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When a person maintains good posture, their head aligns vertically with the spine. Forward head posture (FHP) occurs when a person is leaning their head forward, out of neutral alignment with their spine.

When the alignment of the head is off, it can cause a variety of problems, including stiffness in the neck, pain, and balance issues.

In this article, we look at what FHP is, how it occurs, and what treatment options are available.

The National Academy of Sports Medicine (NASM) define FHP as holding the head out, in front of its natural position over the cervical spine. A person with FHP also typically tilts their head back in order to look forward.

This posture puts a strain on the muscles and bones of the neck. It can also lead to muscle imbalances, as some muscles support more of the load than others.

According to a 2014 study, the forward position of the head puts increasing amounts of weight pressure on the spine.

The study found that the head weighs about 10–14 pounds (lb) in a neutral spine position but increases in weight as it leans forward:

Position of the head Weight of the head
15 degrees 27 lb
30 degrees 40 lb
45 degrees 49 lb
60 degrees 60 lb

According to a U.S. National Library of Medicine clinical trial design, the muscles that FHP weakens and lengthens include:

  • deep neck flexors, including the longus capitis and longus colli
  • scapular stabilizers and retractors, such as the rhomboids, middle and lower trapezius, teres minor, and infraspinatus

The muscles that become shortened and overactive include:

  • deep upper cervical extensors, such as the longissimus capitis, splenius capitis, cervical multifidus, and upper trapezius
  • shoulder protractors and elevators, such as the pectoralis minor, pectoralis major, and levator scapula

With exercise and stretching, a person can reverse FHP and hold their head in a neutral position, in alignment with the spine.

People may associate FHP with using electronic devices for a long time, such as cell phones or computers.

However, any activity that causes a person to lean their head forward for a prolonged period of time can lead to chronic FHP.

Some potential causes of FHP include:

  • slouching
  • sleeping with the head raised
  • carrying a heavy backpack or purse
  • driving with a hunched back
  • sewing
  • reading in bed
  • whiplash or other injuries to the spine
  • weakness in the muscles of the upper back
  • arthritis and bone degeneration

There are several potential side effects and symptoms associated with FHP.

Pain and stiffness

The extra pressure on the neck muscles can cause increased strain and pressure. This in turn can cause pain and stiffness in the neck muscles.

People may experience:

  • Anterior neck pain: The increased tension in the muscle above the hyoid bone can lead to neck pain or tightness at the front.
  • Myofascial trigger points and headaches: FHP increases the load on the muscles in the upper cervical spine. This can cause cervicogenic headaches.
  • Temporomandibular joint disorders: FHP creates tension in the muscles located above the hyoid bone. This results in a greater demand on muscles that are near the jaw.

Rounded shoulders and upper back

The NASM note that FHP can cause a person to develop rounded shoulders and upper back.

Additionally, it can impact the movement patterns for the scapula, or shoulder blade, and the humerus, which is the long arm bone, resulting in a condition called scapular dyskinesis.

If a person experiences FHP and rounding of the shoulders, healthcare professionals refer to this as upper crossed syndrome.

Learn more about upper crossed syndrome here.

Respiratory issues

According to a small 2019 study, FHP can negatively affect a person’s breathing.

The researchers note that FHP can cause the upper chest to expand while the lower chest contracts. This change in shape can interfere with regular breathing.

However, there are limitations to the above study, as it consisted of only 15 male participants from one institution.

Balance issues

FHP may affect balance.

The participants of a 2012 study worked with computers for over 6 hours per day. The study found that those who developed FHP as a result were more off balance than others.

The researchers indicate that the findings may help provide guidance on preventing or correcting FHP in the future.

There are several potential treatments that a person can try at home, along with medical interventions.

A person who works using a computer or other devices can practice sitting upright and keeping their neck in a neutral spine position. This means ensuring that the ears are in line with the shoulders.

A doctor may recommend physical therapy.

Poor posture can lead to postural kyphosis. If this is severe, doctors may recommend surgical intervention.

In some cases, a person may find that pain medications may be helpful in reducing pain. A person may want to speak with their doctor about muscle relaxants or prescription-strength medications for severe pain.

A person can also incorporate exercises and stretching into their daily routine to help loosen stiff muscles and joints.

Chin tucks

The NASM suggest several techniques that strengthen and lengthen muscles, including chin tucks:

  1. Stand with the upper back against the wall, with the feet shoulder-width apart.
  2. Tuck the chin in and hold for a few seconds.
  3. Return to the starting position and repeat a number of times.

This can help stretch the muscles in the upper neck.

Supine chin tucks

To do this, a person needs to lie down on the floor, facing up.

They then need to repeat the steps for the regular chin tucks.

Chest stretch

The United Kingdom’s National Health Service (NHS) provide the following instructions:

  1. Stand upright with the feet shoulder-width apart.
  2. Bring the shoulders back and down.
  3. Interlace the fingers behind the back with the palms up.
  4. Draw the shoulders back and down, ensuring that the elbows are straight and that there is no arch in the low back.

If a person sits at a desk for long periods of time, they should focus on maintaining proper posture.

This includes:

  • adjusting the chair to support the lower back
  • ensuring that the knees are a bit lower than the hips
  • placing the feet flat on the floor
  • positioning the screen at eye level
  • ensuring the keyboard is straight out in front and leaving a space of 4–6 inches on the desk to rest the wrists
  • keeping the mouse nearby and using a mouse mat with a wrist pad
  • ensuring objects are within easy reach
  • taking breaks regularly

Additionally, it is advisable for a person to avoid cradling their phone between their ear and neck.

A person should seek guidance from a healthcare professional if they experience continued neck pain or stiffness.

In some cases, doctors can help identify potential causes and recommend new treatment options.

Doctors can also help determine whether there are any underlying conditions causing the FHP. If any exist, doctors can recommend a course of treatment to address the underlying condition. They may also be able to recommend a specialist to provide further help.

If pain or stiffness is disrupting everyday tasks and a person’s quality of life, doctors may prescribe muscle relaxants or stronger pain medication in addition to other therapies.

FHP occurs when a person holds their head out in front of their body, out of neutral alignment with their spine.

People often shift their posture when using cell phones, computers, and other electronic devices. However, other factors can also lead to FHP.

Over time, it can become a chronic posture issue that causes symptoms such as pain and stiffness in the neck and back.

A person can treat FHP with stretching, exercises, and other therapies, including medication and physical therapy.

A person should speak with their doctor if they experience pain or stiffness that affects their daily life. A doctor can help check for underlying conditions and recommend most suitable treatment.

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