Forward Head Posture

Introduction[edit | edit source]


Because of the rising popularity of media devices such as smartphones and computers, frequent users often exhibit incorrect posture.

Forward head posture (FHP) is a poor habitual neck posture. It often co-exists with Upper Crossed Syndrome

  • Defined by hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae.[1]
  • Thoracic Kyphosis is a complication of the combination of slouched-forward shoulders and rounded upper back.
  • Can lead to a painful shortening of the muscles of the back of the neck, as well as compression of the cervical vertebrae—the uppermost portion of the spine that supports the head and protects the spinal cord.

Due to the increased compressive forces through the neck joints and increased muscle tension, pain is the common outcome. Some of the types of problems associated with FHP are:

  • Headaches
  • Neck discomfort
  • Muscle tension in the neck and shoulders
  • Discomfort in the mid back
  • Chest pain
  • Pain, pins & needles and numbness in the arms and hands

Many people develop chronic or recurrent problems because they receive treatment for the pain (e.g. pain killers or anti-inflammatory medication) but never receive treatment for the underlying cause which is their FHP.[2] This 4 minutes video is a brief summary of FHP


Forward Head Posture - Effects on Health[edit | edit source]

FHP evaluation is clinically important for diagnosis and rehabilitation treatment.

  • FHP increases compressive loading on tissues in the cervical spine, particularly the facet joints and ligaments.
  • Studies have reported that symptoms including neck pain, headache, temporomandibular pain, and musculoskeletal disorders are related to FHP
  • FHP greatly influences respiratory function by weakening the respiratory muscles[1].
  • FHP can have a negative impact on static balance.[4]
  • Forward head and round-shoulder postures (FHRSP) can result in shoulder pain and dysfunction because of altered scapular kinematics and muscle activity and consequently, consequently placing increased stress on the shoulder.[5][6]
  • In the posterior cervical muscles there is stretching and weakness of Semispinalis cervicis and overaction with ultimate shortening of Semispinalis capitis. The corresponding flexor muscles in front, namely, Longus cervicis and Longus capitis shorten and lengthen respectively.[6]
  • There is new evidence that there is no relation between FHP and neck pain; additionally, individual with neck pain had lower range of motion (ROM) and slower neck movement.[7]

Epidemiology/ Etiology[edit | edit source]

The overall prevalence of neck pain in the general population is high, reaching 86.8%.[8]

Risk factors associated with forward head posture include female gender, older age, being an ex-smoker, high job demands, and low social or work support.[8]

Etiologies include:

  • Occupational posture: forward or backward leaning of head for long durations, slouched or relaxed sitting, faulty sitting posture while using computer or screen.
  • Effect of gravity: slouching, poor ergonomic alignment.
  • Other faulty postures like pelvic and lumber spine posture.
  • Sleeping with head elevated too high.
  • Poor posture maintained for long durations.
  • Lack of development of back muscle strength.

Clinical Findings[edit | edit source]


  • Muscle ischemia, pain and fatigue
    Head 1.jpg
  • Decreased range of motion of cervical spine[9]
  • Early disc degeneration and osteophyte formation
  • Temporomandibular joint pain and inflammation
  • Tension Headache
  • Increase in dorsal kyphosis and decrease in height
  • Decrease in vital capacity and range of motion of shoulder and arm
  • Possible protrusion of nucleus pulposus and nerve compression

Assessment[edit | edit source]

Assessment of FHP is important to assess the impact of the therapeutic interventions.

  • Clinical assessment of FHP is done through observation of the position of the head relative to the reference anatomical landmarks.
  • Radiographic techniques can be used to measure postural angles, but it is not always practical.
  • The craniovertebral angle is one of the most reliable methods and common angles for evaluating the FHP. It examines head status relative to the seventh cervical vertebrae (C7). [13]

Physiotherapy Management[edit | edit source]

  • Postural Alignment, Balance and Gait:
    1. Cervical Retraction
    2. Scapular Retraction
    3. Balance Training ( If dysfunction presents)
  • Range of Motion, Joint Mobility and Flexibility[14]
    1. Cervical Range of Motion Exercises
    2. Shoulder Range of Motion Exercises
    3. Cervical Traction
    4. Thoracic Manual Techniques and exercises
    5. Stretching Exercises of tight structures- Trapezius, Scalenes, SCM, Pectoralis Major and Minor.
  • To reduce spasm
    1. Myofacial release
    2. Ischemic Compression
    3. Positional release technique (to relieve tension headache)
  • Muscle Strength and Endurance
    1. Cervical isometric strengthening exercises (initial phase) progressing to isotonic and dynamic strengthening exercises.
    2. Strengthening exercises for scapular retractors (Rhomboids, middle Trapezius).[15]
  • strength neck ex
    Ergonomic Advice
  • correct number of pillows used
    • postural corrections
      scapular strength ex
      srength ex

Outcome Measures[edit | edit source]

Occiput to Wall


References[edit | edit source]

  1. 1.0 1.1 Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. Effect of forward head posture on thoracic shape and respiratory function. Journal of physical therapy science. 2019;31(1):63-8. Available from:$=relatedreviews&logdbfrom=pmc (last accessed 23.4.2020)
  2. Centralcity Health professionals FHP Available from: (last accessed 23.4.2020)
  3. B Bradley Corrective Exercise for Forward Head Posture and Upper Crossed Syndrome Available from: (last accessed 27.4.2020)
  4. Lee JH. Effects of forward head posture on static and dynamic balance control. Journal of physical therapy science. 2016;28(1):274-7.
  5. Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC musculoskeletal disorders. 2019 Dec 1;20(1):86.Available from:
  6. 6.0 6.1 Burt HA, Effects of faulty posture; President's Address. Proc R Soc Med. 1950; 43(3):187–194. Accessed 26 February 2019.
  7. Hilla Sarig Bahat, Andrei Levy & Tomer Yona (2022) The association between forward head posture and non-specific neck pain: A cross-sectional study, Physiotherapy Theory and Practice, DOI: 10.1080/09593985.2022.2044420
  8. 8.0 8.1 Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The relationship between forward head posture and neck pain: a systematic review and meta-analysis. Current reviews in musculoskeletal medicine. 2019 Dec;12(4):562-77.
  9. Kim DH, Kim CJ, Son SM. Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion. Osong public health and research perspectives. 2018 Dec;9(6):309.
  10. Weon JH, Oh JS, Cynn HS, Kim YW, Kwon OY, Yi CH. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork and movement therapies. 2010 Oct 1;14(4):367-74.
  11. Kisner C, Colby LA. Therapeutic Exercises. Fifth Edition. USA: F.A. Davis Company.2007. p384-404.
  12. Levangie PK, Norkin CC. Joint Structure and Function. Fifth Edition. USA: F.A. Davis Company. 2011. p501-37
  13. Salahzadeh Z, Maroufi N, Ahmadi A, Behtash H, Razmjoo A, Gohari M, Parnianpour M. Assessment of forward head posture in females: observational and photogrammetry methods. Journal of back and musculoskeletal rehabilitation. 2014 Jan 1;27(2):131-9.
  14. Szczygieł E, Sieradzki B, Masłoń A, Golec J, Czechowska D, Węglarz K, Szczygieł R, Golec E. Assessing the impact of certain exercises on the spatial head posture. International journal of occupational medicine and environmental health. 2019 Feb 27;32(1):43-51.
  15. Im B, Kim Y, Chung Y, Hwang S. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. Journal of physical therapy science. 2015;28(3):951-5.