Over the past month I have had several discussions with clients who have severe pain in the neck, migraines, and some with jaw related problems that were all related to the same problem – a forward head posture. As the head moves forward, the neck straightens due to the fact that the body will try to keep the eyes lined up in a horizontal position. This is a necessary compensation to ensure you have good eyesight. Unfortunately, this places a great deal of strain on the neck structures as they need to balance the weight of the head which increases the further the head moves forward. Apart from the obvious neck pain that results from this, if left untreated this poor posture can lead to other chronic problems like migraines, jaw pain, poor breathing, weight gain, and overall poor health. Exercises commonly used to correct this condition can sometimes create more problems than they solve and also may miss out on addressing underlying dysfunctions altogether. In this article, I will share with you some of my best ways to address this all too common problem.

The Further You Head Moves Forward, The More Problems It Will Create

As the laws of physics dictate, the further away from the body a weight gets, the more the effective weight is – the heavier it feels and the harder muscles must work to hold it. It takes just an inch of forward head posture to increase the effective weight that the neck muscles and ligaments must support by 10 pounds.

According to a 2014 study, the forward position of the head puts increasing amounts of weight pressure on the spine. The study found that the head weighs about 10–14 pounds (lb) in a neutral spine position but increases in weight as it leans forward:

Weight of the Head In Various Forward Positions

• 15 degrees – 27lb
• 30 degrees – 40lb
• 45 degrees – 49lb
• 60 degrees – 60lb

There are a number of muscles responsible for this but if we were to focus on muscles around the head and neck to begin with you would find there are those muscles that are weak, and muscles that are tight.

Muscles prone to weakness include:

• deep neck flexors, including the longus capitis and longus colli
• scapular stabilizers and retractors, such as the rhomboids, middle and lower trapezius, teres minor, and infraspinatus

The muscles that become shortened and overactive include:

• deep upper cervical extensors, such as the longissimus capitis, splenius capitis, cervical multifidus, and upper trapezius
• shoulder protractors and elevators, such as the pectoralis minor, pectoralis major, and levator scapula

Most people concentrate all their efforts on trying to stretch and lengthen the tight muscles but I have found this to be very ineffective over the longer term, for the muscles will continue to revert back to what they were doing, until the weakened muscles are strengthened. Trying to strengthen these muscles while they are short and tight is often very difficult to do and for some people can even create more pain. Using a combination of mobilizing and strengthening exercises I have found to be the most effective way to correct this problem but it takes a bit of trial and error to find the right type of exercises for each person.

I covered this topic in great detail a few years back in the article – How to strengthen the neck

I think if more people paid more attention to strengthening their neck and their overall posture many of the problems we see today could be prevented. If you don’t believe me all you have to do is to observe the strength and postures of people in traditional cultures in Africa and India who carry massive loads on the top of their head!

This is something I discussed in great detail earlier this year in my article about an interesting book by Esther Gokhale called 8 steps to pain free back. In this book she provides some fascinating insights into how people in Africa and India move in daily life with much different posture in comparison to people in the Western world. She notes how these people are almost completely free of back pain and musculoskeletal problems that are rampant in modern industrialized society.

While the book appears to focus mainly on back pain the emphasis on the head and neck position is also a massive part of the program. The strength of these older women carrying heavy baskets on their head is incredible and would be near impossible for most people in modern society to do. They do not get to be like this from getting massages and stretching their neck each day.

Also this book teaches you how important the strength and posture of the entire body is to the head and neck. You always have to keep in mind there may be other factors contributing to a forward head posture that you may think is okay. The effect poor hip and pelvic positions create on the head and neck cannot be ignored so it is important you have a series of tests and assessments to determine what you may need. This would be the second biggest mistake people make by only focusing on the area in pain and forgetting that the head and neck are only one part of the puzzle.

To explain how the pelvis can create forward head posture take a look at the picture below created by Alois Brügger, a Swiss neurologist. He used the idea of a cogwheel to describe the inter-dependability of the spine on itself. He encouraged patients to adjust the lower cogwheel—the pelvis—into a clockwise position, allowing the chest and head to follow into good posture.

The Cog wheel Model

This is a very simple way of showing what good and bad posture looks like, but it is much better than that for the cog wheels show how different body segments interact.  You can see in the picture below what poor or slumped posture does to the cogs and how they change when moving into a good posture.  I am a visual person so this works for me.  For those that like a description, we are looking at the 3 keys to good sitting posture. 

Brugger named them the three primary movements:

1. Anterior tilt of the pelvis (this is the bottom cog rolling forward)
2. Elevation of the chest (as the bottom cog rolls forward, the middle cog elevates the chest)
3. Elongation of the neck (as the chest elevates, it elongates the neck)

One thing to remember is that pain does not automatically result from this position. The body will be able to compensate around this for some time before you have any pain symptoms telling you something is wrong. And it may not always result as neck pain. The problems the compensation creates can be much worse than just a sore neck.

Ask anyone who has chronic migraines what they would do to get rid of them. While there are many other factors that induce migraines a forward head posture is a big part of the puzzle. This picture clearly shows how easy it is to create tension at the base of the skull leading to migraines and headaches. You can also clearly see how the jaw is left unsupported by the muscles under the chin.

Researchers have found that there is a 70% correlation between forward head posture and a jaw that is pushed back. This can lead to the development of TMJD as this position pinches the pad behind the disc, reduces TMJ blood supply, stretches out the ligaments, and strains the lateral pterygoid muscle that leads to spasms.

You can create an exercise to help reverse this posture by using this concept. Practice moving into this position several times per day.

This is also another big reason why it is so important spend time learning how to bend correctly using the Romanian Deadlift. This one exercise can have a big impact on the stability of the lower back while at the same time improving stability of the head and neck for it teaches you to how to strengthen the muscles used with anterior pelvic tilt needed to create good posture.

The effectiveness of using exercises like the RDL are highly under-rated which is a real shame as it could be the missing ingredient that pulls everything together.

What Causes Forward Head Posture?

Sitting is often the first thing blamed for this and it definitely plays a big part but there may be a number of reasons for developing this type of posture.

I have covered this in great detail before in the article about Kyphosis and the Dowagers hump and highly suggest you read this for a more detailed look at various causes but here is a list of some of the main reasons.

Some may be easier to correct than others.

• Breathing problems
• Eyesight problems
• Our posture during walking
• Our posture standing
• Our sleeping position
• Occupations
• Hobbies (eg musical instruments)
• Postures used in various sports
• Depression and low self esteem
• Lack of calcium and poor diet
• Osteoporosis

I won’t go into too much detail about sitting positions as I have covered this so many times in previous articles and I think most people are aware of the need to address this. Esther Gokhale’s posture retraining method shows several great exercises to address sitting positions in good posture.

Her stack-sitting exercise in particular (see picture below) is a fantastic way to strengthen your muscles to hold your body in good posture. This exercise is all about learning to sit upright without any backrest. This means you need to learn how to use the muscles in your body to achieve a good position without creating too much tension.

For many people this can be quite difficult and once again our thoughts on what is the best position may actually be the problem. Sitting in a good posture should not require a 110% effort from our muscles, it should be effortless. The key to this is sitting a position is where your pelvis is held in a slight anterior pelvic tilt. This is the exact opposite to what many people have been taught who believe it is better to tuck your pelvis under in a posterior tilt.

Other articles with tips on sitting positions are shown below

• Best tips for staying healthy if you work from home
• Move more and sit less

Poor sleeping position are something that needs to be addressed very early on if you want to correct forward head posture. We all know that we are guaranteed to sleep every day for several hours so finding a way to position our head and neck in a good position is vital.

During sleep the muscles and ligaments are not instructed not to hold and protect the spine as much as when you are awake, and as a result of this are more vulnerable to excessive strain from poor sleeping positions. Leaving your head and neck in a strained position for hours on end while your body is relaxed is a guaranteed recipe for pain.

The worst position to sleep in is on your stomach however, sleeping on your back can pose a problem especially if you have a pillow that is either too large or too small (see picture below). Both of these positions will reinforce the forward head position and keep the muscles attaching from the neck to the base of the skull to remain short and tight.

You can see more about this in the article – Are these bad habits causing spinal compression?

Anything that places us in a forward leaning position with our head looking down for hours on end is enough to create a forward head posture.

One recent development is the destructive use of smartphones on our body. In particular the effect they have had on the younger generations who are glued to their phones for hours each day. Take a look at the pictures in the infographic below to see how easily someone can develop a forward head posture from the repetitive positions they place their head in. The statistics are quite alarming and help to explain why so many people are developing poor postures at such a rapid pace.

In almost every case where a person has developed poor postural habits, the neck and shoulder are highly vulnerable to trigger points and stiffness as they attempt to hold the head upright. When you look at a human skeleton you can clearly see how your bones are all stacked upon each other to create stability at your joints. Gravity basically compresses your bones to lock everything into place so you do not fall apart like a bag of bones. The one area that is different to all the others is clavicle (more commonly known as the collarbone) at the front of the shoulder.

The clavicle appears to be the only thing holding up your shoulder as it is not stacked upon other bones vertically like the spine and the lower limbs. The only way it can create stability to hold itself in good position is via use of multiple muscles, tendons, and ligaments.

The clavicle and the scapula appears to be floating in space as neither is connected or stacked upon other bones!

Two of the main muscles that hold these bones in place, LEVATOR SCAPULA and the TRAPEZIUS attach to the neck and the base of the skull. This explains why dysfunctional movement at the shoulder can easily lead to neck pain and headaches.

The levator scapula is often the muscle that people feel neck pain with as it is easily overloaded when weakness is present in other muscles. This is where people try to stretch or massage these muscles, but really they should be trying to strengthen the weakened muscles that are creating the overload in the first place. This is why I believe many people should not stretch their neck muscles.

The other muscle that attracts a lot of attention is the upper trapezius. Once again most people think this muscle is short and tight, when in reality it is the exact opposite, it is usually long and weak. And when that happens the scapula begins to sit too low and disrupt overhead movements forcing the levator scapula to work extra hard to lift your arm.

This constant pulling and straining of levator scapula it easily leads to headaches as it attaches to the upper four vertebrae of your neck. This poor scapula position is referred to as a "depressed shoulder" and is associated with many shoulder and neck dysfunctions. This cannot be resolved via stretching for it is a weakness that has led to this dysfunction being created.

Below is a picture clearly showing the difference between a depressed shoulder, and a functionally stable shoulder.

The upper trapezius is composed of three parts:

1. The upper trapezius
2. The middle trapezius
3. The lower trapezius

This muscle has many functions such as shrugging your shoulders, tilting, turning and extending your neck and pulling your shoulders back and down. Depending on which action you make is what determines which part of the trapezius is used more. You can read more about the upper trapezius in this article - Releasing upper trapezius is all about strengthening

The other thing to take note here is the rhomboid muscles that begin pull the scapula closer together further limiting your ability to move your scapula when you lift your arm. This leads to the thoracic stiffness and a big reason why so many people with neck pain can barely rotate their torso. The simple act of trying to turn your head is almost impossible as the muscles near the neck are on high tension for your upper back muscles are over-active.

Make Sure You Understand How The Spine Functions

Firstly, before we go into the details of each exercise to correct forward head posture I want to discuss another critical mistake people often make once they become aware of this problem and that is, trying to flatten the cervical spine out. This is where they take a bit of good information and take it too far by over-doing it.

When we break down the anatomy of the cervical spine, there are a lot of different things going on. Cervical lordosis is supposed to be there, just as lumbar lordosis is supposed to exist in the lumbar region. We’re not supposed to have a “flat back.” We’re supposed to have curves in the spine, which are there to help dissipate force.

If a person’s head is jutted forward, that puts a lot of pressure on the neck muscles. If it’s too far back, it starts to put a lot of stress on the low back. Everybody’s neutral spine is a little bit different, but the curves are supposed to be there.

The discs in the neck are tiny, and the discs in the thoracic spine are a little bigger but aren’t quite as thick as those in the lumbar spine. In the cervical spine, we have a really tiny vertebral body compared to the really large lumbar vertebral body that has to accept and take a lot of weight.

The vertebrae of each part of the spine is designed differently. Some parts are designed for rotation such as the cervical spine and thoracic spine but the lumbar spine is not and can only provide extension and flexion. This is why stiffness in the hips or thoracic spine can create massive problems in the lower back as it may be forced into rotation.

This is what is known as the "Joint by Joint" approach which was invented by Gray Cook and Mike Boyle. This gives great insight into how many movement problems are often created somewhere else and to correct the problem using this approach can help identify the right course of action.

What you will see is that every second joint needs flexibility and mobility, and the other joints need the exact opposite being stability and strength.

Here is how it works.

• Feet - Stability.
• Ankle – Mobility
• Knee - Stability.
• Hip - Mobility.
• Lumbar Spine - Stability.
• Thoracic Spine - Mobility
• Scapula & Glenohumeral Joints—Needs stability with some degree of controlled mobility.
• Cervical Spine – Mobility with controlled stability

This concept enables you to choose exercises that target the specific function of each joint more effectively therefor restoring function and efficient movement to the body.

What Exercises Can You Use?

As there are so many things to address with strengthening of the neck I will just include the main ones used for a forward head posture. Always remember that there is not just one single exercise that will help you here but the combination of many.

While I have created several videos and articles on neck pain before I want to focus mainly on the ones relating to the forward head posture. But I highly suggest to watch the videos below that show how to put many of these exercises together in order and in combination with more integrated movements.

Improve Your Breathing Before You Do Anything

This part is critical and you can find if your trigger is stress or anxiety your breathing will be behind the neck pain. There may be no dysfunction with your scapula or shoulder, or any of the muscles in the upper body, the problem is you are breathing incorrectly.

In the book “Assessment and Treatment of Muscle Imbalance” by Vladimir Janda on page 162 he states

“An important component of cervical spine treatment is addressing breathing patterns as chronic neck pain is associated with tightness of the accessory respiratory muscles (SCM and scalenes). Simply stretching these muscles may not be effective. Patients with faulty breathing patterns should be given specific breathing exercises to retrain their breathing.”

Learning to breathe through the nose and how to effectively use your diaphragm prevents you from using your shoulder and neck muscles to breathe. This instantly prevents tension going into your neck. Yoga, meditation and Tai Chi are great methods to use here.

The Buteyko method and even the Wim Hoff method are other fantastic ways to learn how to use your breathing to restore homeostasis within the body.

For such a simple tip it is so powerful. I cannot tell you how many people have resolved their problem from learning how to breathe better

You can read more about breathing in these articles

• 7 breathing methods to improve respiratory function and overall health
• Do you know how to breathe correctly?

Mobilize the C7/T1 Junction

This area of the body is often very stiff and very painful to touch for a person with neck problems. If someone has a significant forward head posture this joint takes a beating as it is at this point that they hinge their neck forward. This can be extremely difficult to mobilize and this is where a Chiropractor or Osteopath skilled in manipulation can be very useful in helping you to free this joint up.

I find the two exercises shown in this video are another great way to combat this by yourself to ensure you prevent the joint from stiffening back up. Once again I must stress these exercises are not enough to address the reason for the stiffness, but in the beginning they enable you to get your full range of motion back so you can move your head and neck again.

Watch the video below to see how this works.

Next thing to look at is thoracic mobility and the first one I like to use is the Feldenkrais exercise.

Mobilize The Neck With The Feldenkrais Shoulder/Spine Integrator

This exercise is not a neck stretch. It is actually a great way to mobilize the thoracic spine to allow you to easily rotate your neck. We have all experienced that awful feeling when you can hardly turn your head to look behind you, and this exercise is great for carefully helping your body to get this back.

I prefer this in the early stages with neck pain as it is so gentle. The whole point of this is to be able to move your head with the least amount of effort as the rest of the body moves to allow your head to fall into position. This is usually a favourite exercise for many neck pain sufferers in the early stages as it feels so relieving.

Watch the video to see how this exercise works.

The Feldenkrais method is remarkable and highly encourage you to read the works of Moshe Feldenkrais or take part in some of the courses that run all over the world as it is fascinating stuff.

Improve Your Thoracic Mobility

I won't spend too much time here as we covered this in great detail in the article 10 ways to improve thoracic mobility.

Thoracic mobility is always very tough for the neck pain person to work with for they often have compressed the spine so much that it has lost a great deal of its mobility with extension and rotation. Until this is addressed you will never be able to stabilize the head and neck to prevent the ongoing tension and stiffness in the muscles of the neck.

It is important to understand that the mobility of the thoracic spine is vital for the lumbar spine and the shoulder joint to achieve stability. Both of these joints are regularly exposed to injury when the thoracic region becomes stiff and rigid.

The video below while similar to the Feldenkrais drill is a much harder version to use. I prefer to use this as a test as it tells me a lot about where the restriction is hiding exactly. This is also an example of where the test is also a great corrective exercise in its own right.

Stretch The Pecs and Latissimus Dorsi

While you are not trying to stretch the neck muscles, you are definitely going to be stretching the pecs and the lats. These muscles are very prone to shortening and tightening which greatly inhibits muscles like serratus anterior and lower trapezius from firing. Using stretches to weaken these overworking muscles will give you every chance of succeeding with the upcoming stability and strength exercises to come.

Here is a video showing you 3 ways to release the pecs.

I suggest to read the article - How to identify mobility restrictions affecting how you move to see more on this and several other examples for releasing the pecs and lats.

Using Isolated Neck Strengthening Exercises

Finally you are at the point where you are beginning to strengthen. These exercises are quite simple to do but funnily enough quite hard to get right at first. Most of us know all about the tight muscles at the back and sides of the neck, but very rarely do people pay attention to the weak muscles under the chin that are responsible for holding the head in an upright position.

These muscles are known as the suprahyoid and infrahyoid muscles.

You can feel them contract if you place your fingers on your throat and swallow your saliva. The roof of the mouth is the resting place for the tongue and good posture and jaw mechanics will allow this to happen naturally. These are prone to weakness and when this happens the muscles known for overworking and tightness will begin to work harder and develop trigger points and eventually pain.

For the two exercises to work correctly you MUST ENGAGE THESE MUSCLES BY KEEPING THE TONGUE ON THE ROOF OF THE MOUTH!

This is critical in making this work, otherwise the over-active muscles will attempt to take over the exercise and it will backfire on you. This is why it can be quite hard to learn at first as it takes a fair bit of body awareness and discipline to get this right. Anyone with TMJ pain or jaw pain will usually find this even harder for the tongue will often be quite weak.

If the tip of your tongue touches the front teeth at all then have what is called tongue thrust and you will need to retrain your tongue. Tongue thrust can actually move your teeth and have a huge impact on the joints of the jaw. The best way to get rid of tongue thrust is to train it to sit there. Just like you use bicep curls to make your arms stronger you need to do tongue exercises to make your tongue stronger. This was my biggest problem and it took me a lot of awareness and training to fix it. You must not let the tongue push towards the back of the teeth as it must sit a bit further back on the palate, known as the palatal rugae.

What keeps the tongue on the roof of the mouth is gentle suction that is maintained by keeping your mouth closed. If you open your mouth at any point, you will you lose the suction. You can see why it is so important to learn how to breathe correctly.

The only time your teeth should touch is when you swallow. In order to swallow correctly you need your tongue to be in good shape and function the way it is designed. If the tongue is not strong enough or sitting in the right place you will never get on top of your problem.

It is ironic that the tongue become so weak considering it is the strongest muscle in the entire body. The TMJ is the second strongest!

If you are suffering with jaw problems make sure you read the article – What causes TMJ pain and how to treat it?

There are a few exercises I like to use to help people develop strength with these anterior neck muscles without the complexity of coordination and other muscles becoming a factor. The 2 exercises shown in the video below are great ways to activate and strengthen these muscles.

If you have completed all the exercises shown here then you are on the way to making great progress however, you still need to ensure the rest of the body is integrated and one of the best ways to do this is with the deadlift.

Romanian Deadlift

We discussed this earlier and I would definitely make this a big part of any training program for the head and neck.

The deadlift is a great exercise to strengthen the muscles that hold you in an upright tall posture. This is rated by many as the king of strength training exercises as it requires incredible mobility at the hips and the thoracic region while simultaneously strengthening your glutes, core and upper back muscles! It simply improves many of the things we try to do separately all at once.

The only thing it is missing is providing rotation of the trunk but it is a great starting point for providing a solid base to begin movement from.

In terms of improving posture this is simply the art of standing up tall and learning to use your hips to bend correctly. This exercise if performed correctly will address any weakness at the core and hips that could be contributing to the kyphosis posture.

There are many other great exercises I might use like wall slides, squats, and various push and pull exercises to encourage thoracic mobility and strength. But I think this gives you a great base to work from.

If you are struggling to achieve anterior pelvic tilt and have significant hip restrictions you will need a lot of other exercises around the region to help you. To avoid making this article another 5000 words I suggest to check out the articles shown below that provide you with a stack of hip specific exercises.

• 10 ways to improve your hip mobility
• How to improve your core function and pelvic stability
• Why anterior pelvic tilt is so important

Putting It All Together

As you can see the shoulder and neck are very difficult to work with as there is so many moving parts and pieces to consider. To give you a template of a workout for this reason is impossible as the only way to determine what to do is assess your body first and let the tests dictate what to do.

Two people with identical symptoms may need completely opposing programs. One may need stacks of mobility where the other it may be the strengthening exercises that are of more importance.

To help you out with this process we created a detailed shoulder pain report that provides with all the tests and exercises in a step by step format so you can finally get rid of your problems for good. To see more about what is included in this detailed report click here and to download instantly click the image below.

Summary

There is no doubting the forward head posture is going to be something modern society is going to have to use exercises like these to combat the destruction that they can potentially cause. I cannot see the evolution of smartphones and jobs that require us to sit for endless hours being removed any time soon. We are more likely to become exposed to this posture more often so it is up to each of us to recognize this and create little exercise routines and habits to counter the damage that they may cause. Little things like changing your sitting position in the car, how you sleep, your workstation set up at home and an overall awareness of posture can make all the difference. Once you add exercises like I have shown in this article on top of that your chances of avoiding the onset of problems later in life are much better.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter to stay up to date with all of our latest tips and training methods by clicking here.

If you live in Melbourne and feel you need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 18 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• 8 Steps To Pain Free Back - By Esther Gokhale
• TMJ Healing plan by Cynthia Peterson
• TMJ Therapy by Dr Kimberly Bensen
• Shoulder & Scapula Injuries in Athletes - By Chris Mallac
• Movement - By Gray Cook
• Corrective Exercise Solutions - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Core Stability - by Peak Performance
• Athletic Body in Balance - by Gray Cook
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek