The head-forward posture is easily the most common postural issue I see and it’s the most likely culprit in cases of neck, shoulder, upper back tension.
What surprises me is that most people are utterly oblivious to it. Maybe it’s because we don’t usually see ourselves from the side, that we don’t notice how forward our head is.
The head should sit on the neck and shoulders - the ears should stack over the shoulders. The further forward and out of alignment the head is, the greater the strain on your neck and upper back muscles. Here’s a stunning statistic: for every inch of forward head posture, the weight of the head on the spine increases by an additional 10lbs*. An average head weighs between 10-14 lbs - the weight of a bowling ball. Even 2 inches forward, it’s like you’re supporting the weight of a 32-lb head.
How does it happen?
Bad posture. Nearly everything we do exacerbates it. Looking down at our phones, working on our lap/desktops, driving, sitting slouched on a sofa. It’s not just a problem for worn-out adults; kids wear backpacks that are way too heavy for their frame, causing their head to jut forward to offset the weight.
Besides muscle fatigue, aching neck and shoulders and upper back pain, here’s a partial list of other damage a forward head can cause:
The weight of the forward head clamps down on all the nerve pathways that feed out from the cervical (neck) spine out into the shoulders - that can lead to disc compression, pinched nerves, reduced shoulder mobility, rotator cuff issues, numbness or radiating pain down the arm and hands.
A forward head can also cause tension headaches, increased blood pressure, excessive pressure on the jaw joint that can lead to TMJD.
A forward head flattens the normal neck curve, and over time, the musculoskeletal structures warp and deform under the strain. This can cause a hump (!) to form at the base of your neck where your body develops fatty deposits and calcium growth to help protect your spine and support the weight.
Plus, the damage doesn’t just stop at the upper body. The unnatural shift of your head causes a whole cascade of compensation which involves your lower back, throws off your hips, flattens your butt, etc.
What you can do about it.
It can take time to correct a forward head posture, but the first step towards change is awareness. Knowing is half the battle. If you need proof, ask a friend to take a picture of you from the side.
The head forward posture is actually a combination of muscles that are too tight and muscles that are too weak. (It’s a feature of an Upper-crossed syndrome, which I’d love to get into in another post). To resolve the issue, you’ll have to stretch what’s too tight and overworked, and strengthen the muscles that are too lax. I plan on pulling together a more complete handout with a series of stretching and strengthening exercises but in the meantime, you should start with the chin tuck. It’s one of my favorite neck stretches since it’s easy to do, quick, and most importantly, super effective.
THE CHIN TUCK
You can do this exercise sitting, standing, or even lying on your back. If you’re lying down, bend your knees and keep your feet flat on the floor. This’ll help keep your back in a more neutral position preventing strain.
Slowly pull your chin back and slightly down - like you’re giving yourself a double chin - so that your ears are in line with your shoulders. You should feel a stretch in the back of your neck, like the back of your neck is lengthening. Make sure you’re not scrunching your shoulders or arching your neck.
HOLD for 5 seconds if possible, and then release/relax
REPEAT 10 times, or as tolerated.
PERFORM 5-7 times per day
Fit your Chin Tucks Throughout the Day
Try to do 5-7 sets of 10 chin tucks in the course of each day. 10 repetitions of 5-second chin tucks will only take a minute. If you’re not experiencing any pain (yet), just think about the hump and get motivated. Do a set as you're reading this post!
Build it into your morning routine. Do it before, after, or even while brushing your teeth, or standing in the shower.
Make more of your commute. Tuck on the subway (don’t worry, no one will notice or care), or while driving - push your head back against the headrest. I should probably advise you to wait for a red light to do these chin tucks.
Take Breaks. Impose regular breaks from your desk. Move, take meaningful deep breaths, rest your eyes, go drink some water, go talk to someone about something unrelated to work. And of course, do a set of chin tucks - maybe to kick off a break, or when you’re returning from one and settling back into your work.
* Rene Caillet, MD, renowned author and leader in the field of physical medicine