Forward head, a posture where the head is carried too far forward in relation to the body, is one of the most common postural deviations. It can also be surprisingly easy to miss in yourself. Many people reading this article may have some degree of forward head posture.
And it may matter for more than appearance. Research has associated forward head posture with neck pain and disability, changes in balance and the body’s awareness of neck position, altered swallowing mechanics, temporomandibular joint (TMJ) pain, and even differences in agility, power and balance among athletes.[1-5]
Association does not establish that forward head posture causes every one of these problems. The research does give physical therapists good reason to consider head and neck posture as part of a broader evaluation.
A Simple Exercise Shows Promise
A 2024 randomized pilot study provides encouraging evidence that forward head posture can be improved.[6] Researchers studied 36 young adults with forward head posture and chronic nonspecific neck pain. The participants were divided into three groups. One received therapeutic ultrasound combined with neck retraction exercises. A second received therapeutic ultrasound combined with deep cervical flexor training. A third served as a control group. The two exercise groups trained three days per week for four weeks.[6]
The researchers measured forward head posture using the craniovertebral angle, or CVA. In simple terms, they photographed each participant from the side and measured the angle created by the position of the ear relative to the base of the neck. A larger CVA generally represents less forward positioning of the head.
The group performing neck retraction exercises improved. At follow-up, researchers found significant differences between the neck retraction group and the control group in forward head posture, pain and deep neck flexor strength.[6]
Other research has also found improvements in forward head posture with therapeutic exercise, including cervical retraction and other corrective exercise programs.[1,7]
What Is a Neck Retraction Exercise?
The movement itself is surprisingly simple.
Keep your face level and gently slide your head straight backward, bringing your ears closer to being positioned over your shoulders. Your chin will naturally draw inward slightly.
Physical therapists sometimes describe the motion as making a gentle “double chin.”
The important word is backward. The head translates toward the rear while the eyes continue looking straight ahead. The movement should not require tipping the head upward or forcefully pulling the chin toward the chest.
This type of movement is often called a neck retraction, cervical retraction or posterior translation exercise.
A physical therapist may combine corrective exercise with other treatment when appropriate. Hands-on treatment, strengthening, mobility work, postural training and therapeutic modalities may all be considered based on the individual’s examination. A review of 16 studies involving people with chronic neck pain and forward head posture found benefits from treatment programs that included corrective exercises and certain manual therapy techniques.[7]
Do You Have Forward Head Posture?
A simple side view can provide a clue.
Stand naturally and look straight ahead. Avoid deliberately “standing up straight” for the test. You want to see your normal resting posture.
Physical therapists have traditionally used an imaginary vertical line, sometimes literally a plumb line, as a reference for evaluating posture from the side. In generally accepted postural alignment, that line passes near the opening of the ear, through the shoulder region, near the hip, slightly in front of the knee and near or slightly in front of the outside ankle bone.[8]
Now look specifically at the relationship between the ear and shoulder.
If the opening of the ear sits noticeably forward of the shoulder when you are standing naturally, you may be seeing forward head posture.
This is a useful screening observation. A physical therapist can perform a more complete assessment and determine whether the apparent forward position comes primarily from the neck, the upper back, the shoulders, whole-body posture, or a combination of factors.
Why Physical Therapy Can Help
Forward head posture develops within a complicated system of joints, muscles and movement habits. Correcting it may involve more than repeatedly pulling the head backward.
A physical therapist can evaluate cervical mobility, muscle strength and endurance, upper-back mobility, shoulder blade positioning, balance and movement patterns. Treatment can then target the factors that are contributing most to the individual patient’s posture.
The encouraging part is that posture can change.
A growing body of research supports therapeutic exercise for improving forward head posture, and neck retraction is among the remarkably simple exercises being studied.[1,6,7] For someone who has lived with a forward head position for years without realizing it, learning how to bring the head back over the body can be a very good place to start.
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