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Is Forward Head Posture Linked to Neck Pain?

Research overview, posture-pain relationship, self-testing, self-care techniques, and treatment options.

While most doctors believe there is no direct correlation between Forward Head Posture (FHP) and neck pain, recent studies have shown that neck pain can actually be a result of accumulated physical stress over time.

FHP is a condition described as a sagittal plane postural distortion where the head is held forward and not over the shoulders where it should be. The sagittal plane is a plane of motion that divides your body into left and right halves and involves forward and backward movements. Excessive flexion of the neck at the cervical joints (as if your head is tipped back on top of your vertebrate) together with forward translation and extension of the head results in a center weight shift of the head in space.

"The biggest problem with this type of shift is that as the head moves forward, it becomes functionally heavier. Specifically, the head gains 10 pounds of weight for every inch of forward translation. So, an average 12-pound human head just 2 inches forward of normal, would be as if it weighed 32 pounds!"

This means that when a person is sitting, standing, exercising, or going about their day, the posterior muscles in the neck have to work extra hard to counterbalance the head that is shifting forward. This overuse and chronic holding (constant isometric contraction), can lead to a number of other maladaptive postural issues. These can include: shortening of the muscles in the front of the neck, decreased range of motion, thoracic outlet syndrome, TMJ syndrome, tension headaches, osteoarthritis, and disc pathologies, to name a few.

This article states that FHP doesn’t necessarily promise neck pain or dysfunction, but it stands to reason that the presence of any structural condition can create excess physical stress on the body even though it may take years to get to the point of pain or dysfunction.

In a new study conducted on the correlation between FHP and neck pain, doctors found that neck pain “caused by FHP” was only determined by age. Results showed no correlation in adolescents, but a strong correlation in adults. Dr. Muscolino postulates that if FHP posture is an overuse repetitive injury, why wouldn’t the reason for an increased correlation in adults be linked to accumulation of stress as one ages, therefore, linking neck pain to all FHP cases? His article uses a great analogy to describe the flaws in this study: Why don't adolescents who smoke not die from lung cancer, but adults who smoke do? One reason could be that "it takes time for the cumulative effects of a chronic stressor to impact a persons health". We know that FHP is an overuse repetitive injury so over time and without interruption it can certainly cause neck pain.

Form Dictates Function

FHP is usually part of a larger postural distortion of the upper body called Upper Crossed Syndrome (UCS). It's characterized by thoracic kyphosis (severe rounding of the thoracic spine) and excessive flexion of the cervical spine (neck), which results in the head being held in a sub-optimal forward position. This postural distortion can also cause protraction, or rounding, of the shoulders and internal rotation of the arms. These all can further impact upper back and shoulder mechanics.

Dr. Joe Muscolino believes that "there is no doubt that FHP is a chronic stressor to the tissues of our bodies." and "if we do not change our direction, we are likely to end up where we are headed."

How Can FHP, UCS or Other Postural Distortions Affect Your Body?

Below are some of the most common conditions associated with postural distortions like FHP:

  • Arthritis

  • Back pain

  • Carpal tunnel syndrome

  • Decreased lung capacity

  • Depression

  • Fatigue

  • Headaches

  • Increased blood pressure

  • Indigestion

  • Neck pain

  • Neurological problems

  • Poor circulation

  • Temporomandibular joint disorder

So, How Do You Know If You Have FHP and Can You Fix It?

Short answer: Yes! There are a couple at-home tests that can help you determine if you have FHP. Posture Direct Blog has a great post that outlines the Wall Test and Side Profile (both easy to do at-home tests), as well as a few stretches and exercises to implement to help correct FHP. These, along with targeted orthopedic massage & bodywork techniques (book a MEND session to begin!) can be a game changer.

Momentum Massage & Wellness' signature session, MEND | Sports + Medical Massage, is the perfect place to start if you're looking for relief from any chronic pain or postural change. We will assess, test, treat, and make recommendations as needed. Learn more about our services and book online to begin your wellness journey.

Recommended Service: MEND | Sports + Medical Massage

Recommended Add-Ons: KT Tape, Cupping, CBD Oil

Thanks for reading and we hope you learned something new!


Images taken from Massage & Bodywork Issues: Sept/Oct 2021 and Sept/Oct 2017.

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1 Comment

Mildred Blumberg
Mildred Blumberg
Jun 02, 2022

Love these bits of info that are practical and definitely doable with positive results 😊

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