Have you ever paused to notice people’s posture and movement mechanics? As a CES, I’m constantly observing and assessing posture everywhere I go. I just can’t help it! As a professional specializing in posture alignment and chronic muscle and joint pain relief, it’s been my experience that when people feel pain, most often they look for symptomatic treatments for the affected area only. However, that starts a pain chasing cycle. It is far more effective to identify and change the underlying posture and function imbalances that are the true cause of the pain problem.
One bad posture position that used to be associated with old age is forward head posture (FHP), better known as “text neck” or “iPosture.” Today, FHP is prevalent among people of ALL ages, including young children. Our comfort and technology driven lifestyle has us spending hours of time looking down at our devices or sitting at a desk with shoulders rounded and heads jutting forward at a screen. It shouldn’t surprise us that many people are developing bad posture. Your head is attached to your upper back by the cervical spine. When we adopt postures causing the upper back to round forward, your head has no other option but to move with it.
FHP is becoming so common and habitual, most of us think it is “normal” or we can’t see it at all. It is associated with a myriad of chronic pain conditions such as migraines/headaches, TMJ, pinched nerves, arthritis in the neck to lower spine and muscle/joint strain in the jaw, neck, shoulders and back. Any of these can severely hinder activities of daily living and athletic performance because they affect our function, mobility and flexibility.
What Is Forward Head Posture (FHP)?
It is estimated that for every inch that your head protrudes forward from its optimal alignment, you add 10 to 15 extra pounds of force on the neck (1). FHP occurs when the head begins to jut too far forward and is no longer aligned with the shoulders. A person with good posture will ideally have the head balanced in all three planes of motion relative to a fixed plumb line. It is not tilted, retracted, rotated or forward of the plumb line, with the eyes level on a vertical and horizontal plane. In the side view, the earlobe sits vertical to the acromion process of the shoulder (2).
In reality, most of us have some amount of FHP because any imbalances in the four major load joints will cause a change in the pelvis and spine, causing the head to self-adjust its position to compensate for them. If you are an athlete struggling with persistent neck, upper/lower back, elbow and/or wrist pain, you may be dealing with FHP. Not sure if this is you? Check your posture.
As a CES, I always tell my clients two things:
- You can’t change what you are unaware of
- You can’t fix what you can’t feel
Here are two simple tests to help you assess if you have FHP:
1. Posture Photos
Ask a friend to take a side profile photo of you right now. You should be able to draw a vertical line straight up from the ground with that line passing just in front of the ankle bone, directly up through the center of your knee, just behind the hip joint, through the center of your shoulder and center body of the earlobe. You should not see dramatic curves in the spine, but a nice “S” shape to it. Compare your profile to this description and assess your position. You may be shocked and surprised to see where your head is sitting relative to the rest of your body.
2. Stand at the Wall Test
Stand up with your heels one to two inches from the wall, with your legs straight and the bottom, backs of your shoulder blades against the wall. If you are straining in any area to stand up straight in this position, you are experiencing a newfound awareness of imbalances in your sagittal plane (front-to-back). Notice your head position. Does the back of your head naturally come in contact with the wall? If you have to force it to be there or your chin or nose are pointing up toward the ceiling or angled to one side of the body or the other, you are feeling the effect of FHP.
A person with forward head posture will also have other noticeable posture imbalances, including:
- Rounded shoulders and upper back
- Internal humerus (humerii) with the back of one or both hands showing
- Head forward of shoulders
- Scapular position and function imbalances
- Torso muscle imbalances
Because the body parts work collectively and not independently, these spinal, joint and muscle imbalances affect the entire kinetic chain. Unless an individual is working to address and correct this faulty postural position, exercise alone will not correct the positioning.
In fact, in my professional experience, an athlete is highly likely to build strength on this faulty position. Unless it is addressed, athletes of all abilities place themselves at risk of unnecessary stress, strain and potential for injury. Thankfully, FHP can be reversed with a simple plan of self-myofascial release, stretching and corrective exercise.
How to Correct Bad Posture
The following is a generic example of a corrective exercise plan designed to address basic FHP. As with any form of exercise, things can get lost in translation. If you are struggling with any of these exercises, do not work through strain. It isn’t the exercise itself that isn’t working. You may better benefit from seeking help from a certified professional in your area who can build the right sequence of movements for your unique needs.
1. Lacrosse or Tennis Ball Around Shoulder Blade
- Lay on the floor with your knees bent and head resting on the floor. If your head, chin or nose are jutting forward, place a small pillow/pad under your head to provide good support and get your shoulders, neck and head into level alignment with your hips.
- Pull the same arm that the ball will be placed under across your chest and place a lacrosse ball beside anywhere that feels tender on the shoulder blade.
- Find a sore spot and hold to release tension. Hold for 20 to 30 seconds on each sore spot.
- If you feel the tissue change/soften and there is time left, simply move the ball gently to another spot and hold to release tension.
- Do this for a total of two minutes and repeat on the other side.
Modifications: Do this standing with your back against a wall.
2. Lacrosse Ball Between Shoulder Blade and Spine
- Position the lacrosse ball in the area bordering your shoulder blade (scapula), between your shoulder blade and the spine (stay OFF of the spine).
- Lay on the floor with the same set up as exercise one.
- Pull the same arm that the ball is placed upon down by your hip with the palm facing the hip and the thumb facing the ceiling.
- Reach your arm up overhead with the elbow locked. As you do so, rotate the shoulder so that the thumb is pointing down toward the floor and pinky finger is facing the ceiling.
- Oscillate and breathe deeply if you hit “sticky” or “tender” spots. If you feel the tissue change/soften and there is time left, simply move the ball gently to another spot and hold to release tension.
- Do this for a total of two minutes, then repeat on the other side.
Modifications: Do this standing with your back against a wall.
3. Double-Arm Corner/Doorway Stretch
This stretch sequence helps lengthen muscles of the chest and the front shoulders and allows you to open the chest.
- Stand in a corner with your feet pointing straight ahead and stacked directly underneath your hips, or in an open doorjamb with one foot inside the doorjamb and one foot outside of it.
- Place the palms of your hands and your forearms on the doorjamb so that your elbows are bent to 90 degrees. The upper arms should be level with the shoulders.
- Lightly engage your abdominal muscles and gluteal muscles (corset your spine) in a hollow spine position.
- Keep your chest high, head pulled back without straining, gazing straight ahead and do your best to avoid shrugging your shoulders.
- Lean your upper body through the doorjamb or forward if using a corner of two walls, until you feel the stretch in your chest area. Hold this position for 45 to 90 seconds. Repeat this exercise with (a) your arms extended overhead, slightly wider than shoulder distance apart with palms flat, and (b) with your arms straight down by your sides, slightly wider than hip distance apart with the palms facing the wall.
4. Foam Roller Sequence
Lying down on a vertically positioned foam roller, with your knees bent, feet flat on the floor and head supported on the roller (use a pad or towel to level out the head and neck as necessary), perform 90 seconds to two minutes of each of the following positions:
- Hand down by sides, palms open facing the ceiling (small “i”)
- Arms extended out to the sides, level with shoulders, palms facing the ceiling (“T”)
- Arm extended overhead, wider than shoulder distance apart with thumbs touching the floor, palms facing each other (“Y”)
- Arms straight overhead, shoulder distance apart with thumbs touching the floor, palms facing each other (capital “I”)
- Bend the elbows and lower arms into a (“W”) position. Hands will be slightly wider than the elbows and ideally elbows will touch the floor. Palms are open to face the ceiling. If they do not, place yoga blocks underneath the elbow for stability/support
- Brachial plexus stretch
- Add eight to 10 Snow Angels
- Add eight to 10 Pull-Overs
5. Standing at a Wall with Scapular Presses
This exercise helps re-position the shoulders, promote normal thoracic extension, and allow the head to move independently of the thoracic and cervical spine.
Stand against a wall with your feet one to two inches away, with the bottom, shoulders and head against the wall. If you are straining to get your head to touch, or your chin/nose are poking upward, let your head come off the wall slightly and simply think of pulling the back of the head back. Your feet should be pointing straight ahead, about six inches apart and legs as straight as you can get. (Do not push the back of your knees to the wall. Simply think straight.)
Use your shoulders to pull the arms back against the wall with your palms facing forward and back of the hand (knuckles) touching the wall. Do 20 shoulder blade squeezes without strain or shrugging the shoulders up toward the ears. Think of pulling the shoulder blades back toward the wall and slightly down toward the hips.
Pause for a moment, then allow your head and neck to flex forward toward your chest, WITHOUT letting your shoulder come forward off the wall. Do another 20 shoulder blade squeezes with your palms in the same position, pausing every five repetitions to see if the head and neck will further release forward without the shoulders coming off the wall. At the end of 20 repetitions, bring your head back up to the back of the wall or to your best position.
- Repeat step #1, but this time have the back of the hand on the wall. Remember to use your shoulders to pull them into this position, with your knuckles facing forward. Do 20 shoulder blade squeezes.
- Repeat step #2, but with the back of the hand on the wall.
Postural improvements take some time. Remember that your forward head position didn’t appear overnight. It’s an accumulation of a lifetime of daily habitual posture. These exercises will improve your function and reduce symptomatic pain and with time, help correct your bad posture, so be patient and persistent. Take new photos in six to eight weeks’ time and compare them with your first ones.
Do not work though strain. It is important to only work through muscular discomfort that is new and unfamiliar. If you have any old, symptomatic pain with any of these movements, remember it is not the exercise itself that is the problem. It’s the posture/body going into the movement, or how it is being performed. If you have serious pain, seek the help of a CES in your area.
Try doing the Standing at Wall exercise in front of a mirror to ensure you are setting up and performing it with the best position possible. This will make it easier to see and stop unnecessary incorrect movements that will prevent correction.
Try to stand up more frequently thought your day if you have to sit at a desk or consider investing in a sit-stand desk. If you have to sit, ensure that the top third of your computer monitor is at eye level and adjust the height of your chair so that your feet can rest comfortably on the floor with your knees about six inches apart and bent at a 90 degree angle to the level of your hips. Keep your feet stacked flat on the floor about six inches apart. (Get a foot rest if needed.)
Bring your keypad level with your elbows when bent (also at 90 degrees relative to the shoulders). Instead of sinking into your chair rest, try to sit forward at the edge of your chair with your back in good alignment, shoulders stacked over the center of your hips. Periodically set your timer for a seated posture break and bring some awareness of how straight your back is when you sit and adjust any slouching and forward head positions. Take regular breaks away from your computer and walk around and stretch often.
1. “Assessment of stresses in the cervical spine caused by posture and position of the head.” Hansraj, K.K. 2014.
2. “Muscles: Testing and Function with Posture and Pain.” Kendall, FP and McCreary, EK. 2005.