What is Forward Head Posture?
Forward head posture (FHP) is a postural variation characterized as the head position being forward relative to the neck and considerably out of alignment with the spine. More specifically, hyperextension of the upper cervical spine (C1-C3) and flexion of the lower cervical Spine (C4-C7).
Forward head posture is common in all ages; from children to older adulthood. With technology playing a huge role today, especially in the workforce, it is proposed that the use of various tech devices cause altered postures, including FHP, and sedentary behaviors. There are other potential causes including: sleeping with a raised head, arthritis and bone degeneration, decreased back muscle strength, and even consistently carrying a heavy backpack.
There may be numerous anatomical events occurring in a person with a significant FHP. First being, the deep neck flexors, and the scapular stabilizers/ retractors may be weak and lengthened. Secondly, the deep upper cervical extensors and shoulder protractors/ elevators may be shortened and overactive. In addition, there may be increased compressive loading on tissues in the cervical spine.
FHP is often coupled with Upper Crossed Syndrome which is a further postural deficit of the neck, shoulders, and upper trunk. This includes the head forward position, an increased curve in the neck and upper back, rounded shoulders, and shoulder blades that stick out or move out of place. This increase in postural deficit severity can affect shoulder mobility and result in shoulder pain and dysfunction.
However, there is controversial research that examines if there is an association between FHP and other musculoskeletal conditions including neck pain, shoulder mobility, headache, masticatory dysfunction, and nerve symptoms. While some note that individuals with existing pain do have deviated posture compared to individuals without pain, it is still unknown if altered postures are the cause of neck and shoulder pain or if the postures developed due to pain avoidance. Studies have examined that even when individuals do remain in a “correct” posture for a prolonged period, it still will eventually cause discomfort. Thus, proposing that it is the sedentary behaviors that cause pain.
Despite the conflicting evidence, it is hypothesized that FHP intervention will help address these conditions. Physical therapy can help with pain management through manual techniques, improve postural alignment, improve joint mobility, and increase the endurance and strength of the musculature that supports the spine and head. Physical therapists can also provide ergonomic advice and education to improve postural corrections in everyday activities such as sleeping, driving, and work positions.
It is important to remember that being in a sustained position for long periods of time is natural for the body to develop pain and tension. So the important takeaway is to keep moving and be mindful of your posture to prevent further posture deficits.
Written by Kennedy Hardemion, SPT
References:
Sheikhhoseini R, Shahrbanian S, Sayyadi P, O’Sullivan K. Effectiveness of therapeutic exercise on forward head posture: a systematic review and meta-analysis. J Manipulative Physiol Ther. 2018;41(6):530-539. doi:10.1016/j.jmpt.2018.02.002.
Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Vol 25.; 2014:277-.
Clinical trial: strengthening and stretching exercise to improve forward head posture and rounded shoulders. HT Digital Streams Limited; 2020.
Weon JH, Oh JS, Cynn HS, Kim YW, Kwon OY, Yi CH. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. J Bodyw Mov Ther. 2010 Oct 1;14(4):367-74.
Page P, Frank CC, Lardner R. Assessment and treatment of muscle imbalance: The janda approach. 2010, Champaign, IL: Human Kinetics.
Christensen SWM, Palsson TS, Krebs HJ, Graven-Nielsen T, Hirata RP. Prolonged slumped sitting causes neck pain and increased axioscapular muscle activity during a computer task in healthy participants – a randomized crossover study. Appl Ergon. 2023;110:104020-104020. doi:10.1016/j.apergo.2023.104020).