A forward head is commonly defined by what we therapist nerds call a “plumb line” that is dropped from the hole in the ear (aka the external auditory meatus) directly downwards. Under ideal circumstances, the plumb line that drops from the ear should pass through the anterior portion of the shoulder joint.
From the looks of this photo, our subject’s plumb line drops in front of the shoulder. This is not ideal, and a quick internet search will tell us that even small amounts of anterior translation of the head result in significant increases in stress placed on the neck.
Why do so many people encounter this problem, and what can we reasonably do about it?
There are of course many possible reasons as to why someone might present themselves with a forward head. One reason is obvious: Our eyes are located in the front of our head. Our attention is focused on what is in front of us, and the neck can easily have the tendency to crane forward in order to focus the eyes on computer screens and hand-held devices. Hours of daily office work can slowly draw a person’s head forward. When this occurs over years, the body has a tendency to try to stabilize itself in this problematic position. The final result can be a stiff spine and a forward head.
Here are some simple solutions that we as physical therapists tend to prescribe to patients who have a forward head.
1. Spend a few minutes each day lying on top of a towel roll or a foam roller (see the exercise below). Gravity will gently help to allow the shoulders and spine to relax in the opposite direction that you sit all day. To be safe, make sure that you have adequate head support! Many people need extra support behind their head to rest comfortably. I will tell patients that their heads should not look like a “Pez dispenser,” meaning the neck should not look like it is cocked back into extension.
Exercise: Towel Roll Stretches
2. Adjust your ergonomic set up to favor better posture. A few quick tips… your computer monitor should be close enough so that you don’t have to crane your neck to focus on the screen. 18-24 inches is usually a good range. Also, when you are seated upright, the top of your screen should be at eye-level.
3. Start a gentle exercise program under the direction of a healthcare professional. I will typically start a patient with a gentle deep neck flexor exercise such as the one shown below.
Exercise: Head Holds
Another caution, many people need to start this very gently with the head supported on the table rather than off the table. Strengthening the upper back, shoulder blades, and core are also excellent ideas.
4. Some people try to “over-correct” a forward head by forcibly cramming the head backwards. In general, this is not a great idea. Some better cues to follow would be to gently extend or straighten the lower back. This will actually encourage the upper back and the head above it to assume a more ideal alignment. I have also used the instruction of having the patient pretend that he or she has a string coming out of the top of his or her head. I tell the patient to “pretend that I am gently pulling the string upwards”.