Posture Series Part 1- Improving your neck alignment and head position

By: Kendall Lou Schmidt

Your head is at the center of everything. That big brain of yours is balancing ever so gently on top of your shoulders, and even the slightest change in its position can have a huge effect on your entire body. Forward head posture (FHP) is a very common postural deviation that affects the majority of the population. Not only is it unattractive, FHP can lead to some serious injuries, pain and loss of performance that will ruin your workouts and seriously impair your overall quality of life. This article is your guide to navigating your neck. We will go over the anatomy of forward head posture and how to diagnose it, the ways it affects your muscles, the effect that has on your performance and health, and the best exercises you can do for improvement.

What is forward head posture?

FHP is a very common posture deviation where the head is positioned in front of the body, rather than stacked correctly over the shoulders. A person with forward head will have a skull that is leaning or jutting forward, causing the entire cervical spine to shift anteriorly. Over time, as the muscles of the neck work to support the weight of the head against its new center of gravity, muscular imbalances form, the vertebrae and discs begin to compressed and a cascade of secondary issues start to develop.

How does forward head posture affect your fitness and health?

Head and shoulder posture is a critical component of your fitness and health. Poor posture in the head and neck will snowball into various problems that wreak havoc in all areas of your life, including your workouts and overall health. As the center of gravity of the head shifts forward, it alters the weight load on the muscles, soft tissue and bones that support it. As a result, muscles and joints in front of the neck lengthen and grow weak, while muscles in the back of the neck, upper back, and shoulders grow very tight. When these imbalances are not corrected, they intensify over time as daily tasks are performed, accelerate even faster when weight training activities are done with incorrect alignment, and eventually lead to a large array of secondary complications.

Image source http://www.alexanderasheville.com/?p=648

When the head is aligned correctly over the shoulders, the shoulder blades and the muscles that control them are able to perform efficiently. This is especially critical during overhead movements like a shoulder press, and during shoulder flexion movements like a front raise⁸. Individuals with FHP have a much greater internal rotation and upward rotation of the scapula (shoulders that round forward and shrug up). As a result the serratus anterior, a muscle that runs from the middle border of the scapula to the ribs at the side of the chest, is much less active during exercise and while performing daily tasks⁸. The main function of the serratus anterior is moving the scapula forward and around the ribs as the arm is extended forward. Proper function of the stratus anterior is necessary to punch, push, press, and lift optimally. As the muscle atrophies and grows weak, shoulder problems are more likely to develop and the risk for injury and chronic pain increases dramatically⁴.

Source http://www.massagefreo.com.au/serratus-anterior-muscle/

Overactive traps goes hand in hand with underactive serratus anterior muscles. The trapezius is one of the major muscles behind the neck that is shortened and overworked in forward head posture. Studies show that individuals with FHP have a significantly greater activity of both the upper and lower trapezius during loaded isometric shoulder flexion in the sagittal plane (holding the arms out in front of you). This can lead to neck and shoulder pain during weight bearing exercises like a front raise, or daily tasks like driving and doing computer work⁹. Persistent pressure in the muscles, tissues, bones and nerves in this area can lead to muscle spasms, compressed or herniated disks, arthritis, chronic neck pain, tension headaches, migraines¹, balance disturbances and changes to gait speed⁷.

Source https://www.google.com/amp/s/twsmassage.wordpress.com/2016/05/23/trapezius/amp/?source=images

As if the detrimental effects on muscles, bones and nerves isn’t bad enough, forward head posture also impairs your breathing. When the head is aligned in a neutral position, the respiratory synergist muscles work in harmony and pulmonary functions of the lungs are the strongest. Severe FHP leads to overactivity of  the sternocleidomastoid muscles (muscles that run from the breast bone and collar bone to the area of the skull just behind the ear) and the anterior scalene muscles (muscles that runs from the cervical vertebrae to the first rib). With these muscles working inappropriately, the vital capacity of the lungs is significantly reduced³. When you can’t breathe as deeply you get winded easier. Your body becomes less effective at getting the oxygen it needs to fuel the activities you demand of it. Whether your trying to make it through a strenuous workout, do mental gymnastics, or just perform basic bodily functions, FHP will lead to faster fatigue and impaired performance in every aspect of your life.

Source https://www.google.com/amp/s/www.howtorelief.com/anterior-scalene-origin-insertion-action-nerve-supply/amp/?source=images

POSSIBLE SIDE EFFECTS OF FORWARD HEAD POSTURE

Do I have forward head posture?

The first step to correcting any postural deviation is identifying that you have it. So how do you know if your head and neck are neutral, or if you have FHP? A quick assessment using a wall is an easy way to find out.

• Stand with your back against the wall. Feet should rest hip width apart.
• Bring both your buttocks and your shoulder blades against the wall. Relax the shoulder back and down to open the collar bone and lengthen the distance from ear to shoulder. It shouldn’t feel forced. Just try to find your best neutral spine and relax into it.
• Check your head position. Is the back of your head touching the wall?
• If so, congratulations! You have a neutral head posture.
• If not, you are one of the many with a forward head posture. DON’T WORRY!! Next I am going to give you some simple exercises to begin improving it.  

Simple exercise to correct forward head posture

Would you believe that neck pain accounts for 15% of soft tissue problems seen by primary care doctors⁶? The solution isn’t painkillers. These issues are referred to physical therapy, because without addressing the muscular imbalances that cause the pain, the problem will only continue.

By stretching the muscles that are overworked and tight we can create mobility in the joints that have become stiff and rigid in the forward head posture. By strengthening the muscle that are neglected and weak we can create the stability in the neck and shoulders that is necessary for proper alignment. With as little as four week of consistent effort, you can see serious improvement is your forward head posture⁶.

The suboccipital muscles are positioned at the base of the skull just above the back of your neck. They are responsible for head movement like rocking, tilting, or rotating and also work to stabilize the head as it sits on top of the spine. By softening and loosening them, the head is able to move more efficiently through its preferred range of motion, alignment is improved, and less pressure is placed on the cervical spine. This can do wonders in helping alleviate headaches, neck pain, and more.

• Lie on your back with your knees bent, feet resting on the floor, relaxed in neutral spine.
• Place a ball under your sub-occipital (shown in the image with an X).
• If you’re classy, they have trigger point balls made for this exact purpose you can purchase online. If you are the budget friendly resourceful type, go to your local superstore or little league practice. A soft ball works perfectly well. If it is too large for your current range of motion try a baseball, or for softer pressure use a tennis ball.
• Use the ball to gently massage areas where you feel tension. Be patient, go slow and as always LISTEN TO YOUR BODY.

2. Sternocleidomastoid Release

As the name suggest, the sternocleidomastoid (SCM) runs from the sternum and clavicle up to the mastoid process just behind the ear. When one of your SCMs contracts it rotates the head to the opposite side. If they both act together they flex and extend the head. In forward head posture the SCM shortens and grows tight. Self massage is a great way to release the muscle, decrease neck pain and improve posture and mobility.

• Locate your SCM muscle. If you have never found them before, take a look is the mirror and turn your head towards one side. Your SCM on the opposite side should pop out as it contracts. Gently take hold of it between your index finger and thumb. Then return your head to midline, allowing your SCM to relax.
• Gently pinch and pull the SCM the stretch and release the tissue. Repeat up and down the entire length of the SCM, spending more time anywhere that feels more tender.

3. Trapezius Stretch

The trapezius is a major muscle in the back that stabilizes the shoulder blades, moves the shoulder blades, and extends the head at the neck. In forward head posture, the neck is constantly extended, so the trapezius grows very tight. Creating length in the muscle can help improve alignment in the head and neck. Stretching the trapezius will also allow the shoulders to relax down further from the ears. As a result the other smaller muscles that work on the neck can also work more appropriately.

• Sit on a sturdy chair or bench in the gym.
• Take hold of the side of the bench with one hand. Relax your shoulder and neck as your body weight gently falls away from your arm.
• Let your head fall gently to the opposite side.
• If you prefer you can use the opposite hand to add a small amount of assistance. Rather than pulling on the head, let the weight of your hand resting on your head bring it further into the stretch.
• Hold for at least 30 seconds, then repeat on the opposite side.

4. Chin Tucks

Training the deep cervical flexors is the most effective way to improve forward head posture ². This group of muscles lies deep in the neck, behind the sternocleidomastoid, and include the longus capitis and the longus colli. Together they work to stabilize the neck and flex it forward like you would when tucking your chin; therefore, the best way to strengthen them is with chin tucks. Here are a variety of chin tuck variations  you can incorporate into your gym routine and everyday life. With each variety please be gentle. Never try to force your head and neck into a position it isn’t willing to go yet.

• Sit or stand with your best upright posture. Lengthening the torso and engage your core to stabilize the waist and rib cage.  Relax the shoulder blades back and down.
• As you tuck your chin, focus on lengthening the back of your neck as though the base of your skull is lifting towards the ceiling. Try to keep the movement at the base of your skull instead of further down the neck.
• Hold for a few moments and release. Repeat 3 to 5 times. This can be done periodically throughout the day as often as you remember to fit it in.

• Lie face down on a gym bench or bed with your head hanging off the end. Draw your shoulders away from your ears and open the collar bone, broadening your shoulders. Keep your navel drawn up towards your spine to engage your core.
• Lengthen the back of your neck by reaching the crown of your head forward while drawing your chin up from the floor as your tuck it.  
• Hold for 5 to 10 sec. Relax.  Perform 3 sets of 8 to 12 repetitions.

• Lie on your back on a firm surface like gym bench or the floor. Keep your knees bent and your feet resting comfortably.  Draw your shoulders away from your ears and open the collar bone broadening your shoulders. Keep your navel drawn down towards your spine to stabilize your neutral spine.
• Lengthen the back of your neck by reaching the crown of your head forward while drawing your chin down towards the floor as your tuck it.
• Hold for 5 to 10 sec.  Relax. Perform 3 sets of 8 to 12 repetitions.

• Sit with your best upright posture. Lengthening the torso and engaging your core to stabilize the lower back and rib cage.  
• Wrap a resistance band behind your head, anchoring the ends in your hands in front of you. The ends of the band should be at the same height as your nose. Relax the shoulder blades back and down.
• Starting from your forward head position, draw your head back away from your hands against the tension of the band. As you do so, focus on lengthening the back of your neck as though the base of your skull is lifting towards the ceiling.
• Hold for 5 to 10 sec. Relax. Perform 3 sets of 8 to 12 repetitions.

5. Serratus Punches

As we discussed earlier, the serratus anterior tends to grow very weak as a result of FHP. Strengthening it is a great way to improve shoulder blade stability while in proper alignment, which will make your progress towards a neutral neck that much faster.

• Lie on your back on a firm surface like a gym bench or the floor. Keep your knees bent and your feet resting comfortably.  Draw your shoulders away from your ears and open the collar bone broadening your shoulders. Keep your navel drawn down towards your spine to stabilize your neutral spine. Maintain your best neutral neck, lengthening the back of your neck and slightly tucking your chin.
• Begin with you arm extended up towards the ceiling, elbow straight, shoulder blade still flat to the floor.
• While keeping the head, ribs, and waist stable and perfectly still, reach further toward the ceiling as your shoulder blade lifts up off the floor (protracts).
• Hold for 5 to 10 sec. Relax. Perform 3 sets of 8 to 12 repetitions.

Extra tips

You might be wondering why forward head posture is so common in the first place. Here are some simple tips to lower your risk of developing FHP and all the complications that come with it.

All those hours staring at your cell phone are spent in bad posture. Studies show a direct correlation between pain, fatigue and FHP with longer smartphone use⁵. It is recommended to take posture breaks of at least 20 minutes when using smartphones⁵, and while you are on them try to maintain your correct alignment.

If you sit at a computer for extended periods of time, the number one most import thing you can do to improve your posture is set up your workstation correctly. Ideally your desk, chair and computer will be arranged in a fashion that allow your neck to remain relaxed and neutral while you work.

• Adjust your seat and monitor height so that the top third of your screen is at eye level.
• Set your monitor 18 to 24 inches from your face. There should be no need to strain or slouch forward.
• Your seat should sit high enough that your arms can relax at your sides while you type. Avoid shrugging or tensing the neck and shoulders.

Your ideal neck position should also be maintained while you are lying down. Whether you are on your back or side, select a pillow that places you in a neutral neck. Do your absolute best to avoid sleeping on your stomach.

Backpacks and purses can place a tremendous amount of stress on your spine. Studies on the spine have shown that daily backpack use can lead to dramatic postural changes. The younger the person, the greater the deformity¹. Heavy purses or briefcases that are constantly carried on one shoulder can cause an imbalance in strength, shift the alignment of the spine, and create strain in the neck and shoulders.

As you walk around town, stand in line at the grocery store, sit at the dinner table, or do any other daily activity, focus on maintaining your best posture. Pretend a little string is tied to the crown of your head and it is constantly being lifted up to the sky. Maintain a gentle tuck in the chin and lengthen from tail to crown. Engage your core and relax your shoulders. Before you know it you will break any bad habits and great posture will be your new normal.

Stay tuned for more articles in this posture series. More often than not, one postural deviation comes with others. If you have FHP, odds are you also have some degree of forward rounded shoulders or a curve in your upper back. Good news is…. I will be covering this next!

RESOURCES

1. Grimmer KA, Williams MT, Gill TK. The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features. Spine (Phila Pa 1976). 1999 Nov 1;24(21):2262-7. Accessed web. 5.31.18. at https://www.ncbi.nlm.nih.gov/pubmed/10562994
2. Gupta BD et. al. Effect of Deep Cervical Flexor Training vs. Conventional Isometric Training on Forward Head Posture, Pain, Neck Disability Index In Dentists Suffering from Chronic Neck Pain. J Clin Diagn Res. 2013 Oct;7(10):2261-4. Accessed web. 5.12.18. https://www.ncbi.nlm.nih.gov/pubmed/24298492
3. Kang JI, Jeong DK, Choi H. Correlation between pulmonary functions and respiratory muscle activity in patients with forward head posture. J Phys Ther Sci. 2018 Jan;30(1):132-135. Accessed web. 5.18.18. at https://www.ncbi.nlm.nih.gov/pubmed/29410583
4. Khosravi F et. al. Scapular Upward Rotator Morphologic Characteristics in Individuals With and Without Forward Head Posture: A Case-Control Study. J Ultrasound Med. 2018 May 15. Accessed web. 5.14.18. At https://www.ncbi.nlm.nih.gov/pubmed/29761537
5. Kim SY, Koo SJ. Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. J Phys Ther Sci. 2016 Jun;28(6):1669-72. Accessed web 5.31.18 at https://www.ncbi.nlm.nih.gov/pubmed/27390391
6. Kong YS, Kim YM, Shim JM. The effect of modified cervical exercise on smartphone users with forward head posture. J Phys Ther Sci. 2017 Feb;29(2):328-331. Accessed web 5.31.18. At https://www.ncbi.nlm.nih.gov/pubmed/28265167
7. Poole E, Treleaven J, Jull G. The influence of neck pain on balance and gait parameters in community-dwelling elders. Man Ther. 2008 Aug;13(4):317-24. Accessed web. 5.17.18. At https://www.ncbi.nlm.nih.gov/pubmed/17553727
8. Thigpen CA et. al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks.  Electromyogr Kinesiol. 2010 Aug;20(4):701-9. Accessed web. 5.17.18. at https://www.ncbi.nlm.nih.gov/pubmed/20097090
9. Weon JH et. al. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. J Bodyw Mov Ther. 2010 Oct;14(4):367-74. Accessed web. 5.13.18. at https://www.ncbi.nlm.nih.gov/pubmed/20850044