Forward head posture. It is easy to spot and you probably know several people who have it (hopefully you’re not one of them).
Forward head posture is very common.
Forward head posture is when your head sits forward of a vertical line drawn up from your ankle. Ideal posture is when that gravity line goes from the front edge of your ankle, through the middle of your knee, middle of your hip, middle of your shoulder, and through the front edge of your ear as shown below:
Correct Functional Posture
Self-Test
You can do this simple test to find out if you have forward head posture. Stand with your heels and shoulder blades touching a wall or door and relax. Is your head touching the wall without you having to pull it back? If your head is off the wall at all, you have forward head posture.
You can do this simple test to find out if you have forward head posture. Stand with your heels and shoulder blades touching a wall or door and relax. Is your head touching the wall without you having to pull it back? If your head is off the wall at all, you have forward head posture.
Forward head posture has been an issue for years (evidenced in books like “Body Mechanics and Health" originally published in 1922) and seeing normal head position today is becoming more and more uncommon. From classrooms to red carpets, retirement homes to professional athletic fields, forward head postures are the norm.
Forward head posture can cause many problems like headaches, neck pain, shoulder and upper back pain, breathing issues, difficultly sleeping, TMJ and even depression.
The book Body Mechanics and Health published in 1922 explains how forward head posture affects the diaphragm, stomach, and liver:
The stomach and liver are attached to the diaphragm, and the suspensory ligament of the diaphragm is the pericardium, especially of the right side, which finally attached to the anterior part of the lower cervical spine. Because of this anatomic make-up it is possible by simply correcting the position of the head, to raise the diaphragm, stomach, and liver one inch or more. If the diaphragm is lowered as a result of the habitually forward position of the head, the movement of the diaphragm in respiration must be less than normal. The effect of this upon the breathing, as well as upon the circulation, especially in the large abdominal veins, to say nothing of the function of the other organs, must be apparent.
You have to remember that the head is balanced on top of everything below it, so forward head posture is caused by things like kyphosis, hinged shoulders, swayback posture and pelvic tilt imbalances. These imbalances not only cause pain and limitation, but kyphosis has now been linked to an increased rate of death due to atherosclerosis!
At Oregon Exercise Therapy we always look at the body as a unit and do not just focus on the symptom. We know that forward head posture often starts with pelvic imbalance. An anterior pelvic tilt puts excessive compressive stress in the lumbar spine and the upper back will round forward to ease the pressure. This rounding when severe is called kyphosis. Kyphosis can cause back pain, neck pain, thoracic outlet syndrome, breathing problems, digestive problems, chest pain, cardiac and pulmonary problems including eventual pulmonary and/or heart failure. This anterior-kyphotic posture can be seen below:
Anterior-kyphotic posture - Kendall
Forward head posture can also be caused by the pelvis tilting the opposite way. A posterior pelvic tilt flattens the lumbar spine which causes the thoracic spine to flex excessively into a kyphotic posture also. This loss of the normal lumbar curve can cause lower back pain, disc herniations, nerve impingement's, degenerative disc disease, and degenerative hip joints or osteoarthritis of the hip. This posture is shown below:
Posterior pelvic tilt, flat lumbar spine and kyphosis - Kendall
At OET we see one more major postural imbalance that can cause forward head posture. Swayback posture is when the hips are forward of the ankles instead of sitting directly above them. This causes the upper body to lean backwards to counterbalance the hips moving forward. The head then moves forward in response to the rest of the body as seen below:
Swayback posture causing forward head - Kendall
Forward head posture is also very influenced by bad sitting posture which creates kyphosis and rounded shoulders pushing the lower cervical spine into flexion and the upper cervical spine into hyperextension. Bad sitting posture is not caused by poor ergonomics and cannot be fixed by a new chair, better computer setup, or any other piece of equipment. Poor sitting posture is a reflection of your muscular imbalances and faulty movement patterns, but can be corrected. The spinal curvature changes can lead to muscle tension, spasm, and pain. The cervical spine alignment imbalances create an environment where cerebral spinal fluid, nerves, lymphatic fluid, blood flow, and air can become restricted and impeded. Cervial flexion can lead to spinal disc herniation. Cervical hyperextension can lead to degenerative disc disease and spondylolisthesis. Besides neck and upper back pain, this can lead to a magnitude of problems including tension headaches and migraine headaches and temporal mandibular joint dysfunction (TMD).
 Bad sitting posture |  Lower cervical flexion and upper cervical hyperextension. |
Forward head posture can be fixed. The treatment must look at the true underlying cause of forward head posture. Treating your neck without looking at the rest of your body will not have any longterm positive effects. Correcting postural imbalances in your pelvis, spine, and shoulders with Postural Alignment Therapy will result in normal head posture and a freedom from pain and symptoms.
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