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How to Fix Forward Head Posture: Tips from Doctors and PTs

How to Fix Forward Head Posture: Tips from Doctors and PTs

Forward head posture (FHP) is an abnormal, sometimes unattractive and often painful condition in which the neck tilts forward. It's one of the most prevalent posture issues, estimated to affect more than 66% of the population. The good news is you can correct forward head posture when you follow the advice of doctors and physical therapists. The following offers an overview of forward head posture symptoms and causes, plus lists tips for how to fix forward head posture. 

Contents

  • Forward head posture, explained
  • How to tell if you have forward head posture
  • Forward head posture symptoms
  • Forward head posture causes
  • How to fix forward head posture
  • How long does it take to fix forward head posture

Forward head posture, explained

Forward head posture is when your neck hyperextends toward the front of your body. It's also referred to as forward neck posture, forward head syndrome, anterior head carriage, text neck, tech neck or upper crossed syndrome. 

"Forward head posture, or anterior head carriage, is when you literally carry your head out in front of your shoulders," says Dr. Matt Tanneberg, DC, CSCS, who owns and operates Body Check Chiropractic & Sports Rehabilitation in Scottsdale, AZ. He works with elite athletes from the NFL, MLB, NHL, USA Track and Field, NCAA and high school. "Ideal posture is when your head and neck are directly on top of your shoulders, allowing the curvature of the spine to rest in a neutral position. This allows our body to function 'normally' without handling any additional stress through certain joints or areas."

A telltale sign of forward head posture is if your ears are in front of your shoulders when you're sitting or standing. 

FORWARD HEAD POSTURE VS OPTIMAL POSTURE

"Optimal posture of the head is typically defined as the head being in line with the rest of the spine. A measure can be your ears in line with your shoulders. Another way I define this with my patients is vocal chords, over diaphragm, over pelvic floor" says Shannon Leggett, PT, owner of Shannon Leggett Physical Therapy in New York City. "Forward head posture would be the head moving in front of the spine, or the ears are ahead of the shoulders. We naturally move in and out of this position all day long. We want to make sure we always have the ability to come back to 'home base.'"

Physical therapist and creator of the LYT Yoga Method Lara Heimann says modern lifestyles have led to increased time spent sitting or standing in front of computer screens and other electronic devices. 

"All of us are spending more time on technology and it is wreaking havoc on our necks," Heimann says. "Our skulls tend to shift forward – the wretched 'forward head' – and the neck muscles have to work overtime."

A PERSON LOOKING DOWN AT THEIR PHONE

She explains that this positioning offsets the head's neutral, optimal alignment where the skull balances on top of the first cervical vertebra. As the skull moves forward (or forward and down), it strains neck muscles that attach to the skull and run down to the scapula, humerus and clavicle. The constant load pulls on the spine's vertebral structures, creating torque that can twist and rotate the spine out of alignment. 

In fact, for every inch your head moves forward, it exerts 10 pounds of additional weight that stresses your neck and upper back. 

 DEPICTING 10 LBS. OF ADDITIONAL WEIGHT FOR EVERY INCH THE HEAD MOVES FORWARD

COVID-19 and the work-at-home movement spurred increased cases of forward head posture, and doctors and therapists are beginning to see the condition affect more children and teenagers who spend a lot of time on their phones and other devices. 

"Forward head posture is something, as a chiropractor, that I am seeing more and more. An increase in this condition was seen throughout the COVID pandemic when more people were working from home in make-shift offices, often sat at the kitchen table at an uncomfortable chair, staring at a computer, laptop or iPad all day," says Dr. Charlotte Hurst, DC, Bsc (hons), PG Dip, MMCA, of UK-based Hurst Health. "More alarmingly, this neck complaint is now seen in children, teenagers and young adults as more time is spent looking at their mobile phones or glued to other devices. 

"Our heads are incredibly heavy and the structures that support this weight are designed to be in an upright position. Unfortunately, when a long time is spent staring down at a phone or screen, then the tilt of the head puts unnecessary stress on these supporting structures, which they are simply not able to withstand."

Read: Posture corrector before & after stories and photos

How to tell if you have forward head posture

Though you could ask a doctor or therapist about a forward head posture test, Leggett says observation is the best way to tell if you have FHP. She says you can use a mirror to see where your head rests in relation to your body. If your ears are ahead of your shoulders, you have forward head posture. Sometimes, she directs her patients to enlist help.

"I sometimes have clients ask coworkers or family members to take a picture of them at their computer or doing some other activity when the client doesn't realize it," she says. "It can be eye-opening to them to see how they hold themselves."

  • Note whether your ears are set in front of your shoulders (use a mirror if needed)
  • Ask a coworker or family member to take a picture of you when you're not paying attention to see how you hold your head when you sit or stand

A PERSON ASSESSING THEIR POSTURE IN FRONT OF A MIRROR

Once you've determined you have forward head posture, the next step is to understand what optimal posture feels like. Heimann says she often instructs patients to use a wall as a reference point for feedback:

  • Stand against the wall so that your head, scapulae (shoulder blades) and sacrum (lower back) make contact with the wall
  • Walk away from the wall and attempt to maintain that alignment
  • You can alternatively use the back of your car seat or lie down and take note of your neck position when the back of  your head touches the floor

A PERSON STANDING AGAINST THE WALL, WHERE THEIR HEAD, SCAPULAE AND SACRUM TOUCH THE WALL

"Many people have difficulty finding a neutral cervical spine position and will need feedback of some kind," Heimann says. "This feedback will help you neurologically understand and locate a neutral neck position which will be highly beneficial for preventing pain."

Forward head posture symptoms

Forward head posture symptoms include:

  • Chronic neck pain and stiffness
  • Upper back pain
  • Headaches (tension headaches and migraines)
  • Jaw (temporomandibular) pain
  • Muscle fatigue and muscle spasms
  • Chest pain
  • Eye strain
  • Dizziness
  • Rounded shoulders
  • Aesthetic issues (head tilted forward)

If forward head posture isn't corrected, it can also lead to:

  • Decreased range of motion
  • Humped neck
  • Bulging, herniated discs or disc degeneration
  • Decreased height
  • Issues with balance
  • Breathing issues (decreased respiratory function)
  • Arthritis
  • Nerve irritation and compression
  • Tingling and numbness in arms and hands
  • Muscle performance and mobility impairment

In addition, those with chronic or severe pain due to FHP are at risk of developing a reliance on painkillers. Moreover, some studies have found a link between forward head posture and increased mortality. 

A person with a headache with FHP symptoms

"This text neck/forward head position places an inordinate amount of strain on the back muscles, which leads to pain, pinching, soft tissue restriction, numbness and tingling. The increase in muscular tension can create discomfort, headaches and shoulder pain," says Heimann. 

She adds that chronic forward head posture weakens the front neck muscles – cervical flexors – and FHP combined with subsequent weakness strains the upper back. 

"Long-term, people can suffer from tensions headaches, nerve compression, excessive collagen production at the back of the neck above the scapulae leading to a fibrotic 'hump,' decreased neck, shoulder, and thoracic spine mobility, weakened core muscles, suboptimal breathing and more," she says. 

 FIBROTIC HUMP

 

How does FHP cause so many complications? Leggett explains the physiological mechanisms of a few symptoms:

  • Headaches: "This can come from the compression of the muscles and joints at the base of the neck. Over time, the muscles in the front and back of the neck will shorten or lengthen depending on where they are. This can lead to trigger points in these muscles. Trigger points can refer pain to the head and face."
  • TMJ: "When our head comes forward, this creates a misalignment of the TMJ, putting stress on the joint. Also, gravity will want to pull our jaw open. We automatically will use our jaw muscles harder to keep our mouth from hanging open. This can create tightness and trigger points in these muscles which can then compress the TMJ, also causing pain. I had a client whose jaw locked due to sitting poorly in front of a laptop for long periods of time!"
  • Neck pain: "When the head is forward, this creates shear in the joints of the neck. Over time, this can lead to pain. This shear also makes the space where our nerves exit the spine smaller, so forward head posture can irritate the nerves. This shear will also tension the arteries that run through the vertebrae in the neck, which can cause headaches, dizziness and brain fog."
  • Suboptimal breathing patterns: "If the head is forward, this will impede a diaphragmatic breath. Good breathing mechanics are needed for optimal core activation and pelvic floor health. Also, if our head is forward and we don't use our diaphragm effectively, we use the muscles of the neck to breathe. This will create tightness in these muscles, which can cause pain and headaches. Use of accessory muscles of the neck to breathe also signals to our nervous system that we are in danger. This can perpetuate the stress response, keeping us stuck in fight or flight mode. This leads to a host of health issues."
  • Forward head posture causes

    The most common cause of FHP is poor posture: 

    • Leaning your head forward for extended periods
    • Craning your neck downward to view smartphones, laptops and other screens
    • Work that requires looking down (occupational posture): Laptops and desktop screens, hairstyling, cooking, writing, programming, massage therapy, slouching while driving, etc.

    "It is typically caused by habitual bad posture, people who sit for a living and allow their bodies to get used to that body posture. Eventually, their bodies will stay that way and continue to create muscle memory, keeping that person in that same position," says Dr. Tanneberg. 

    PEOPLE LOOKING DOWN IN DIFFERENT OCCUPATIONS

    Other potential causes include sleeping with your head too high, poorly developed back and neck muscles, congenital disabilities, injuries such as whiplash and other postural issues such as kyphosis.

    Read: Can a posture corrector fix kyphosis?

    Dr. Tanneberg says there might be a genetic component in some FHP cases. 

    "Forward head posture does have correlation to genetics as well, so if you have family members who carry their heads forward, start fixing yourself sooner than later," he says. "Long-term, degenerative damage will occur to the cervical and thoracic spine at a much higher likelihood due to the ongoing and consistent strain."

    Leggett adds that poor computer set-up is a common culprit, as most of us keep our screens too low and look down all day. Poor eyesight is another cause that can be easy to overlook: when you struggle to see your computer screen, you'll tend to push your head forward and compress neck joints and muscles. 

    Woman sitting at a desk with good and bad posture

    The state of our nervous system can also cause FHP, especially for those with chronic stress and anxiety.

    "If we are in flight or fight, our bodies need to move our head and shoulders in order to create an environment to be able to run from a perceived threat," Leggett explains. "When in this state, our head moves forward so our jaw opens to increase our respiratory rate and our shoulders round to protect our heart. For those who live with chronic stress and anxiety, this becomes a natural way of positioning their bodies."

    How to fix forward head posture

    Forward head posture is treatable, and if you suffer from it, it's important to take corrective action before it leads to long-term, irreversible health consequences. 

    The good news is you can work to correct forward head posture with the following types of self-care. 

    Forward head posture exercises and stretches

    Exercises and stretches are among the best ways to correct FHP over time. 

    "Stretching is a huge part of giving your muscles a 'new memory' to allow them to help support you in better posture," says Dr. Tanneberg.

    Try the following exercises and stretches recommended by doctors and physical therapists. If an exercise or stretch is too painful, back off until it no longer hurts. 

    1. Lateral flexion - WATCH VIDEO HERE

    Bring your ear to your shoulder and stretch as far as you can without causing pain. Hold for 15 seconds, 2 repetitions on each side.

    2. Rotation with flexion - WATCH VIDEO HERE

    Look over your shoulder as far as you can, then bring your chin to your chest. Rotate your head to the side as far as you can before pain. Hold for 15 seconds, 2 repetitions on each side. 

    3. Rotation with extension

    Look over your shoulder as far as you can, then look up as high as you can. Rotate your head to the side as far as you can before pain. Hold for 15 seconds, 2 repetitions on each side. 

    4. Rhomboid

    While sitting in a chair, scoot to the edge of the seat. Spread your legs out with your feet flat on the floor. Take your right hand and grab your left ankle. Then, take your left hand and press down in the elbow crease of your right arm. You should feel this stretch in your rhomboid muscles between your spine and shoulder blade on the right side. Hold the stretch for 15 seconds, 2 repetitions on each side

    5. Retraction - WATCH VIDEO HERE

    Stand in a door frame with your head back against the wall. Relax your arms and pinch your shoulder blades down and back against the door frame. Hold the stretch for 5 seconds, 10 repetitions. 

    Read: How to use a posture corrector

    6. Corner stretch - WATCH VIDEO HERE 

    Stand in a corner and put your forearms flat on the wall with your upper arms parallel with the floor. Lean into the stretch as far as you can. You should feel the stretch in your pectoral muscles on both sides. Hold for 15 seconds, then bring your arms up 45 degrees and hold another 15 seconds, then fully extend your arms overhead and hold for 15 additional seconds. Complete 2 repetitions at each level.

    7. Floor stretch - WATCH VIDEO HERE 

    Lie on your back with your knees bent, feet on the floor. Slide your skull on the floor to lengthen the back of the neck without jutting your chin toward the ceiling (you can also place your skull on a hardback book or yoga block and gently bring the chin toward the throat). When you feel the stretch, hold and breathe for one minute. Coming out of the stretch, try and recreate the feeling of alignment when you come up to sitting position. 

    8. Standing stretch

    Stand and place one hand behind your head. Move your skull into your hand and lengthen the back of your neck as your lower your chin. Moving the head back is the first step. When you take the hand away, keep your skull in alignment and become accustomed to this position. You will often feel like you are gazing down, but this results from lifting your gaze when your head is forward in the text neck position. Just lift your eyeballs without lifting your chin. Perform this frequently throughout the day. 

    9. Doorway stretch - WATCH VIDEO HERE 

    Stand in a door frame and place your arms on the frame like a goalpost or cactus shape (elbows bent and in line with your shoulders). Pull your shoulder blades into the back body as you gently lean forward with your chest to stretch the chest tissues, which are shortened in a text neck position. Maintain tone in the abdominals so your ribcage doesn't jut forward. Gently draw your chin toward your throat to strengthen the front neck muscles while stretching the back of the neck. Hold for one minute and breathe. Perform several times a day. 

    10. Stomach stretch

    Lie on your stomach and place your forehead on the floor with your arms in the goalpost position (like the doorway stretch). Hold tone in your abdominals by lifting your belly away from the floor. This might already give you a big stretch in the back of your neck. Lift the arms, but keep your forehead on the floor. Then, lift your head by pulling the front neck muscles up (like the abdominals) without lifting the chin. If the neck and throat feel compressed, lightly lift the chin to make it easier. Repeat 10 times each day. 

    11. Bed/couch stretch - WATCH VIDEO HERE

    Lie on a bed or over the end of a couch and let your head hang over the edge to allow gravity to move your skull back in place. Your chin will lift, but the goal is to dangle your head to free up the pull of the neck muscles in back. Hold and breathe for 15 to 30 seconds. Coming out of this position, you can use one hand to cradle your skull and engage the front neck muscles by pulling the chin toward your throat before lifting your whole head to upright (think of it as an abdominal curl for your neck). 

    Yoga for forward head posture

    "I think yoga is a great way to fix forward head posture," explains Leggett, who says many yoga poses stretch and strengthen the muscles needed to support the head and neck and help maintain better posture. 

    Yoga can also help calm the nervous system, which is beneficial because forward head can be caused by a "fight or flight" protective state. 

    "The breathing, mindfulness, movement and meditation components of yoga bring a state of relaxation," Leggett says. "This will absolutely show up in how a person holds their head and shoulders. One will have a soft and open chest, and their head will be over their body."

    Some of the best yoga poses for forward head posture include: 

    1. Cat/cow pose - WATCH VIDEO HERE

    2. Camel pose - WATCH VIDEO HERE

    3. Cobra pose - WATCH VIDEO HERE

    4. Dolphin pose - WATCH VIDEO HERE

    5. Downward dog - WATCH VIDEO HERE

     

    Posture correctors and braces

    Forward head posture braces gently retract your shoulders and provide ongoing physiological feedback that reminds you to maintain proper posture while sitting, standing and moving throughout the day. 

    "Posture correctors and braces help as a tactical cue in correcting people's posture," says Dr. Tanneberg. "Braces and kinesiology tape both work well in retraining the soft tissue involved to get back to a new normal and develop new muscle memory."

    Read: Do Posture Correctors Work? Here's What Back Doctors Say

    Some posture correctors are designed for comfort and style. The BackEmbrace posture corrector, for example, features attractive patterns and can be worn over and under clothes. That's ideal for working in professional settings, because it lets you discreetly take advantage of the advantages of posture braces without advertising your condition or inviting questions from coworkers. 

    "Posture braces can give feedback to people to help them understand where they are in space," says Leggett. "This can help them find and sustain a more optimal posture."

    BackEmbrace posture corrector

    Posture apps

    You can install posture apps on your mobile phone, tablet or desktop computer. Four types of posture apps can help correct forward head posture:

    1. Posture exercises, stretches and yoga: Guided posture workouts
    2. Reminders: Periodic or real-time notifications to maintain proper posture
    3. Analysis: Posture assessments using your phone camera and sensors
    4. Slouch detectors: These apps use your webcam to detect slouching and remind you to hold proper posture

    Learn more and get recommendations for the best posture apps

    Massage

    Massage can prove a great way to loosen muscles and coax your neck into proper posture, especially when combined with exercises and stretches over time. 

    "Work on soft tissue imbalances that are created by prolonged forward head posture. Massage, whether by a practitioner or self-massage with balls and foam rollers, can help with the pain and tightness of muscles that have shortened," says Leggett. 

    Massage therapy

    Pillows

    Sometimes, forward head posture can result from sleeping with a pillow that's too high. Switching to a low-profile pillow could help. 

    "If you sleep on your back, you want one thin pillow so that your head isn't flexed forward too far," says Dr. Tanneberg. "The thinner the pillow, the better if you are a back sleeper."

    He says there are also specific pillows made for those who sleep on their backs that have extra cushion only on the lower half to help support your neck, and adds that the best pillows for back sleepers are usually memory foam that have extra cushion to support your neck. Down and feather pillows are also thin enough to keep your neck in neutral position. 

    Person sleeping with a pillow

    Tummy sleepers should likewise use one thin pillow – or no pillow at all.

    "If you sleep on your stomach, you want either one thin pillow or no pillows at all so that your head isn't stuck back in extension all night," says Dr. Tanneberg. "Look for very thin pillows to keep your head as neutral as possible while being on your stomach. Pillows made from feather or down material are usually thin enough for tummy sleepers, as you don't want that extra support when you are on your stomach. When you sleep on your stomach, you will want a pillow that is smaller in size because usually you will use only a corner of it."

    Be mindful of your posture

    Fixing forward head posture requires an ongoing conscious focus. It's easy to lose sight of our posture when we're engaged in work, so take regular breaks to refocus your mindfulness. 

    "Correcting is an ongoing process and usually the issue is long-term bad habits, so it starts with recognizing, correcting and changing those bad habits. I recommend people stretch and break up the time that they spend seated. One simple tip to keep yourself from slouching is to put a lumbar support or a small pillow in the small of your low back. The pressure it exerts against your low back will force you to stay upright through your upper back," says Dr. Tanneberg. 

    "Also, try not to sit for longer than a half hour at a time. I tell my patients to set an alarm on their phone for every 20 to 30 minutes. When the alarm goes off, get up, stretch out, get a drink of water, go to the bathroom – do something else to move around. Even if you stand up for 30 seconds and then sit back down, that is much better than prolonged sitting."

    Read: Are posture correctors safe? Here's what experts say

    Other tips include:

    • Keep screens (including phones) at eye level
    • Use an ergonomic desk and chair
    • Alternate between a sitting desk and a standing desk to prevent being in a fixed position for too long
    • Get your vision checked, especially if you struggle to see your screen
    • Practice mindfulness: "I have patients do check-ins throughout the day to see where their head is in space," says Leggett. "They can't fix what they aren't aware of."

    Ultimately, practicing mindfulness is one of the best ways to fix forward head posture. Don't allow yourself to be chained to a chair or to fixate on your phone all day. 

    "It is important to remain vigilant about not staying in a fixed position for longer than approximately 30 minutes," says Dr. Hurst. "Scheduling regular breaks so that you get up and move out of that fixed position is paramount."

    Doctors, chiropractors and physical therapy

    If your forward head posture is severe, you're experiencing significant pain, or you're struggling to fix forward head posture on your own, it's time to consult a medical expert. The good news is that surgery is rarely, if ever, recommended for forward head posture. Instead, a chiropractor or physical therapist well-versed in the condition can help you regain proper posture naturally over time. 

    "Once the pain progresses to the point of negatively affecting your daily activities, it is time to get checked out by a medical professional," says Dr. Tanneberg. "When you are unable to perform 'normal' daily tasks because of the pain or if it begins to limit what you are able to do, then what you are doing for yourself is no longer good enough and you need to get some help." 

    How long does it take to fix forward head posture?

    It depends on the severity of your condition, but in general, it can take anywhere from a few months to years to fix forward head posture. That said, with a commitment to treatment, you can begin to see results much quicker. 

    "Fixing forward head posture is a process and can take years to fully fix. With ongoing repetition of poor posture, sitting, slouching, etc., you will continue to set yourself back in your progression," explains Dr. Tanneberg. "Fixing the issue itself usually will take a diligent effort with consistency over several months, three to six months minimum to get a good baseline, with continual work to keep the condition under control."

    Leggett echoes that sentiment: "If someone has been in a forward head position for a long time and their soft tissue has adapted, it might take eight to twelve weeks of consistent work to restore balance," she says. "People will see progress along the way, but to see a true change takes time. If people build awareness early and become more mindful of how they hold their body in space, forward head can be avoided. I think with anything, awareness is key!"

    As Dr. Hurst puts it, "The longer someone has had this complaint, the longer it takes to help start to reverse the changes. Exercises, discipline, seeing a physical therapist and seeking professional advice are the most important factors to consider when experiencing forward head posture." 

    Forward head posture is a common condition with causes rooted in our high-tech, high-stress world. Follow the expert advice in this article and find the right combination of exercises, therapies and tools such as posture correction braces to help alleviate pain, regain proper form and reverse forward head posture.

    Looking for a lightweight, comfortable, stylish posture corrector that works? Try BackEmbrace!
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