Technology is wreaking havoc on our necks and low backs, accelerating our musculoskeletal aging. The mechanical stress placed on the neck associated with collapsed upper back and forward head posture is comparable to the stress on the neck holding a backpack in front of you with your arms extended (elbows locked). Just like the backpack is designed to be on your rib cage, the skull is designed to be on top and in alignment with your rib cage.
Hello, I’m Todd Ball, a Physical Therapist at Healthy Posture Club. We are a digital physical therapy provider, specializing in personalized physical therapy that you can access from the comfort of your home or office. Today, I want to enlighten you about a common, but often misunderstood contribution to neck pain: forward head posture.
Through my extensive experience and evidence-based practice, I have focused the last 8 years of my career on simplifying this very important aspect of physical wellness to inspire and motivate those with neck pain to take positive steps forward. The Healthy Posture Club will safely guide you on your journey to a healthier spine.
What Is Forward Head Posture?
Forward head posture is when your skull is sitting on the anterior aspect of C1. Let’s take a look at the anatomy to get a better understanding of forward head posture.
Occiput
The base of the scull that articulates with the atlas (C1) is call the occiput. It is categorized as a saddle joint, the pedicle at the bottom of the occiput has a convexity similar to a cowboy or cowgirl’s bottom.
Atlas (C1)
The first cervical vertebrae is called the atlas. The top of the atlas has a concave surface similar to a horses saddle. The occiput sits on C1 much like a cowboy or cowgirl sits on the saddle of a horse. Your skull is designed only to rock forward and back on the atlas.
Can Forward Head Posture Cause Headaches?
Yes, forward head posture can cause headaches. As the diagram illustrates, the vertebral artery runs through theC1 and the occiput. Any deviation of the occiput from its neutral position can compress the vertebral artery. The vertebral artery supplies the brain with oxygen. Forward head posture is a common clinical finding with those suffering from chronic headaches. There is research connecting prolonged forward head posture to cognition and memory.
Can Forward Head Posture Cause Neck Pain?
Yes. The anterior positioning of the skull on C1 causes facet loading in the rest of the cervical spine. Your facets are designed to guide motion in the neck, not support the skull. Forward head posture can cause pain in the neck as a result of arthritis in the facets, in addition to causing muscle pain. Overtime forward head posture will progress into a head tilt posture. This overloads the facets even more on the side of the tilt and the soft tissue on the side opposite the tilt. This mechanical overload can cause nerve entrapment and muscle tension. The longer period of time you spend with forward head posture the more you are stressing the ligaments that counteract forward head posture. So, addressing forward head posture is not a consideration in treating neck pain, it is the foundation of any good neck pain treatment protocol. The good news, you can treat your forward head posture safely from the comforts of home with the Healthy Posture Club.
How Bad is Forward Head Posture?
The illustration to the left provides insight into the effects of forward head posture on the upper cervical spine. It places tremendous stress on the joints, muscles, and ligaments of the O-A joint as well as the alar ligament. The effects of expand beyond neck pain and headaches. Cognition, memory and self-esteem are negatively affected. It also places stress on the shoulders and low back.
What Causes Forward Head Posture?
Although sometimes caused by trauma, most forward head posture is caused by collapsed upper back posture (kyphotic posture) associated with the use of technological devices. Your upper thoracic spine supports your neck. When collapsed your skull slides forward on C1 to keep your skull level with the horizon. This is driven by the fluid in your ears and the vestibular system. So, you are not at the mercy of your neck pain!
What is Healthy Neck Posture?
Getting into healthy posture is a little more complicated than pinching your shoulder blades back. And it is definitely not a “Chin Tuck”. This misrepresentation of healthy neck posture only cause more compression through the upper and lower cervical spine, and thereby, more pain.
Healthy neck posture is posture that positions the skull on top of the rib cage and aligns each vertebrae so that they are weightbearing through their vertebral bodies and not facet joints. This allows for equal transfer of load.
You cannot unload the neck from a collapsed posture. You must “Stack the Upper Back™“. This extends the upper thoracic spine and provides a strong support for the lower cervical spine. We refer to this as a Chest Lift®.
Chest Lift® posture establishes a stable foundation for the lower cervical spine which allows you to unload the upper cervical spine through a Head Nod®. Notice I did not use the term “chin tuck”. That is an hyperbolic way of describing what is happening. If you are in Chest Lift posture, then all that is needed to position the skull on its neutral position on C1 is a subtle head nod.
Can You Reverse Forward Head Posture?
Yes. But it requires a structured program that addresses all aspects of your daily routine and a wellness practitioner that is trained in neutral spine conditioning. If you have an active pain condition, such as pain from a bulging disc or facet joint syndrome, a rehabilitative specialist trained in neutral spine alignment is required. In most instances you will have to place a few fitness, sport and/or recreational activities on hold until you condition yourself to perform them from neutral spine alignment.
What Exercises Reverse Forward Head Posture?
As allude to above, there is no one exercise or group of exercises that reverse forward head posture. It takes a structure program that addresses all aspects of your daily routine. At the Healthy Posture Club, we have developed a functional fitness program that combines 6 levels of neutral spine conditioning with proprietary joint clearing techniques to safely restore your ability to function from healthy posture. We have spent the last 8 years refining the communications, exercise progressions and video resources required to reverse forward head posture safely in 6 to 8 weeks.
Check out our blog on How Do I Reverse Forward Head Posture? to learn more about our approach or purchase a $50 Posture Screen to get started.
What Lifestyle Modification are Required to Improve Posture?
It takes a minimum of 6 weeks to safely improve your neck posture. Add a week or 2 for this in an active pain condition or compromised cervical spine. That is if you follow a structured program that includes a daily workout routine, hourly mobility program and adopt the appropriate lifestyle modifications. The Health Posture Club walks you through such a structured routine. Our video-on-demand library consist of 6 levels of neutral spine conditioning combined with proprietary joint clearing techniques to condition you to perform your daily activities from neutral spine alignment.
Weeks 1 – 3
Week 1 you must learn how to get into neutral spine alignment (aka healthy posture). Lifestyle modifications are limited to an hourly mobility exercise, and a 3 minute “Start Your Day Routine.
Week 2 you are conditioning yourself to sit, stand and walk maintaining neutral spine alignment. Lifestyle modification consists of starting each hour in neutral spine alignment without back support when sitting or standing without shifting to the left leg. You are now performing 15 minute daily neutral spine conditioning workouts.
Week 3 you are conditioning yourself to pick objects off the floor and get in/out of chair maintaining healthy neck posture. You have raised your monitor, sleeping with a body pillow and sitting with a wedge pillow. When standing you are on a saddle stool to help you keep equal weight through your feet.
Weeks 4-6
Week 4 you are conditioning yourself to go up and down stairs maintaining neutral spine alignment. You are maintaining healthy neck posture when getting in/out of a chair, picking object off the floor. You are now performing 2 upper body conditioning workouts a week and 2 lower body conditioning workouts a week.
Week 5 you are conditioning yourself to lift objects overhead without losing neutral spine alignment. You are spending 51% of each day in healthy posture. Now and only now are you rewiring your nervous system for functioning from healthy posture. The key now is consistency. You can never look back. What it took to get here is your new life!
Week 6 you are now conditioned to perform fitness from healthy posture. There are 3 levels to safely returning to the traditional fitness regimens maintaining neutral spine alignment. At this level of the Healthy Posture Club, you are choosing 1 of 3 maintenance memberships to be safely guided through these three levels of fitness conditioning.
Check out our blog on How Do I Reverse Forward Head Posture? to learn more about our approach or purchase a $50 Posture Screen to get started.
There is no one exercise or group of exercises and stretches that reverse forward head posture. It takes a structured program that addresses all aspects of your daily routine. How you sit and stand drives your posture. Any program that attempts to reverse forward head posture must transform your sitting and standing posture. This blog is a follow-up to the What is Forward Head Posture?
If you are working with a wellness practitioner or medical practitioner and they are not addressing your forward head posture before strengthening exercises, you may be strengthening your forward head posture.
At the Healthy Posture Club, we have developed a functional fitness program that combines 6 levels of neutral spine conditioning with proprietary joint clearing techniques to safely restore your ability to function from healthy posture. We have spent the last 8 years refining the communications, exercise progressions and video resources required to reverse forward head posture safely in 6 to 8 weeks. This blog is designed to share with you all we have learned in best practices for improving your posture.
Can Stretched Help Reverse Forward Head Posture?
In general, stretching tight neck muscles associated with forward head posture is a waste of time. The muscle tightness is being driven by the nervous system. The faulty posture causes the nervous system to increase the tone of the long neck muscles. This limits mobility throughout the cervical and thoracic spine. So, the most logical place to start correcting froward head posture is hourly functional mobility exercises.
What Exercises Help Reverse Forward Head Posture?
You cannot unload the neck from a collapsed posture. You must “Stack the Upper Back™“. This extends the upper thoracic spine and provides a strong support for the lower cervical spine. We refer to this as a Chest Lift®. So, let’s review a few safe functional mobility exercises that can improve your ability to stack the upper thoracic spine.
Functional mobility exercise focused improving mobility of the upper thoracic spine into extension can significantly reduce the pressure on a pinched nerve in the lower cervical spine by restoring neutral alignment of the lower cervical spine vertebrae. The upper thoracic spine is the primary support for the base of the neck (lower cervical spine). It is important to perform these exercises gently to prevent further nerve damage. It is best to have us walk you through them during a 15 minute “self-care” digital coaching session. Below is a summary of our Level 1 Self-care for Neck Pain workout video.
Hourly Mobility Exercises:
The key to relieving pain from a pinched nerve is to function from neutral spine alignment. The series of mobility exercise below mobilize your upper thoracic spine to allow the vertebrae that is pinching your nerve restore its neutral position.
1. Seated Chest Lift®
The key to treating the foundation of your pinch nerve pain is improving your upper thoracic spine mobility into extension. The cervical spine cannot unload itself when the upper back is collapsed! The seated chest lift exercise is a safe way to unload the neck by mobilizing the upper back.
- Sit at the edge of your chair without back support (healthy sitting strategy)
- Cross your arms across your chest.
- Slide your shoulder down until your elbow lift (this is a Chest Lift®).
- Holding Chest Lift® posture, rock your skull back on C1 to perform a subtle Head Nod® until you are looking straight ahead.
You are now sitting in Healthy Sitting Posture!
Perform 4 seated chest lifts every few hours to unload your neck. Start the next hour in healthy sitting posture.
2. Seated Head Nod®
- Sit at the edge of your chair without back support in Chest Lift® posture.
- Cross your arms across your chest.
- Rock your skull back on your C1 until you are looking straight ahead. This is neutral O-A positioning (aka Head Nod® Position).
- Rock your skull back on C1 a little more until you are looking down 1 inch.
- Return back to neutral Head Nod® position.
Perform 4 Head Nods every few hours to unload your neck.
3. Head Turn thru Spine Twist
This exercise is not only a good for improving upper thoracic spine mobility, but it also serves as a “strategy” exercise to help you use more of your upper thoracic spine when turning your neck.
- Sit at the edge of your chair without back support in Chest Lift® and Head Nod® posture.
- Cross your arms across your chest.
- Holding Chest Lift® and Head Nod® posture turn your head to look to the left by rotating your thoracic spine. We refer to this movement of the spine as a Spine Twist. Then turn your head to the right by performing a spine twist to the right.
Perform 4 Spine Twists every few hours as part of your hourly mobility program.
There is no cervical rotation during this exercise!
Start Your Day Routine:
A key aspect to relieving pain from a pinched nerve is to start the day with optimal position of the vertebrae the is pinching your nerve. This routine can help you start each day with healthy posture. This self-care routine is best view prior to execution. link
1. Seated Mobility Routine (same as above)
The key to relieving pain from a pinched nerve is to start the day with optimal position of the vertebrae the is pinching your nerve. This routine can help you start each day with healthy posture.
2. Head Nod Stretch w/ Roller
Now that you have mobilized your upper thoracic spine, your neck is ready to be unloaded. We will do this with gravity eliminated at level 1.
- Lay on the ground with a foam roller under you neck like a pillow and your knees flexed 90 degrees.
- Gently roll your foam roller away from your shoulders until it grabs your skull so that your feel a gentle stretch of the muscles under your skull.
- Roll your pelvis back until your tail bone unloads from the floor without pushing into your heels (this is a Tail Bone Tuck® aka a Pelvic Curl).
- Hold this posture for 4 deep breaths or 1 minute.
Since you have nothing to do for 1 minute, why not work on your respiratory capacity?
3. Ceiling Punches (Gravity Eliminated)
Many of the muscles of the neck attach to the shoulder blades (scapulae). Let’s stretch them out while we have the neck unloaded with gravity.
- From Head Nod Stretch® laying on your back with your knees flexed (bent) 90 degrees bend both elbows 90 degrees
- Maintaining a Pelvic Curl® contract your upper abdominals to push your rib cage into the floor. You are now in Neutral Spine Alignment (NSA).
- Maintaining neutral spine alignment extend the left elbow, then return that elbow to the floor; repeat on the right.
Perform 4 alternating ceiling punches without losing NSA.
Lifestyle Modifications:
- Healthy Sitting and Standing Posture (with seated mobility exercise)
- Healthy Sleeping Strategies
Your Partner in Self-care for Neck Pain
At Healthy Posture Club, we provide telehealth and digital physical therapy resources at affordable rates to help those suffering from neck pain establish a foundation for long-term injury management and prevention from the comforts of home. Always consult with your physician or rehabilitation specialist before starting any exercise program for pain reduction. We are here to medically guide you toward healthy posture.
The HPC Self-care for Neck Pain Program consists of 6 levels of neutral spine conditioning exercises. Here is a breakdown of how we help our clients treat the foundation of their pinched nerve to establish long-term injury management and prevention.
- Level 2 – Exercises against gravity to perform Work tasks from NSA.
- Level 3 – Exercise against gravity to perform Home tasks from NSA.
- Level 4 – Exercises to condition you to perform Fitness from NSA.
- Level 5 – Safe Gym Exercise for a pinched nerve.
- Level 6 – Safe strengthening strategies for a pinched nerve.
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