Written by: Ellen M Martin

How to fix forward head in a world of keyboards and mobile devices.

Part 2. Fixes and Prevention [also see part 1]

Forward Head Posture (FHP), or more likely, pain in the neck, shoulders and back (1), drives many people to see their doctors, only to find that conventional medicine is behind the times about posture as a trigger of musculoskeletal pain. Read this post to find out more about the major causes and symptoms of forward head posture (FHP), the most common form of head/neck imbalance. Therefore, chiropractors, osteopaths, personal trainers and physical therapists have become the first-line practitioners who deal with postural pain. With the popularity of Yoga and Pilates, these teachers are also on the front lines of FHP assessment and correction.(2)

Pain isn’t the only reason to correct FHP; mitigating degenerative spine or bone problems is another, as is vanity, because FHP looks old and depressed. Nevertheless, the first step is becoming aware of your problem .

NOTE: If you have chronic neck pain or headaches, do see a doctor first. There are serious conditions that produce chronic or intermittent head and neck pain, such as migraines, artery blockages, arthritis, chiari malformation, craniocervical instability, hypertension, spinal infections, stenosis, etc. that should be ruled out before you do exercises on your own. Once diagnosed, there are many fixes you can pursue:

Exercise

Most people with FHP have sedentary commutes, jobs and entertainment. In such cases increasing any exercise, not just exercises for the head and neck, is likely to help with pain, stiffness and fatigue. Specific FHP correction exercises are cheap and easy to learn but harder to make a habit.

See selected illustrations, instructions and many links to resources below. If at all possible, get a knowledgeable physical therapist, corrective exercise, Yoga or Pilates instructor to assess and coach you to work the correct muscles for your posture issues. (2) Once you know how to strengthen your weak muscles, especially the deep neck flexor muscles, you can then be mindful to use them in everyday activities. (3)

Take breaks and stretch: Even if you are not doing down-looking work, take frequent breaks (some people set an alarm). Stretch, look upward, stand up and extend your upper back and neck, do a set of deep neck flexor exercises, or any of the stretches shown below. (4)

These are stretches and exercises you can do without leaving your desk. Set an alarm for every hour, or stretch every time you get up for a bio-break, coffee or a meeting. Just getting up and walking around can be helpful, especially if you are aware of your posture and make adjustments.

Roll and release: You can also use tennis balls or foam or wood rollers to do counter exercises, like neck of thoracic extension, and to release neck tension and trigger points. (5)

Breathing: Yes, it matters how you breathe. Many people (I was one) over use their scalenes and SCMs to assist with breathing, raising the first ribs and breathing too high in the lungs. Diaphragmatic breathing is recommended for everyone, but unless you sing or practice pilates or yoga, you may not even know how to do it. (17)

Improve your Ergonomics: Often, discomfort and pain are triggered by the postural stress of work or play that puts your head and neck in a narrowly focused, downward-looking position. These aren’t bad postural habits so much as bad postural situations, and often quite fixable. There are many resources for ergonomics, often with specific measurements and angles, some trying to sell you products. We believe one size does not fit all, so be prepared to do a little research and experiment with your set up.

Desktop ergonomics (6)

Good sitting ergonomics. You may need to adjust your workspace, but the principles are the same: feet on floor or rest, knees at 90 degrees, elbows, wrists and keyboard on same level. Monitor at eye level and arm’s length (adjust vision correction if needed).

Chairs: Find chairs that fit comfortably when you sit in good upright posture, with upper back as well as lower back support. For example, I am very short-waisted and my most comfortable office chair is armless with a high, narrow back and headrest. Make sure you sit back in your chair, which may mean positioning it closer to the monitor. Or try a standing desk, but place your monitor and keyboard at the right heights to support good standing posture.

Here’s one of many designs sold to help you adjust your monitor and keyboard to the best configuration. This product also lets a user convert her workspace from sitting to standing.

Monitors: Position your monitor at eye level (use a stand, or prop it up on a shelf or a few books) to keep you looking straight ahead, and put your keyboard and mouse at elbow level to keep your shoulders down. (I use a lap desk for the keyboard and mouse).

Screen usage: Place document windows on the monitor at eye level, adjust font sizes so you don’t have to lean into the monitor to read, adjust your colors and brightness to reduce eyestrain. Place paper documents on a stand at eye level.

Vision correction: Make sure you have appropriate vision correction for your arms-length screen distance. Many people need prescription glasses specifically adjusted for their workspace screens.

Phones: Use a headset, earbuds or speaker for phone calls. Only head-banging and whiplash are worse for your neck than holding a phone cradled to one ear with your shoulder!

Laptops are notorious for enabling hunched-over posture. If you must use a laptop, buy a lap desk or a stand to raise the screen to eye level and use a separate keyboard and mouse at elbow level. Take frequent stretch breaks. Don’t sit cross-legged and hunch over your laptop in bed—get a bedside stand instead.

Driving: Adjust the steering wheel and seat to keep you comfortably sitting against the back of the seat with your arms relaxed. Use neck and lumbar support. Hold the wheel at the 3 & 9 position. Take frequent breaks and stretch. (7)

Especially if you have a long, stressful commute or a job that requires frequent driving, take the time to adjust your seat to provide the best ergonomics. You may try adding your own lumbar pillow, wedge support or neck cushion to customize the car seat for your comfort.

Ergonomics at play: Reading or watching TV? Whenever possible, support your head and neck. Read books propped at an angle on a stand in front of you, or use an e-reader or laptop on a hands-free upright stand. In bed, get a reading wedge and fiddle with it, add small pillows until it comfortably supports your head. Adjust your TV screen and seating to minimize eyestrain and leaning forward. Adjust the brightness and sound volume for comfort.

Sleeping: Make sure your sleeping mattress and pillow(s) provide comfortable support for your back, head and neck. Observe if your sleeping positions stress your neck overnight (neck, head, arm pain, numbness or snoring are signs of this) and adjust accordingly. Many specialty cervical pillows are for sale, or you can engineer your own combination of pillows, shims and extra padding to support your head and neck. [add resources]

Seek hands-on therapy: Chiropractic, massage, osteopathy, physical therapy (especially ART and trigger-point work), Pilates and yoga can all help—seek out practitioners who are knowledgeable about FHP and can help you assess and rebalance your carriage to correct it as well as providing hands-on relief.

How NOT to coach posture.

Treat your pain: While you work to correct the problems, don’t hesitate to use pain relief. Take aspirin or ibuprofen, or use local pain relief (link to pain relief post) such as capsaicin, camphor, menthol or methyl salicylate liniment or patches.

Consider devices: There are a huge variety of devices sold to correct FHP and slumping: Bras and braces (8) traction slings & collars, support collars, cervical pillows, head weights (9). inversion tables, biofeedback units and more (10). Work with your care team to find the right devices for you and use them carefully.


Exercises: Strengthen your deep neck muscles for grace and balance.

Almost all of us, but especially those with FHP, can benefit from exercises that strengthen the deep neck flexor muscles. If you have osteoporosis or osteopenia, strengthening the muscles around your spine is key to healthy posture and reduced risk of fracture or deformity. A strong neck also offers some protection from whiplash and other accidental damage to the spine. As we age, neck exercises can improve neck appearance as well as function and comfort (11).

There are many online resources with exercises to correct forward head published by physicians, osteopaths, chiropractors, physical therapists, trainers, Pilates and yoga instructors. I have chosen a limited but suggestive selection of exercises here, see links and endnotes for more specifics, photos, illustrations and videos (12), (13).

Anti-forward head exercises fall into four groups:

Head retraction (chin tuck): The deep front neck muscles are small and delicate to begin with and FHP makes them weaker and shorter. Exercises can help retrain your deep and front neck muscles to slide your head back to balance on the first and second cervical vertebrae: the altas and axis, which make possible rotation of your head on your neck (14), (15).

Keeping your chin level (look straight ahead), retract your head back over your neck. Yes, that will produce a temporary double chin. Do 10 repetitions and return your head to a neutral, not forward, position. Work up to 20 reps. You can do these standing against a wall, lying on your back, or lying on your front (keep looking down, not ahead). No, you won’t hold your head this way all the time!

Neck traction and shoulder retraction: stretches and exercises that help keep your neck from collapsing into your chest and shoulders like a turtle. This is where traction devices can help, too, as well as manual traction from a physical or massage therapist or chiropractor. Once you get the idea, daily mindfulness can help you keep from turtling back down. (16)

How to traction your own neck. Can be done sitting or standing. Find your occipital bumps at the base of your skull. Use your thumbs to support the skull and pull up, keeping your chin down. Hold for 20-30 seconds, repeat 2-5 times. As you get less tight, you can add reps. This makes a good break stretch at work.

Upper back muscle strengthening: The big superficial upper back muscles, especially the trapezius, tend to be overused, but that doesn’t mean they are in good shape. The smaller back muscles (levator scapulae and rhomboids) are often weak. Systematic training of the smaller muscles without over training the big muscles will help make your carriage more graceful, fluid and strong.

Thoracic Extension: Chest muscle stretches and releases: if your head is forward, the muscles of the front of the neck and the chest especially the big Sternocleidomastoids (SCM) pair and the upper pecs, tend to be short, tight and weak. With kyphosis, the main chest muscles (pectoralis major and minor) become shortened and weakened. Stretching and release are the first corrective steps, followed by strengthening. Foam roller stretches are also useful (17).

A foam roller is an inexpensive and easy to use piece of equipment to facilitate thoracic stretching. Remember to not stick your lower ribs out and be careful to make you head and neck, follow, not lead the movement. There are many more of these at (18).

A more advanced neck exercise is the belly dance head slide (19). Notice the neck warm-ups, too. If you can master this, you are likely well along the way to a balanced head!

Last but not least, be mindful. Exercise can retrain your muscles, but the biggest challenge will be changing your everyday habits. Be aware of your head posture and pay particular attention when you are stressed or tired, when old habits will reassert themselves. When you catch yourself leaning forward, peering down, or slumping, correct your posture: shoulders back and down, head upright and on top of your neck. Stretch, take a few deep breaths in proper alignment and you and your head are ready to take on the world!

Author’s note:

I first learned about head and neck pain in 1994 when I was director of investor and public relations for a genetically engineered tomato company. I was on the phone for hours every day and developed neck and back pain and stress headaches. A chiropractor diagnosed “forward head” and “twisted butt syndrome.” I could see it on the X-ray. He recommended headphones, a change of chairs and raising my monitor. So, I bought a headset, swapped my executive chair for the side chair and borrowed a 6” thick science publication from the library to prop up my monitor! Since then, I’ve received body work and education from chiropractors, massage and physical therapists, and my Pilates coach of 15 years [link to PhisIQa]. Since then, I’ve modified my work ergonomics, my reading habits and my exercise regimen to prevent and mitigate forward head and neck pain. My posture is visibly improved, with my neck looking less old.


References

  1. Larsen, K. (2017). The multifactorial causes and solutions to chronic neck pain. Retrieved July 23, 2019, https://trainingandrehabilitation.com/multifactorial-causes-solutions-chronic-neck-pain/
  2. Castaldo, A. (n.d.). About PhysIQa. Retrieved July 23, 2019, http://physiqa.com/about/
  3. Wong, M. (2016). FORWARD HEAD POSTURE CORRECTION. Retrieved July 23, 2019, http://posturedirect.com/forward-head-posture-correction/
  4. Gouthro, J. (n.d.). 9 Seated Stretches to Release Neck + Back Pain. Retrieved July 23, 2019, https://blog.paleohacks.com/seated-stretches-neck-back-pain/
  5. Ingraham, P. (2018). Tennis Ball Massage for Myofascial Trigger Points. Retrieved July 23, 2019, https://www.painscience.com/articles/tennis-ball.php
  6. Sheth, U. (2012). Neck Pain: Forward Head Posture VII: Posture Awareness. Retrieved July 23, 2019, http://repetitive-stress-injury.blogspot.com/2012/07/neck-pain-forward-head-posture-posture.html
  7. Auto Loan Solutions. (n.d.). Your Posture Does Matters While Driving. Retrieved July 23, 2019, https://www.autoloansolutions.ca/blog/your-posture-does-matters-while-driving/
  8. Posture Corrector. (n.d.). Improving Your Posture With a Posture Corrector. Retrieved July 23, 2019, http://posturecorrector.net/
  9. Dave. (2016). Head Weights for Posture – Do They Work? Retrieved July 23, 2019, http://www.posturesorted.com/head-weights-for-posture-do-they-work/
  10. Ornstein, S. (n.d.). Correcting Neck Posture: A Key To Pain Relief. Retrieved July 23, 2019, https://www.necksolutions.com/neck-posture/
  11. Larsen, K. (2016). The true cause and solution for temporomandibular dysfunction (TMD). Retrieved July 23, 2019, https://trainingandrehabilitation.com/true-cause-solution-temporomandibular-dysfunction-tmd/
  12. North American Spine Society. (2012). Cervical Exercise: The Backbone of Spine Treatment. Retrieved July 23, 2019, https://www.spine.org/KnowYourBack/Prevention/Exercise/Cervical-Exercise
  13. Asher, A. (2019). Forward Head Posture Exercises. Retrieved July 23, 2019, https://www.verywellhealth.com/neck-exercise-for-forward-head-posture-296838
  14. McQuilkie, S. (2019). How To Fix Forward Head Posture – 5 Exercises. Retrieved July 23, 2019, https://backintelligence.com/how-to-fix-forward-head-posture
  15. Happeny, D. (2015). Get your Head on Straight – Correcting Forward Head Posture. Retrieved July 23, 2019, https://csspt.com/2015/12/01/get-your-head-on-straight-correcting-forward-head-posture/
  16. Lackowski, R. (2017). Stretch of the Week: Self Neck Traction. Retrieved July 24, 2019, https://www.athletico.com/2017/06/07/stretch-week-self-neck-traction/
  17. Wong, M. (2017) Forward Head Posture Correction. Retrieved July 14, 2019, http://posturedirect.com/forward-head-posture-correction/ This post, by a practicing physiotherapist, has a wealth of information in one place.
  18. Lefkowith, S. (2015). Thoracic Extension Exercises – The Thoracic Bridge And More! Retrieved July 23, 2019, https://redefiningstrength.com/thoracic-extension-exercises-thoracic-bridge/
  19. Match Less. (2016, September 6th). How to Do a Head Slide Belly Dancing [Video file]. Retrieved July 23, 2019, https://www.youtube.com/watch?v=61alCXBLf-Y

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