How to Fix Forward Head Posture and Regain Proper Alignment
Dec 12, 2024
Does your head feel heavy? You're not alone if you often notice your head jutting forward or your neck feels stiff and achy. Many people struggle with forward head posture, which can develop when the head shifts forward from its optimal alignment over the shoulders. This position can become the new normal when we spend long hours sitting at desks, looking down at phones, or hunched over devices.
Over time, forward head posture can lead to various issues, from neck and shoulder pain to headaches and reduced mobility. If this sounds familiar, you're in the right place. In this guide, we'll explore how to fix forward head posture to help you achieve better alignment and reduce discomfort with posture exercises.
Table of Contents
What Is Forward Head Posture?
Forward head posture (FHP) occurs when a person leans forward out of neutral alignment with their spine. When a person maintains good posture, their head aligns vertically with the spine. A person with FHP also typically tilts their head back to look forward. This posture puts a strain on the muscles and bones of the neck. It can also lead to muscle imbalances, as some muscles support more of the load than others.
According to a 2014 study, the forward position of the head puts increasing amounts of weight pressure on the spine. The study found that the head weighs about 10–14 pounds in a neutral spine position but increases in weight as it leans forward: Position of the head Weight of the head 15 degrees 27 lb 30 degrees 40 lb 45 degrees 49 lb 60 degrees 60 lb According to a U.S. National Library of Medicine clinical trial design, the muscles that FHP weakens and lengthens include deep neck flexors, including the longus capitis and longus colli scapular stabilizers and retractors, such as the rhomboids, middle and lower trapezius, teres minor, and infraspinatus.
The muscles that become shortened and overactive include deep upper cervical extensors, such as the longissimus capitis, splenius capitis, cervical multifidus, and upper trapezius shoulder protractors and elevators, such as the pectoralis minor, pectoralis major, and levator scapula With exercise and stretching, a person can reverse FHP and hold their head in a neutral position, in alignment with the spine.
What Causes Forward Head Posture?
People may associate FHP with using electronic devices such as cell phones or computers for a long time. However, any activity that causes a person to lean their head forward for a prolonged period can lead to chronic FHP. Some potential causes of FHP include slouching, sleeping with the head raised, carrying a heavy backpack or purse, driving with a hunched back, sewing, reading in bed, whiplash or other injuries to the spine, weakness in the muscles of the upper back, arthritis, and bone degeneration.
What Are the Side Effects of Forward Head Posture?
Several potential side effects and symptoms are associated with FHP. Advanced stages of FHP can contribute to upper CS compression, which significantly reduces the ability of the first cervical vertebrae (C1) to rotate around the second vertebrae (C2) as it usually would (Pop et al., 2018). Suppose the upper CS loses its ability to rotate. In that case, the middle and lower segments of the CS must attempt to make up for this restriction, which predisposes them to become hypermobile (having the ability to move past a standard range of movement) (Pop et al., 2018).
This can increase the risk of spinal instability, degeneration, and pain (Pop et al., 2018). Other conditions associated with FHP include myofascial trigger points, anterior neck tightness/pain, temporomandibular joint (TMJ) disorders, rounded shoulders, and its promotion of respiratory inefficiency.
1. Myofascial Trigger Points and Headaches
Myofascial trigger points (MTP) are painful regions within a tight band of skeletal muscle and also give rise to referred pain (pain perceived at a different location than the source) (Simons et al., 1999). FHP results in increased load bearing on the musculature in the upper CS, which can reduce pain thresholds and predispose MTP (Hong, 2019; Patwardhan et al., 2018). Overactive musculature and MTPs in the upper CS can predispose and contribute to developing cervicogenic headaches (headaches originating from the neck) (Barmherzig & Kingston, 2019). The posterior and lateral aspects are the most common areas of the head where individuals experience cervicogenic headaches (Barmherzig & Kingston, 2019).
2. Temporomandibular joint (TMJ) disorders
A link also exists between FHP and TMJ function (Chaves et al., 2014; Zafar et al., 2000). FHP contributes to the development of pain in the TMJ region by altering length-tension relationships in head and neck musculature (Chaves et al., 2014). FHP creates excessive tension in the muscles above the hyoid bone, which, in turn, places greater force demands on the muscles that close the jaw (An et al., 2015). Over time, excessive force demands on the jaw muscles can lead to the development of myofascial trigger points and TMJ pain (Fernandez-de-las-Penas et al., 2010).
3. Anterior Neck Tightness/Pain
FHP also increases tension in the musculature located directly above the hyoid bone (a small bone located in the upper neck below the jaw), which can cause this bone to be equipped above its normal resting position. (Zheng et al., 2012). This can contribute to the onset of anterior neck tightness, pain, and other symptoms, such as difficulty swallowing food (An et al., 2015; Zheng et al., 2012). Restoring postural alignment of the head and neck has been demonstrated to reduce myofascial symptoms by re-establishing normal hyoid bone position (Pettit & Auvenshine, 2018).
4. Rounded Shoulders and Upper Back
Many individuals with FHP also demonstrate anterior rounding of the shoulders and upper back. FHP is associated with overactivity of the upper trapezius and levator scapulae muscles. This condition can contribute to rounded shoulders and negatively impact the normal movement patterns of the humerus and scapula (a condition known as scapular dyskinesis)(Bayattork et al., 2019).
Rounding of the shoulders also predisposes to shoulder pain and impingement (Bayattork et al., 2019). The thoracic spine, especially the upper thoracic region, contributes to neck mobility (Tsang et al., 2013). Increased thoracic kyphosis (excessive anterior rounding of the upper back) can also promote hyperextension in the upper CS, leading to neck pain and stiffness (Roussouly, 2011).
Additionally, a forward-held head, rounded shoulders, and excessive TK predisposes contracture (shortening) of the pectoral muscles, which also negatively affects overhead reaching ability (Olszewska et al., 2018). If both FHP and rounding of the shoulders co-occur, this postural distortion is known as upper crossed syndrome (Janda, 2002).
5. Respiratory Inefficiency
Another negative influence of sustained FHP is the promotion of respiratory inefficiency. Normal inspiration (breathing in) is initiated by the contraction of the primary respiratory muscles- the diaphragm and external intercostal muscles (Kenney et al., 2015).
However, in individuals with FHP, the diaphragm's muscle activity and function may decrease, which can reduce lung expansion during inspiration (Okuro et al., 2011). To compensate for impaired diaphragm muscle power, individuals with FHP may utilize accessory respiratory muscles such as the sternocleidomastoid (SCM) muscle to inspire air (Okuro et al., 2011).
Excessive SCM activity when breathing at rest can cause an individual’s shoulders and rib cage to move up and down rather than remain stationary (Okuro et al., 2011). Correction of FHP has been demonstrated to improve respiratory function and efficiency (Kim et al., 2015).
How To Check If You Have Forward Head Posture
Here are three tests to check if your head is protruding forward. X-Ray Scan Request an appointment with your doctor to obtain a lateral view X-ray scan of your cervical spine. The Craniovertebral Angle is formed by creating lines from the Tragus (part of the ear) to the C7 spinal process, then drawing a horizontal line that passes through a C7 vertebra. A value around 50 degrees would be considered normal.
Forward Head Posture Test Instructions
Keep your back completely against the wall. Ensure that your pelvis and shoulder blades are touching the wall. Do not over-arch your lower back. Do not tilt your head backward. Does your head back touch the wall while standing in this position without making any additional movements?
Results
If your head does not touch the wall behind you without trying, it may indicate you have a Forward Head Posture.
Side Profile Instructions
Please take a photo of yourself from the side. Draw a line down the torso in the middle, starting from the ear canal. This line should be parallel to the midline of the torso.
Results
You may have a Forward Head Posture if your ear canal's line is ahead of your torso's.
Related Reading
• Is Good Posture Attractive
• What Good Posture Looks Like
• Does Good Posture Make You Taller
• Symptoms of Bad Posture
• Does Running Improve Posture
• Posture Exercises for Seniors
How to Fix Forward Head Posture
Change Your Environment to Fix Forward Head Posture
Any ergonomic changes to your workspace, environment, or lifestyle habits that make sitting or standing upright more comfortable will help reduce the risk of forward head posture. However, there might need to be more. A 2017 study comparing targeted exercise to workstation modification for reducing office-related neck, shoulder, and back pain found that exercise was more effective.
Use The Corrective Exercise Continuum to Improve Forward Head Posture
Corrective exercise techniques to address postural and movement dysfunctions can help prevent the negative impacts of FHP. Below are the steps of NASM’s (National Academy of Sports Medicine) Corrective Exercise Continuum.
Important
The specific pain treatment is well outside a fitness professional’s scope of practice. If your client is experiencing neck pain, it is essential that the fitness professional stay within their scope of practice by referring them to a licensed healthcare professional to diagnose and treat their condition and clear them from participating in fitness programs.
Step 1: Inhibit Overactive Muscles
Self-myofascial release
Daily, 1 set. Hold tender spots for 30-90 seconds, depending on the intensity of application.
Important
Several areas of the body should be avoided when using a foam roller for self-myofascial release due to the risk of causing pain or potential injury in the structures below the skin. The CS is an excellent example of a contraindicated region for foam roller use due to its sensitive nature. To ensure client safety, it is also recommended that the fitness professional address inhibition of the sternocleidomastoid and suboccipital by utilizing the self-applied pressure technique rather than using instrument-assisted devices.
Foam roll the thoracic spine (Do not foam roll the cervical spine)
Perform instrument-assisted self-myofascial release for the levator scapulae and upper trapezius (Do not foam roll)
Perform self-applied pressure to the SCM and suboccipital
Step 2: Lengthen Shortened Muscles
Perform static stretching of shortened muscles: Daily, 1-4 repetitions, 20-30s hold.
Step 3: Activate Underactive Muscles
Supine Chin Tuck and curl
The supine chin tuck and curl exercise targets activation of the deep cervical flexors, which are commonly underactive in individuals with forward head postures.
Beginner
Instruct the client to perform a chin tuck (moving their chin straight back).
While maintaining the chin tuck position, instruct the client to contract their deep neck flexor muscles by attempting to lift their head off the towel roll; however, their head should not raise off the towel; instead, they are performing an isometric contraction of the deep flexor muscles.
NASM recommendations for positional isometric exercises include one set of four repetitions, holding the isometric contraction for four seconds during each repetition, and two seconds of rest between contractions.
Intermediate
In step 2, the client lifts their head 1 inch off the towel roll, holds it for 2 seconds, and then lowers their head back to the towel roll in 4 seconds. The client performs 3-5 repetitions, gradually progressing to 10 repetitions as strength is gained.
Advanced
In step 2, the client lifts their head 2-3 inches off the towel roll, holds it for 2 seconds, and then lowers their head back to the towel roll in 4 seconds. The client performs 3-5 repetitions, gradually progressing to 10 repetitions as strength is gained.
Important
The fitness professional should NOT apply direct pressure to the client’s head during this exercise.
Chin Tuck
The chin tuck exercise activates the cervical erector spinae (cervical extensors), which is commonly underactive in individuals with forward head posture.
Instruct the client to place two fingertips on their chin.
Instruct the client to apply light pressure in the posterior direction with their fingertips to help guide their head posteriorly to tuck their chin (and head) in this same direction, moving out of the forward head posture.
Following the NASM isolated strengthening cadence, clients isometrically hold their heads in the tucked position for 2 seconds and then return them to the starting position in 4 seconds. Using NASM recommendations for isolated strengthening exercises, the client can perform 1-2 sets of 10-15 repetitions, 3-5 days per week.
Note
Once the client understands how to perform this exercise correctly, it can be performed without using fingertips on the chin.
Progression - Chin tuck with band
After the client has been performing the chin tuck exercise below for at least two weeks, a chin tuck with band resistance can be implemented. This exercise activates and strengthens the cervical erector spinae (cervical extensors), commonly underactive in individuals with forward head posture.
Provide the client with an exercise band 4 to 5 feet long. (Important: Begin with a light resistance band and gradually progress to heavier resistance bands.)
With the client seated, assist them in placing the middle portion of the exercise band around the back of their head while holding on to the end band with their hands in front of them at eye level. In this starting position, their shoulders and elbows should be flexed at a 90-degree angle (as shown in the image).
Instruct the client to perform a chin tuck against the band's resistance while extending their elbows (as shown in the second image).
Following the NASM isolated strengthening cadence, clients will isometrically hold their heads in the tucked position against band resistance for 2 seconds and then return them to the starting position while flexing their elbows back to a 90-degree angle in 4 seconds. Using NASM recommendations for isolated strengthening exercises, the client can perform 1-2 sets of 10-15 repetitions, 3-5 days per week.
Scapula Retraction in Prone
The scapula retraction in prone exercise activates and strengthens the rhomboid muscles, which are commonly underactive in individuals with rounded shoulders and forward head postures.
The client lies prone, face-down. The client’s arms are relaxed by their side.
Instruct the client to “squeeze their shoulder blades together” while raising their arms approximately 2 to 3 inches off the floor.
Following the NASM isolated strengthening cadence, clients isometrically hold this position for 2 seconds and then slowly return to the starting position in 4 seconds. Using NASM recommendations for isolated strengthening exercises, the client can perform 1-2 sets of 10-15 repetitions, 3-5 days per week.
Progression 1
This first progression of the scapula retraction in prone exercise also activates and strengthens the rhomboid muscles, which are commonly underactive in individuals with rounded shoulders and forward head postures. Modifying the arm position increases the difficulty of this exercise and activates the rhomboid musculature.
The client lies prone, face-down. The client’s arms are resting on the floor in the following position: shoulders abducted (moved away from their side) to a 90-degree angle, elbows are flexed to a 90-degree angle.
Instruct the client to raise their arms approximately 2 to 3 inches off the floor and “squeeze their shoulder blades together.” Following the NASM isolated strengthening cadence, clients will isometrically hold this position for 2 seconds and then slowly return to the starting position in 4 seconds. Using NASM recommendations for isolated strengthening exercises, the client can perform 1-2 sets of 10-15 repetitions, 3-5 days per week.
Progression 2
This second progression of the scapula retraction in prone exercise also activates and strengthens the rhomboid muscles, which are commonly underactive in individuals with rounded shoulders and forward head postures. Modifying the arm position further away from the body makes the exercise substantially more complex, allowing for greater activation of the rhomboids.
The client lies prone, face-down. The client’s arms are resting on the floor in the following position: shoulders abducted (moved away from their side) to a 90-degree angle, elbows are extended (straight).
Instruct the client to raise their arms approximately 2 to 3 inches off the floor while “squeezing their shoulder blades together.”
Following the NASM isolated strengthening cadence, clients isometrically hold this position for 2 seconds and then slowly return to the starting position in 4 seconds. Using NASM recommendations for isolated strengthening exercises, the client can perform 1-2 sets of 10-15 repetitions, 3-5 days per week.
Step 4: Integrate Dynamic Movement Patterns
Ball Tuck Chin Combo
Instruct your client to lie in a plank position on an exercise ball under the abdomen. The client’s shoulders are abducted to 90 degrees, elbows extended, and hands resting on the floor, holding a lightweight.
Instruct the client to perform a chin tuck and then move their arms up toward the ceiling until they are horizontal to the floor. The client should return their head to a neutral position between each repetition.
Using NASM recommendations for integration exercises, the client can perform 1-3 sets of 10-15 repetitions (using a slow and controlled repetition duration) 3-5 days per week.
Ball Squat to Scaption
The client holds light dumbbells in their hands. Instruct the client to descend into a squat using an exercise ball behind the thoracic spine. The client’s arms should remain by their side with elbows extended during the descending phase.
Instruct the client to ascend to the upright standing position while raising their arms upward in the scapular plane until their arms are parallel with the ground (this plane is approximately 30-45 degrees anterior to the frontal plane—see photo).
Using NASM recommendations for integration exercises, the client can perform 1-3 sets of 10-15 repetitions (using a slow and controlled repetition duration) 3-5 days per week.
Squat to Row
The client stands with feet side-by-side, shoulder width apart, and places one hand on their hip.
The client holds to a cable handle with the opposite hand shoulder flexed to 90 degrees and elbow extended.
The client descends into a squat position.
The client returns to a standing position while performing a one-arm row. After the set, the client repeats the above steps to integrate the opposite side of their body.
Using NASM recommendations for integration exercises, the client can perform 1-3 sets of 10-15 repetitions (using a slow and controlled repetition duration), 3-5 days per week.
Single-Arm Row to Arrow Position Start and Finish
Instruct the client to take a split stance, putting one foot forward and one hand on their hip.
The client holds a cable handle with their opposite hand, shoulder flexed to 90 degrees, and elbow extended. (For example, if the left foot is forward, the client uses their right hand to row.)
The client performs a single-arm row while rotating their trunk approximately 90 degrees toward the side of the body performing the row.
The client returns to the step 2 position. After the set, the client repeats the above steps to integrate the opposite side of their body.
Using NASM recommendations for integration exercises, the client can perform 1-3 sets of 10-15 repetitions (using a slow and controlled repetition duration), 3-5 days per week.
Additional Corrective Strategies for Tech Neck
The more aware we are of the problems and solutions with tech neck in ourselves, the better we can support our clients. Take time to practice the NASM Corrective Exercise Continuum on yourself using self-myofascial release, static stretching, focused strengthening exercises, and integrated dynamic movements. Below are examples from each stage of the continuum. Apply the model to your clients once you feel confident in the approach.
Muscles targeted
Upper trapezius, levator scapulae, sternocleidomastoid (SCM).
Self-Myofascial Release
Add corrective strategies to the mix by using self-myofascial release (i.e., teach clients how to do this). Target the upper trapezius and levator scapulae with a small ball or tools like a Backnobber® (backnobber-store.com) or Thera Cane® (theracane.com). Find tender spots along these muscles and hold pressure against each spot until the tenderness has subsided (30–60 seconds).
Static Stretching Lengthen
Static Stretching Because sensitive nerves and blood vessels are located in the neck near the SCM, use static stretches for this area (SCM, scalenes, levator scapulae) instead of SMR. Hold for 30 seconds.
Quadruped Activate: Strengthening Exercise
While on all fours, let the head drop toward the floor in the forward-head position. Then, retract the head into a neutral position, drawing a straight line from ears to shoulders to hips. The quadruped position allows the exercise to be done directly against gravity, providing more resistance than is possible in the standing position. Do 10–15 reps with a 2-second isometric hold. Note: This exercise does not call for heavy resistance to weigh down the head and “muscle it” out of the tech-neck form. Frequent repetition of lightly resisted movements is needed to train the nervous system to encode a new pattern. This exercise is very effective and can be performed easily without equipment.
Pushup Integration Integrate: Solidify and Coordinate
Integration exercises are often full-body moves that focus on the area being addressed. Pushups are a good choice as they put the head and neck in the same position as the activation exercise listed above but with added work. It is essential to cue clients to focus more on the head and neck position and less on how many pushups they can do. Modify the exercise to meet each client’s needs. Aim for 10–15 reps.
Related Reading
• How Can Poor Posture Result in Back Pain?
• How Long Does It Take to Fix Forward Head Posture
• How to Improve Shoulder Posture
• Best Posture for Reading
• Best Posture for Gaming
• Best Sitting Posture on Floor
• Physical Therapy for Posture
Things To Avoid While Suffering From Forward Head Posture
The Pillow Dilemma and Forward Head Posture
If you suffer from forward head posture, avoid using a too-high pillow. A pillow that is too high can push your head forward and increase the strain on your neck and spine. When sleeping, your head and neck should stay aligned with the rest of your spine. If you sleep on your side, a pillow that is too high will equip your head, causing it to tilt unnaturally and creating a forward head posture. Instead, look for a firm pillow with a low profile or cut-out area to cradle your head. If you sleep on your back, use a pillow that supports the natural curve of your neck without propping your head up too high.
The Trouble with Uneven Weight Distribution
Carrying heavy backpacks or bags on one shoulder can worsen forward head posture. This habit can lead to uneven weight distribution and strain on one side of your body. Instead, try to distribute weight evenly on both sides of your body. For example, if you must carry a backpack, wear both straps to distribute the weight evenly. If you must take a bag, switch off between shoulders frequently to avoid muscle imbalances.
The Downside of Tech Neck
Avoid texting or using a smartphone for long periods. Looking down at your smartphone or other devices for long periods can cause your neck to flex forward and contribute to forward head posture. Instead, hold your phone up to eye level. If you use a tablet or laptop for work, adjust the height of your device so that you don’t have to look down at it.
Why High-Impact Exercise Is a No-Go
High-impact exercises requiring a lot of jumping or jarring can worsen forward head posture. They can also strain your neck and spine. If you are suffering from forward head posture, try to avoid or modify these exercises until your symptoms improve. You can consult a physical therapist or certified personal trainer to help you find safer alternatives.
Watch Your Form When Lifting Weights
Lifting heavy weights with poor posture can strain your neck and spine. If you struggle with forward head posture, correct your form before lifting heavy weights to avoid worsening your condition. If you can’t seem to correct your form, ask a trainer for help.
Improve Your Posture with Our Posture Correction App
Posture AI's posture correction app transforms your posture and well-being using advanced AI technology and your smartphone camera. Our app provides personalized posture analysis, expert-guided exercises, and progress tracking to help you move and feel better. Simply take front and side photos, and our AI generates detailed reports with tailored improvement plans. Features include instant posture scanning, AI-powered analysis, customized exercise programs, and progress monitoring. Whether looking to prevent long-term issues, reduce daily discomfort, or boost confidence, Posture AI offers an affordable, at-home solution for better alignment. Skip expensive treatments and transform your posture with just a few minutes of guided daily exercise.
Related Reading
• Exercises for Better Posture
• How to Fix Posture
• How to Fix Neck Posture