A Pandemic of Forward Head Posture (FHP)

Do you drive, use a mobile phone or laptop? If so, then your head and neck are probably suffering. Click here to learn causes and symptoms of forward head posture, the most common form of head/neck imbalance.

Why are we seeing a forward head posture (FHP) pandemic? Did you know that your head weighs 8-12 pounds (4-6kg)?(1). That’s like carrying a bowling ball perched on your neck all day! So, it comes as no surprise that there’s a FHP pandemic exacerbated by the COVID-19 pandemic. Between lockdowns and work from home (WFH) increased use of mobile phones and laptops has only worsened an existing epidemic of FHP. Chronic FHP can produce neck and back pain as well as other symptoms caused by from the strain of schlepping your head around. This post explains major causes and symptoms of forward head posture (FHP), the most common form of head/neck imbalance. Plus, we’ll explain some relevant neck anatomy to get you oriented. Part 2: Rebalance Your Head and Neck offers some ideas about what you can do to correct and prevent FHP. That post has links to outside resources and an emphasis on exercises you can do to help yourself. Part 3: Exercises to Strengthen Deep Neck Muscles has additional exercises and posture tips to fight FHP and reduce that pain in your neck.

Illustration showing the extra weight your head feels from looking down

The more you look down, the heavier your head feels. This increase in force means you may be carrying more than 50 pounds on your cervical and upper thoracic spine!
Resource (1)

Causes of the FHP (forward head posture) pandemic

Many of us develop chronic FHP because we spend hours every day driving, peering at laptops and other devices, and typing at one-size-fits-none workstations. (2,3) Even children are developing FHP from backpacks, laptops and mobile phones. (4) All this adds up to a modern chronic FHP pandemic. But it’s not just computer users and programmers. Many older professions lead to FHP: artists, craftspeople, hair stylists, massage and physical therapists, shoemakers. Thus, FHP has acquired various nicknames: “scholar’s neck,” “reader’s neck,” “tech neck,” “text neck.” People with autoimmune or other chronic diseases are even more likely to develop FHP. This is especially true of those of us with joint or bone disorders (arthritis, osteoporosis, rheumatoid arthritis, tendonitis) or chronic fatigue. Also, people with a history of whiplash or upper back injury are at risk.

Symptoms triggered by forward head posture (FHP)

Looking down so much can lead from FHP to chronic anterior head syndrome or “chicken head.” That means over-arching the cervical spine and over-flexing the upper thoracic spine in order to keep looking forward. Chronic forward head can pinch nerves, lead to headaches and neck pain, and trigger or exacerbate TMJ (temporomandibular joint) pain (4). Even worse, FHP can create eye strain, bite problems, shortness of breath and snoring. If uncorrected, FHP can progress to vertebral disc herniation, bone degeneration and “dowager’s hump,” a permanent kyphosis (hunchback) deformity.

An example of how Forward head posture can lead to Dowager's hump
An advanced case of dowager’s hump. showing severe kyphosis and chicken head compensation

Depressed stance and stress contribute to the pandemic of forward head posture (FHP)

If that’s not scary enough, forward head posture can itself be a chronic source of stress. It worsens depression and fatigue, reduces lung capacity and drains your life of joy. Especially people who already suffer from mood disorders or chronic fatigue are prone to adopt FHP, which only makes them feel worse.

How you hold your head affects your mood.
Resource (5)

How to tell if you have forward head posture (FHP)

If you start looking, you can easily observe FHP in other people. What’s more, if you pay attention to your own posture, you may catch yourself looking down much of the time. Thus, awareness is the first step towards rebalancing your head and neck. (7) Pay attention as you type at your workstation, read on a tablet or text on your mobile phone and you will quickly see the problem.

How to test if you have forward head posture (FHP)
Here’s an easy test. Get someone to spot you or take a photo. Stand with your back against a wall, buttocks and shoulders touching the wall, heels touching the baseboard, feet hip-width apart and pointing straight ahead. Does the back of your head naturally touch the wall? If not, you have forward head posture (FHP). Can you retract your head back on your neck, chin down, to touch the wall? If not, your FHP is more advanced and may take more time and effort to fix. Resource

If you can, find a physical therapist or exercise coach who is hip to posture issues, and can show you where your posture is off. A good coach can also show you how to do corrective exercise properly to strengthen weak muscles instead of over-strengthening the big superficial neck muscles that are already working too hard.

Some Relevant Neck Anatomy

Why the neck is so complex

The neck connects our major sensory organs (nose, tongue, ears, eyes) and the brain to the rest of the body. So, that means our flexible and narrow necks contain many complex anatomical structures. Squeezed into this slender space are the spinal cord, vagus and other nerves, plus large blood vessels. Therefore, many layers of muscles and tendons support the highly mobile sensory functions of our heads. These muscles attach to the ribs and clavicles, the seven cervical vertebrae, the skull and the free-floating hyoid bone that anchors the tongue. Clearly, these complex structures enable an astonishing variety of movements, like nodding and shaking, tilting, extending and flexing. The neck is a key component of ballet, belly and jazz dance moves, as well as head-banging (not recommended!).

More about neck anatomy

Neck anatomy is very complex and these pictures only provide a few highlights related to FHP. See below for two links (8, 9) to more detailed discussions and illustrations of neck anatomy (many sub-links to explore), especially as it relates to FHP. In addition to the term FHP, you may see bodybuilders, trainers and exercise physiologists use the term “upper cross (or crossed) syndrome” (UCS). UCS refers specifically to a putative and not universally accepted imbalance across four sets of front and back muscles.(7)

Forward head puts strain on the back of the neck muscles
(semispinalis capitis and levator scapulae, plus trapezius and rhomboids, not pictured)
and shortens and weakens the front muscles (SCM and scalenes)

Weak in the front, strong in the back encourages forward head posture (FHP)

The front neck muscles are small and flexible, in support of sensory input and output (seeing, smelling, hearing, tasting, breathing, eating, speaking, singing, kissing). Because our pre-hominid ancestors did not walk upright, the back of our neck is stronger than the front. In quadrupeds, the head hangs horizontally from the big muscles of the back that attach to the skull. While we have developed many structural changes as our species stood upright, our front neck muscles remain weaker than the back. 

An illustration of how chronic forward head posture affects muscles
The sternocleidomastoid (SCM) muscles rotate the head. In chronic FHP, they do too much work holding your head up, and become short, tight and weak. The hyoid bone floats below the tongue, providing attachment points for the delicate hyoid muscles.
In FHP, the hyoid muscles become weaker and tighter,
triggering knock-on effects to jaw and breathing.
Resource (10)

Forward head carriage throws this delicate and complex mechanism off balance. People with forward head posture/FHP overuse the large superficial muscles of the back of the neck, especially the upper trapezius and SCM (sternocleidomastod). And of course, FHP means we underuse the smaller front and deep muscles. The smaller back muscles: rhomboids, teres, deltoids, and triceps, which attach to the scapulae and humerus, may also be weak.  

Written by: Ellen M Martin

Part Two discusses FHP fixes and what you can do.

For further reading: see Bonnie’s oral posture post

Resources

  1. Happeny, D. (2015). Get your Head on Straight – Correcting Forward Head Posture. Retrieved 19 July, 2019, from https://csspt.com/2015/12/01/get-your-head-on-straight-correcting-forward-head-posture/
  2. Sheth, U. (2012). Neck pain : Forward Head Posture III: Why and How does it happen? Retrieved 19 July, 2019, from http://repetitive-stress-injury.blogspot.com/2012/06/neck-pain-forward-head-posture-part-iii.html
  3. Stanley-Becker, I. (2019). ‘Horns’ are growing on young people’s skulls. Phone use is to blame, research suggests. Retrieved 19 July, 2019, from https://www.washingtonpost.com/nation/2019/06/20/horns-are-growing-young-peoples-skulls-phone-use-is-blame-research-suggests
  4. Larsen, K. (2017). The true cause and solution for temporomandibular dysfunction (TMD). Retrieved 19 July, 2019, from https://trainingandrehabilitation.com/true-cause-solution-temporomandibular-dysfunction-tmd/
  5. Hitching, B. (2018). Do You Walk With the Charlie Brown Posture of Depression? Retrieved 19 July, 2019, from http://www.barbarahitching.com/2018/07/25/do-you-walk-with-the-charlie-brown-posture-of-depression/
  6. Sheth, U. (2012). Neck Pain: Forward Head Posture IV: Identification of the Problem. Retrieved 19 July, 2019, from http://repetitive-stress-injury.blogspot.com/2012/06/neck-pain-forward-head-posture-part-iv.html
  7. Ingraham, Paul (2018) Does Posture Correction Matter? Retrieved 20 July, 2019 from https://www.painscience.com/articles/posture.php
  8. Morrison, G. (2018). Forward Head Posture’s Effect on the Cervical Spine. Retrieved 19 July, 2019, from https://www.spine-health.com/conditions/neck-pain/forward-head-postures-effect-cervical-spine
  9. Fitzgordon, J. Forward Head Posture: The SCM and the Trapezius Muscles. Retrieved 19 July, 2019, from https://corewalking.com/forward-head-posture-the-sternocleidomastoid-and-the-trapezius-muscles/

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