Forward Head Posture (What Is It and Does It Matter?)
The Posture of the Future
There is no doubt that technology has slowly consumed our everyday lives. We spend hours everyday on our smart devices looking at the internet, checking social media, answering emails, etc. Many of us also work jobs consisting of prolonged computer use. These activities are thought to lead to issues such as neck pain and/or headaches. Do the postures conveyed in "Text/Tech Neck" really cause long term problems or are we overreacting?
In my opinion, the answer is a little bit of both. To use sitting as an example:
Sitting at a computer is not BAD. Heck, sitting in general is not BAD. The hysteria on social media that "sitting is the new smoking" creates a perception that any and all sitting is not ideal. This is a little misleading, obviously. Really, any activity that we do repetitively and for long duration can POTENTIALLY lead to issues. What may cause an issue in one person may not affect another.
With that being said, let's highlight one of the common postural traits that are associated with technology usage, the forward head posture.
What Causes A Forward Head Posture?
Forward head posture, or anterior head carriage, is a term that describes when the head sits too far forward on the shoulders. It is incredibly common and I would wager that every single one of us has it to a certain extent. Is it something to worry about? Well, it depends. As stated above, any one posture is not inherently bad. However, prolonged and repetitive postures can be. This postural tendency seems to be common in those with chronic neck pain and headaches. In fact, we find that postural dysfunctions can be one of the 3 biggest contributors to tension headaches.
One thing to keep in mind is that many people have a forward head posture and have no symptoms. In fact, many studies have concluded that there is no correlation with posture and pain. I certainly look at the mechanical factors of posture but I tend to draw conclusions on the overall big picture.
An Issue of "Stacking"
An evaluation of head posture involves assessing the position, curvature, and adaptations of the muscles and joints. In theory, the further that the head translates forward, the more compensation is needed within these joints and muscles. When you factor in the weight of the head, and gravity, the natural position of our face would be in a downward direction (when the head is pulled forward). So in order to adapt, we crank the upper cervical vertebrae into extension. This creates a secondary "rounding" or flexion of the lower part of the neck/upper back.
Essentially, the upper part of the neck is "compressed" while the lower part is "hunched". It is for this reason why the majority of cervical disc problems and degeneration occur at the levels C5/C6/C7. So when you consider the potential long term changes, prevalence of forward head positions and the distribution of forces, it seems wise to have a strategy to reverse these positions from time to time.
It's All About the Chin Tuck
I will often have a patient demonstrate how they would go about reversing their postural position. At first attempt, they will often just pull their head straight backwards (retraction). This causes a "jamming" effect at the mid to lower part of the neck. It is often uncomfortable and can exacerbate any symptomatic discs or joints. We need to incorporate more flexion, or better stated, chin tuck.
The images below demonstrate some common computer postures (image one and two) and a correction strategy using the chin tuck (third image).
My natural computer posture. My head sits forward as do my shoulders (red arrows). The dotted lines indicate face position relative to parallel. Nothing wrong with this position. However, prolonged and repetitive sitting like this MAY result in unfavorable adaptations.
Here we see an attempt to sit up straighter with the head translated backwards (blue arrows). This is often what patients do to "correct" their posture. Due to a lack of chin tuck, there is compression in the upper part of the neck (red arrows).
This is an ideal scenario where the head is stacked, the chin is tucked, and the face is parallel (blue arrows). I try to assume this position with prolonged computer use or driving. When I don't, I often have neck issues. Again, not everyone will have these issues so every case is different.
Exercises for Forward Head Posture
Deep Neck Flexors
Check out the video below on some of our favorite neck exercises:
In addition, to strengthening the muscles in the neck, it helps to incorporate some range of motion exercises to help with joint tightness. Remember, a forward head posture often involves increased extension (compression) of the upper vertebrae of the neck as well as increased flexion (rounding) of the lower vertebrae. Motion is Lotion when it comes to joint function so give these exercises a try:
How Do We Help Forward Head Posture?
We certainly pay attention to head posture. Especially when neck pain, shoulder pain, and headaches are involved. However, it is just one component of a thorough assessment. We never draw specific conclusions to posture and pain but recognize that certain postures MAY lead to adaptations within the muscles and joints.
We implement joint mobility techniques, like adjustments, to the joint structures that are most restricted. Myofascial therapy is used for the overactive and "tighter" muscles. Implementation of a rehab/exercise program is vital to help improve function by addressing muscular weakness, movement impairments, and breathing to name a few. The purpose of this article is to recognize the biomechanical factors of forward head posture, but also to stress that it does not necessarily mean anything and may not be clinically significant. If you are struggling with conditions such as neck pain and headaches, and think your posture may be related, give us a call (636-728-8607) to set up a FREE consultation!
Originally posted 06/26/2019