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! Therefore, it’s no surprise that there’s a forward head posture (FHP) epidemic. Everyone in COVID-19 lockdown using mobile phones and computers has only worsened things. And then the pandemic forces many people to work from home. Chronic FHP can produce neck and back pain and other symptoms simply from the strain of schlepping your head around.
This post will discuss 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, will offer 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.
Causes of FHP
People with autoimmune or other chronic diseases often develop forward head posture (FHP). This is especially true of those of us with joint or bone disorders (arthritis, osteoporosis, rheumatoid arthritis, tendinitis) or chronic fatigue. Also, people with a history of whiplash or upper back injury are at risk. As well, certain professions are associated with FHP: artists, craftspeople, hair stylists, massage and physical therapists, programmers, shoemakers. Thus, FHP has acquired a variety of nicknames: “scholar’s neck,” “reader’s neck,” “tech neck,” “text neck.”
Furthermore, many otherwise healthy people develop chronic FHP. This is because so many of us spend hours every day driving, typing at one-size-fits-none workstations, and peering at laptops and devices.(2,3) Even children are developing chronic forward head from backpacks, laptops and mobile phones. (4) All this adds up to a modern epidemic of chronic forward head posture.
Symptoms triggered by 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.
Depressed stance and stress
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 to tell if you have 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.
If you can, find a physical therapist or exercise coach who is hip to posture issues, who 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 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 the flexibility of our necks makes them complex anatomical structure. Squeezed into this slender space are the spinal cord, vagus and other major nerves, plus large blood vessels. Therefore, many layers of muscles and tendons support the highly mobile sensory functions of our heads. These are attached to 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)
Weak in the front, strong in the back
The front neck muscles are small and flexible, in support of sensory input and output (seeing, smelling, hearing, tasting, breathing, eating, speaking, singing). Because our pre-hominid ancestors did not walk upright, the back of the neck is stronger than the front. In quadrupeds, the head hangs horizontally from the big muscles of the back and neck 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.
Forward head carriage throws this delicate and complex mechanism off balance. People with FHP overuse the large superficial muscles of the back of the neck, especially the upper trapezius. And of course, they underuse the smaller front and deeper 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 will discuss fixes and what you can do.
For further reading: see Bonnie’s oral posture post
- 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/
- 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
- 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
- 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/
- 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/
- 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
- Ingraham, Paul (2018) Does Posture Correction Matter? Retrieved 20 July, 2019 from https://www.painscience.com/articles/posture.php
- 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
- 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/