What Is Forward Head Posture?
Forward head posture is a nearly ubiquitous postural adaptation these days. Our posture is the embodied expression of our genetics interacting with all the creative ways our body adapts to the stresses we put on it. Some of those creative postural adaptations have become so common that we’ve given them names. Forward head posture is one of those. In this article, we’ll discuss what forward head posture is, why it’s a concern, and what kind of treatments research is exploring to address it.
Postural patterns
So what does a healthy postural pattern look like? Healthy postural patterns are those that minimize the stress of gravity on the body. When the heavy parts of our body, like our head and our pelvis, are balanced over each other, then we don’t have to use as much muscular effort to hold them up in gravity. But, if for example, our head is way out in front of our pelvis, the muscles that keep our head attached, have to work a lot harder.
Forward head posture
The situation described above is what happens when we’ve acquired a forward head posture. In that pattern, our head is shifted forward (protruded) in front of the shoulder girdle and rib cage. The layers of neck muscles on the front, back, and sides of our neck are out of tensional balance with each other. Some are overly lengthened and strained. Others are short and tight.
Anatomy of a forward head
Keep in mind, that as with any postural pattern, there is more than one way to create a forward head position. However, generally, in forward head posture, the lower cervical spine and upper thoracic spine are flexed. Then the upper cervical spine is extended and the head is hyperextended and protruded forward on the neck.
Specifically, the suboccipital muscles (at the base of the skull) are almost always short and tight in a forward head posture. The upper portion of splenius capitis and the upper trapezius may also be shortened and tight. Additionally, splenius cervicis and the sternocleidomastoid muscles may be long and tight in forward head posture. Muscles that may also be eccentrically contracted and strained include levator scapulae on the back of the neck and the longus colli and capitis on the front of the neck.
Why is forward head posture a concern?
Postural issues anywhere in the body can contribute to dysfunction and pain. Forward head posture is no exception. That particular postural compensation has been associated with neck pain, trigger points, tension headaches, temporomandibular joint disorder, negative effects on static balance, and reduced respiratory function (Kang et al., 2012; Koseki et al., 2019; Yang et al., 2023).
Where does this pattern come from?
Sources of this pattern vary from person to person, however, there are common contributors that many of us experience. Many hours at a computer, looking at a mobile phone, and driving a car can certainly contribute to a forward head pattern. Additionally, no pattern in our body exists in isolation.
All of the patterns we are born with and those that we acquire during our life are in relation to one another. So, although forward head posture and some resulting neck pain might be the postural patterns that are getting our attention, we likely have other patterns lower down in our body that are contributing as well. Forward head posture is one of the creative work-arounds that our body does to orient our eyes to the horizon when our head would be positioned otherwise if we kept it in line with the rest of our spine.
How to work with this pattern
The first step to working with this pattern is to get a full assessment from an appropriate medical professional. A physical therapist, structural integration therapist, or experienced massage therapist can help you better understand your specific pattern. There is variability in each person’s specific version of a forward head pattern. Work with a professional to determine the specifics of your pattern. They can then recommend the most appropriate therapy. Some physical therapy exercises have been helpful in correcting this pattern. Additionally, some types of manual therapies have been helpful as well for reducing the pattern and reducing associated pain.
Once you’ve worked with an appropriate professional to understand and adjust your specific pattern, then it’s important to consider how you’ll maintain a healthy posture. If you work at a desk much of the day, consider how your workstation is set up and whether making some adjustments to your chair, desk, and or computer monitor could support maintaining your head in a more neutral position. Similarly, consider how you sit in a car and what posture you adopt when looking at your smartphone. Being more mindful in all of these kinds of activities can support maintaining a more neutral posture over the long term.
Conclusion
We all have postural patterns. If genetics, activities we do, injuries, etc. lead to structures getting out of balance in our body, we can create creative work-arounds that are not always the most functional in the long term. Sometimes those dysfunctional patterns, like forward head posture, can cause pain and other negative effects. In those situations, we can seek out appropriate medical professionals to assess the pattern and recommend appropriate therapies.
References
Chaitow, L. and J. DeLany. 2011. Chapter 12: The Cranium. In Clinical Application of Neuromuscular Techniques. Volume 1 – The Upper Body (Second Edition). New York, NY: Churchill Livingstone Publishing.
Travell, J.G. and D.G. Simons. 1993. Chapter 5: Overview of Head and Neck Region. In Myofascial Pain and Dysfunction –The Trigger Point Manual. Volume 1.