreased range of neck motion
    • Headaches
    • Back pain 
    • Jaw pain in the temporomandibular joint 
    • Numbness and tingling in arms and hands 
    • Decreased balance control 
    • Muscle spasms

    Stretching and exercise can help relieve pain and restore correct posture. Fixing FHP necessitates paying attention to your posture and continuing to stretch and do particular exercises throughout the day.