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Perfect Posture Series: Forward Head Syndrome

Posted August 11, 2012 by

Over the next couple of blog posts I’m going to be discussing an issue that is largely ignored by people looking to build more aesthetic physiques, even though it’s one of the most critical components. I’m talking about the issue of posture—or how you naturally hold your body, both through movements and at rest.  I don’t care how much muscle you build, or how much fat you burn from your body—if you have the posture of a caveman, then at best you’re going to look like a muscular, lean Hunchback of Notre Dame.

When talking about posture, it’s important to understand that it’s not as simple as looking at the area (in particular, the joint or joints) in question and making a superficial assessment based on what is seen. In today’s example for instance, where we’ll discuss “Forward Head Syndrome,” it’s important that we not only look at the soft tissue at the base of the skull itself, but that we also focus on surrounding musculature and joint structures of the upper back, shoulders and chest as well in order to fully understand the cause of this condition and appropriate steps to correct it.

Forward head syndrome refers to the abnormal extension of the head and neck out in front of the body. The natural position for the head is directly over the shoulders and lined up with the midline of the body, which allows for a balance of loading to the front and back of the cervical spine. According to leading orthopaedic surgeon Adalbert Kapandji, MD, author of The Physiology of the Joints, Vol. 3, “For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.” This is an issue because this extra weight leads to long term muscle strain, disc herniations, arthritis, headaches and pinched nerves—and additionally, from an aesthetic point of view, having your head drawn out in front of you causes you to look less confident, less balanced and less bodily aware.

First and foremost, it’s important to be able to correctly identify if this is in fact an existing issue. The easiest indicator to look for is whether the midpoint of the ear lines up with the shoulders, hips and heels or whether the ear is in front of this imaginary line. The degree to which the ear is positioned in front of this line would determine the severity of the condition. The further the ear is from the midline, the more pressure is being exerted on the front of the cervical spine. The spinal discs are designed to be under a balance of pressure, similar to a water bed. Just as uneven pressure in a water bed causes the cushion to bottom out in the area of pressure and bulge everywhere else, uneven pressure on the discs over time can cause bulging discs and other spinal disorders.

Like most, if not all muscle imbalances, this condition is caused by a combination of tight, shortened muscles and weak, lengthened muscles. The short, tight muscles pull on the skeletal structure while the weak, lengthened muscles fail to provide opposing resistance to keep the skeletal structure in proper alignment. When looking for the root cause of the issue, broadening our view of the body past the immediate structure in question to look for the true source(s) comes in handy. As far as the tight, shortened muscles go, while the muscles in the front of the neck (namely, the scalenes and sternocleidomastoid) do directly contribute to the forward pull of the head, tightness in the upper trapezius (top of the shoulder), chest and deltoids typically contributes to the situation.

The forward pull due to the tightness from the front of the torso at the chest and shoulders, combined with the tightness of the upper trapezius, can result in an increase of roundness in the upper back between the shoulder blades. Because the spine is one continuous unit, any postural distortion further down the line is clearly going to affect the position of the spine further up. A rounded thoracic spine causes the cervical spine to move into a more horizontal angle that is more susceptible to the forces of gravity than it’s natural, more upright angle. Thus, not only are we now fighting against the uneven pull of the neck musculature, but we also have to contend with the daily influence of gravity.

As previously mentioned, we must also consider the lengthened, weakened muscles of the opposing side that are failing to properly do their job. In the case of forward head syndrome, these include the cervical extensors, middle trapezius and rhomboids, primarily. Because the opposing muscles are tight and short, these muscles are perpetually stretched and underused, resulting in a weak, under active support system. Not only must these muscles be strengthened, but the individual must also learn to properly activate them (which is actually a prerequisite for an effective strengthening program, since you can’t fully strengthen what you can’t fully activate).

It should be clear by now that had we just addressed this issue at the neck alone, we would have been temporarily solving the problem at best. Stretching the neck and bringing the head back in alignment is important, but if the entire cervical column is in a compromised position, it’s just a matter of time before gravity once again pulls the head down into the same position as before. What we will find as we go through the different postural issues of the body in this article series is that these problems are all interrelated, and that in order to truly address any of them, we must look for and address any others that are present as well.

Now that we’ve addressed the cause of forward head syndrome, how do we fix it? The two areas to focus on are stretching of the tight muscles, and strengthening of the weak muscles. Strengthening exercises include the “chin tuck,” where you simply pull your chin back towards the back of your spine while keeping your skull as “tall” as possible and holding for 30 seconds at a time, weighted neck extensions in which you push your head backwards against resistance, and rows of all sorts to increase the strength in the middle back muscles. It’s also important to avoid a lot of strengthening exercises for the already tight muscles in order to prevent further aggravating the imbalances.

Stretching exercises for the overactive muscles include the trapezius stretch, where you tilt each ear to the respective shoulder, look up slightly and hold for 30 seconds per side and the doorway chest stretch, where you place your lower arm with the elbow bent at 90 degrees on the edge of the doorway and gently step forward till you feel a stretch in the pectoral muscle of the same side, and hold for 30 seconds.

In order to be effective, these exercises and stretches need to be performed on a consistent basis, along with a conscious effort being made to maintain proper posture throughout the day. Progress may be slow at first, but with consistency, you will begin to see significant results after several weeks. Next time we will move down the body and focus on the issue of a protracted shoulder girdle/rounded shoulders and proper steps to fix this postural distortion as well.

Comments on Perfect Posture Series: Forward Head Syndrome »

  1. renea

    This is good information, as I sit at a desk all day and my neck stays sore most of the time.

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