Most cases of neck pain have a postural component as part of the underlying problem. In such cases, recognizing and understanding poor posture can play an important role in finding neck pain relief.

The Difference Between Good and Poor Posture

Normal head posture vs forward tilt

Good posture, as it relates to the neck, is commonly considered when the ears are positioned directly above the shoulders with the chest open and shoulders back. In this neutral position, also called normal head posture, stress on the neck is minimized because the head’s weight is naturally balanced on the cervical spine.

See Posture to Straighten Your Back

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Forward head posture occurs when the neck slants forward, placing the head further in front of the shoulders rather than directly above. This head position can lead to several problems:

  • Increased stress on the cervical spine. As the head is held forward in poor posture, the cervical spine must support increasing amounts of weight. One rule of thumb is that for every inch that the head is held forward in poor posture, an additional 10 pounds of weight is felt on the cervical spine.1 So if the average head weighs between 10 and 12 pounds, just 1 or 2 inches of forward head posture can double or triple the load on the cervical spine.
  • See Cervical Spine Anatomy and Neck Pain

  • Hyperflexion and hyperextension. The lower cervical spine goes into hyperflexion with the vertebrae tilting too far forward. The upper cervical spine, however, does the opposite and goes into hyperextension as the brain automatically keeps the head up so the eyes can look straight ahead. This alteration of the cervical spine’s curve lengthens the spinal canal distance from the base of the skull to the base of the neck, causing the spinal cord and nearby nerve roots to become somewhat stretched.
  • Muscle overload. Some muscles in the neck and upper back must continually overwork to counterbalance the pull of gravity on the forward head. As a result, muscles become more susceptible to painful strains and spasms.
  • Watch: Neck Strains and Sprains Video

  • Hunched upper back. Forward head posture is often accompanied by forward shoulders and a rounded upper back, which can lead to more pain in the neck, upper back, and/or shoulders.

The longer that poor posture is continued—such as being hunched over a computer or slouching on the couch—the more likely that neck pain, stiffness, and other symptoms may develop.

See Neck Pain Symptoms

Long-Term Effects of Forward Head Posture

Over time, forward head posture can put increasing amounts of stress on the neck and other areas of the body. Some long-term effects of forward head posture can include:

  • Muscle imbalances. Some muscles in the neck, upper back, shoulders, and chest can become shortened and tight, whereas others can become elongated and weak.
  • Elevated risk for spinal degeneration. Extra stress on the cervical spine’s discs, facet joints, and vertebrae may increase the risk for or worsen degenerative spine issues, such as cervical degenerative disc disease and cervical osteoarthritis.
  • Reduced mobility. With increased stiffness in the muscles and/or joints, the neck’s range of motion is decreased.

See Stiff Neck Causes, Symptoms, and Treatment

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Many other long-term effects of forward head posture have been reported, such as headaches, jaw pain, reduced breathing capacity, and altered balance.2,3

References:

  1. Kapandji IA. The Physiology of the Joints, Volume III. 6th ed. London: Churchill Livingstone; 2007.
  2. Kim S-Y, Kim N-S, Kim LJ. Effects of cervical sustained natural apophyseal glide on forward head posture and respiratory function. J Phys Ther Sci. 2015; 27(6):1851-54.
  3. Lee, J-H. Effects of forward head posture on static and dynamic balance control. 2016; 28(1):274-77.
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