Forward head posture is a common postural fault. The head’s center of gravity rests forward of the normal position when viewed from the side of the body. Now more than ever, this is associated with frequent electronic device and screen use. Neck pain and back pain, as well as headaches, can often be the result.
The further the head sits in front of the shoulders, the harder the muscles in the back of the neck, shoulders, and upper back must work to keep the head upright. In addition to pain in the neck, upper back, and shoulders, forward head posture has been linked to headaches, respiratory impairments, and reduced nerve conduction in the cervical spine.
Aside from general advice to limit screen time and sit up straight, what treatment options might benefit the person with forward head posture?
A 2021 randomized trial compared scapular stabilization exercises (SSE) to no exercise. This was in 39 young women with forward head posture. The exercise group performed SSEs using elastic bands at ten reps a set. They did three sets a day over three days a week for four weeks. The control group did not perform any exercises. Results showed improvement in forward head posture in only the exercise group.
When the head is too far forward, it hurts the muscles, joints, and stresses the nerves.
Another study compared SSE with abdominal control feedback (ACF) in 135 women with forward head posture. They were separated into three groups: SSE and ACF; SSE only; and general exercise. The results showed that the individuals in the SSE and ACF group had the best outcomes. This was with respect to posture, pain, balance, and strength.
In 2019, a study compared mobilization therapy of the neck and upper back with deep neck flexor exercises. The group consisted of 31 patients with forward head posture. The results showed the patients in the mobilization group were more than twice as likely (60% vs 25%) to report significant improvements. This registered for neck posture, pain, and respiratory function.
Two years previous, the same research team compared upper thoracic (UT) mobilization with mobility exercises verses upper cervical (UC) spine mobilization with stabilization exercises. It was done in a group of 32 participants with forward head posture for four weeks. Outcome assessments showed that 11 of 15 patients in the UT group experienced significant overall improvement. Eight of 16 patients in the UC group showed improvement. Additionally, members of the UT group exhibited greater improvement with respect to neck posture.
What does the research tell us?
The results from these studies suggest that specific exercises and manual therapies are
effective for managing the patients with forward head posture. This is especially true when used together.
Doctors of chiropractic frequently use a multi-modal approach when managing patients with
musculoskeletal disorders in order to achieve the best outcome for the patient.
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