The human race has made some amazing technological strides in recent years. Think about it: how many intricate electronic devices do you use in the run of a day? Chances are you wake up to an alarm each morning on your smartphone, listen to music on a tiny mp3 player at the gym, and maybe check your email from a tablet during a coffee break. You might work in a cubicle in front of a computer, or at least a decent percentage of your work day probably involves looking at a computer screen. After work, perhaps you take a bus or subway home and spend the transit time looking down at your phone; sending texts, checking social media accounts, and online window shopping. Thanks to some very talented software engineers, we are able to document every minute of our lives and have the answers to all of our questions at our fingertips.
Unfortunately, with the rise of smartphones and desk jobs in our midst, we have also seen a recent surge in the prevalence of “forward head posture”, a postural condition where the cervical spine adopts a forward-leaning misalignment and can cause mild to severe neck and upper back pain 1. It can also progress into other postural conditions such as the similar upper crossed syndrome and lower back pain. Also known as “texting neck”, forward head posture is commonly found in those with seated desk jobs, poorly designed working conditions, and excessive smartphone use 2. Luckily, forward head posture can be prevented or even corrected with therapeutic exercises and stretches that target the supportive musculature of the neck. Let’s take a closer look at what forward head posture is and get into some of the preventative and corrective measures you can take to fix it. Of course, if you are unsure or feel any pain while performing any exercise, stop and seek the advice of a healthcare professional.
Your human head weighs around 10 pounds, and when standing upright with perfect posture, it is stacked evenly over your cervical vertebrae, down your thoracic and lumbar spine, over your pelvis and finally down through your legs into the center of your feet (3). That 10 pounds of skull won’t feel all that heavy when your joints are stacked. The musculature of your neck acts like guy wires in all directions with no particular muscle group doing more work than the others at any given time (4). Now picture yourself looking down at your phone with your head tilted down and sagging forward. Your skull and vertebrae are no longer stacked, and the musculature in your neck and upper back now has to work isometric overtime to hold your head in that position (5). Over time, this will develop into a constant forward head posture. Your neck vertebrae will start to creep out on an angle so that your ears are always in front of your shoulders. The muscles in the back of your neck will lengthen and weaken and their fascia will thicken, leading to soreness and knots. The muscles in the chest and front of the neck will shorten. You may start to develop neck pain, headaches, or tingling in your hands 5. You won’t even stand as tall as you did before.
The first key to preventing forward head posture is to take inventory of your postural habits. Have someone take a picture of you sitting and standing normally. Are your ears over your shoulders or in front of them? Are your shoulders rounded forward or pulled back and down to open the chest? Having these pictures can give you clues as to where to start with your prevention or correction program and also show your progress over time. It is recommended to use the series of exercises described below at least once every day. You may find it easiest and most effective to do the exercises immediately upon waking each morning and again when you are going to bed. These exercises stretch the muscles most commonly shortened in forward head posture and strengthen the muscles that have weakened to bring your head and neck back into alignment 6.
Exercise #1: Seated Chest Stretch
Sit on the floor with your knees bent and your feet flat. Place your hands about a foot behind you and as far apart as your hips. Ideally, your fingers will face forward, but to the side is fine if you don’t have that range of motion yet. Take a soft bend in the elbows. Draw the shoulder blades back and lift the upper chest. Keep your hips on the floor. Draw your chin back so your ears are in line with your shoulders. You should feel this stretch just below your collarbones. The exercise stretches the pectoralis and brachialis muscles. Hold the stretch for 30 seconds and repeat for three repetitions.
For a deeper stretch as you progress with this exercise, you can start to slowly lift the hips straight up and away from the floor. Keep your weight in your heels and maintain your neck alignment. Eventually, your torso and upper legs will come to parallel with the floor.
Exercise #2: Upper Back Pulls On the Wall
Stand facing a wall and place the palms of both hands at least shoulder height high on the wall in front of you. Lean forward into your hands and bend at your hips so you are shaped like an “L”. Squeeze your shoulder blades together and down your back. Pull your chin back so your ears are in line with your shoulders. This exercise trains the middle and lower trapezius muscle fibres to pull your cervical spine back into alignment. Hold the contraction for 30 seconds and repeat for three repetitions.
Exercise #3: Stretching Trapezius and Suboccipital Muscles
While sitting or standing tall, tuck your chin into your chest and look down. Place the palms of your hands on the back of your head and gently press downward. Hold for 30 seconds. Then, rotate your right ear down slightly, maintaining the downward pressure with your hands, to stretch the left side. Hold for 30 seconds. Rotate your left ear down, maintaining downward pressure, to stretch the right side. Hold for 30 seconds. Repeat the sequence three times.
Exercise #4: Chin Retractions
Begin by sitting or standing tall with your chin parallel to the ground. Keeping your chin level, use your index and middle finger on one hand (your “peace” fingers) to gently press your head back, giving yourself a double chin. Relax any tension in your jaw. Take your fingers away and try to keep your head in that position for 20 seconds. Repeat for a total of three repetitions. This exercise will train your neck musculature to retain the “ears-over-shoulders” position for optimal posture.
Prevention and early correction of forward head posture is key to eliminating neck and upper back pain. If you work a desk job, you may find it helpful to adjust your workstation to accommodate your new postural habits 7. Try to raise your computer screen to eye level and keep it about two feet away from your face to encourage proper spinal alignment. Paying close attention to your posture at work and at home, along with performing the above exercises, can help you commit to your health and wellness in just a few minutes a day.
1. Morningstar, M. W. (2003, March 31). Cervical hyperlordosis, forward head posture, and lumbar kyphosis correction: A novel treatment for mid-thoracic pain. Journal of Chiropractic Medicine, 2(3), 111-115. doi:10.1016/s0899-3467(07)60055-x
2. Kang, J., Park, R., Lee, S., Kim, J., Yoon, S., & Jung, K. (2012). The Effect of The Forward Head Posture on Postural Balance in Long Time Computer Based Worker. Ann Rehabil Med Annals of Rehabilitation Medicine, 36(1), 98. doi:10.5535/arm.2012.36.1.98
3. Troyanovich, S. (2000). Structural rehabilitation of the spine and posture: Rationale for treatment beyond the resolution of symptoms. Journal of Manipulative and Physiological Therapeutics, 23(6), 0437-0437. doi:10.1067/mmt.2000.108138d
4. Kebaetse, M., Mcclure, P., & Pratt, N. A. (1999). Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics. Archives of Physical Medicine and Rehabilitation, 80(8), 945-950. doi:10.1016/s0003-9993(99)90088-6
5. Borg-Stein, J. (2002). Cervical myofascial pain and headache. Current Pain and Headache Reports, 6(4), 324-330. doi:10.1007/s11916-002-0055-0
6. Bae, W., Lee, H., Shin, J., & Lee, K. (2016). The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J Phys Ther Sci Journal of Physical Therapy Science, 28(5), 1636-1639. doi:10.1589/jpts.28.1636
7. Tornqvist, E. W., Hagberg, M., Hagman, M., Risberg, E. H., & Toomingas, A. (2009). The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users. International Archives of Occupational and Environmental Health, 82(6), 689-702. doi:10.1007/s00420-009-0396-7