Getting Your Head on Straight – Pilates Exercises for Forward-Head Posture

By: Courtney Holcomb, Certified Pilates Instructor, Waveforms Pilates

How many text messages have you sent today?  When is the last time you pulled your head back to use your headrest in the car?  How often during the day do you spend on a smartphone, tablet, or at computer?  How many hours a day do you sit?

All of these things share something in common: They put stress on our head, neck, and shoulders.  All this, creates a lifestyle that leads to poor posture, muscular imbalances, and chronic pain.

The Physical Effects of Media Culture

In July of 2016, Nielsen Company released a report that the average American spends 10 hours and 39 minutes daily consuming media.  This “included how much time we spend daily using our tablets, smartphones, personal computers, multimedia devices, video games, radios, DVDs, DVRs and TVs.”  All this usage doesn’t come without a toll on our bodies.

Two physical effects come of excessive media use: forward posture of our head and a sedentary lifestyle. The sustained forward and downward movement of our head pulls our body out of alignment. Sitting for hours a day or maintaining a mostly sedentary lifestyle weakens the core muscles. Together, misalignment and decreased core strength drags us down a road of pain.

Pressure From the Head

The average head weighs 10-12 pounds.  For every one-inch forward our head extends beyond alignment, an additional 10 pounds of pressure is put on the spine.  Our spinal extensors begin to engage in a losing battle with gravity. They pull our whole spinal structure forward with our head.  This (now common) misalignment is known as Forward Head Posture (FHP).

FHP is an excessive anterior (forward) positioning of the head in relation to a vertical reference line.  Our spine is curved, so we are not trying to flatten our neck, but rather bring it back to rest on top of the spine.  When viewed in profile, the head is designed to sit stacked over the spine with the tip of the earlobe aligned with the center of the shoulder.

We also receive a lot of pressure from the downward tilt of the neck.  Added gravitation pull of 15 degrees of tilt increases of the weight of pressure to 27 pounds. 30 degrees adds 40 pounds of pressure, and once you tilt to 60 degrees (like many of us do while texting), the increase is 60 pounds of pressure on the spinal cord.

This version of FHP is ironically called “Text Neck” by many doctors, and more formally called Tilting Head Posture (THP).

Pair Forward Head Posture, with Tilting Head Posture, and that’s a whole lot of pressure for the body to bear.

Physical Effects of Forward Head Posture

With the head forward, our deep cervical flexors (the muscles that pull our head back) become very weak from inactivity, and our cervical extensors become shortened (from being held so long in the forward position).  Because our bodies do their best to compensate for inefficiencies, other superficial muscles take on the job that the neck flexors and extensors were designed to do.  Our sternocleidomastoid, anterior scalenes, and other superficial neck muscles try and take on the job.  This causes overactivity for the muscles and less efficiency in the body.

The overactivity of the cervical extensors can cause neck pain, the most noted symptom of FHP. With the extra pressure on the spine, you could experience nerve pain leading to headaches.

Not only do muscles try and do their part, but the spine also will begin to compensate.  Our body loves to counterbalance; as the head goes forward, the chest begins to go back, the hips respond by rounding forward, and the body perceives balance.  Now, we end up with a tight chest and upper back, and a pinched low back.  This common counterbalance act associated with FHP is called Upper Crossed Syndrome.

What’s the Big Deal?     

Just like Newton explained in his Laws of Physics, with every action, there is an equal and opposite reaction.  We cannot perpetually hold our body in a compromised posture and expect to not experience side effects.  There is a ripple effect throughout the whole body that becomes habit forming, for the better, or for the worse.  This becomes tight, that becomes weak.  This becomes long, that becomes short.

While the effects of our body are easy to visualize, other impacts aren’t obvious. Just as serious, poor posture threats our source of life: our breath.

FHP can result in up to 30% decrease in the lungs capacity. Rene Cailliet M.D., former director of the department of physical medicine and rehabilitation at the University of Southern California explains,  “These breath-related effects are primarily due to the loss of the cervical lordosis which blocks the action of the hyoid muscles, especially the inferior hyoid responsible for helping lift the first rib during inhalation.  Proper rib lifting action by the hyoids and anterior scalenes is essential for complete aeration of the lungs.”  Having a forward head limits the range of motion for the ribcage, causing a decrease in lung capacity.

Fixing Your Poor Posture to Prevent FHP

First we want to feel the effects of poor posture on our breathing. This will help us understand how damaging it can be for our well-being. Erik Dalton, PhD a pioneer of Myoskeletal Alignment Therapy, gives these simple instructions.

1. Place your hand on your chest and breath normally.  Take a few inhales and exhales.  Sense your ability to make the chest rise and fall with each breath.
2. Gently and carefully reach your head forward in space and take a few more breaths.  Sense the difference in the ability to move the chest.
3. Pull the chin in and back, as if to make a “double-chin”, repeat a few inhales and exhales.

You should find that the movement of the chest decreases the further forward the head moves in relation to the spine.

Why Focus on the Head?

When the spine, muscles, and lungs are all affected, why focus primarily on the head?

I like how Rene Cailliett, M.D. put it:

“Most attempts to correct posture are directed toward the spine, shoulders and pelvis. All are important, but, head position takes precedence over all others. The body follows the head. Therefore, the entire body is best aligned by first restoring proper functional alignment to the head.”

We can begin to combat this by strengthening our deep neck flexors through lengthening and releasing our neck extensors.  A great rule of thumb for any imbalance in the body.  We want to strengthen what is weak and stretch what is tight.

How to Strengthen the Deep Neck Flexors

If our neck is already flexed forward, why are we working our neck flexor muscles?

The neck flexor muscles are what bring our head back to our spine.  Our deep neck flexors help pull the head back into alignment.  Here are three exercises I use in Pilates class that work these muscles.  Each exercise has increasing difficulty, so I advise working from top to bottom.

Also, start slowly.  The neck is a sensitive area, so begin with a few repetitions and work up to more.

1. Craniocervical Flexor Activation

Sit or stand and hold a loose fist underneath your chin.  Push upwards on your chin, but resist the head from tipping back.

Hold this connection for 5-10 seconds.

Repeat this 10x.

You should feel the muscles on the back of your neck engaged. Be careful not to push too hard, or to clench your first too hard.

2. Prone Neck Lift

Lay down on your stomach with your legs resting comfortably behind you.  Place your hands on top of one another and rest your forehead onto your hands.  Press the arms into the ground and lift the head and upper back off of your hands.  Make sure to keep the neck long and the chin tucked, as if you were holding a clementine between your chin and your chest.

Feel the neck flexors pull your head up towards the ceiling, and avoid the tendency to reach your chin forward to lift up.  Hold this for 10 seconds.

Reach energy out of the crown of the head (not leading with the chin) to lengthen and lower down.  You may find that you have to move your hands further away from lengthening and strengthening the neck.  Adjust as needed.

Repeat 5-10 times.

3.Head Hover

Lay on your back with your feet in the hook- line position (feet planted on the ground hip width apart, and knees at a 90-degree angle).

Rest your head and shoulders on the mat. Before you begin, imagine lengthening the back side of the neck to pull the chin slightly downward into a “double chin-like” position.  Take a breath in, and press the head lightly into the ground as if to push an imprint in memory foam, exhale and pick the head up off of the ground, while keeping the head parallel to the ground.

Sustain the hold for another breath or two, then lower back down.  Repeat 5-10 times.

You will feel the neck really work in this position!  You’ll also notice how heavy the head is with gravity working against you.

Stretching and Lengthening the Neck and Neck Extensors

After performing neck flexor exercises, it’s great to stretch the neck to help bring the head back into balance.  When stretching the neck, use caution and move slowly.  Use full breaths to support the stretch. I recommend the following stretches, these are also great after extensive time sitting at a desk, at a computer, or using your phone.

1. Neck Massage

Using a 4” or 6” diameter foam roller, place it lengthwise behind your neck.  Let the head rest back onto the foam roller.  Keeping the head heavy in gravity, Slowly turn the head from right to left. Nod the head up and down.

Trace small circles with the nose in each direction.  Do each step a few times before moving on to the next stretch.

2. Standing Neck Stretches

Stand up with the feet hip-width apart. Take your hands and interlace them at the nape of the neck.  Let the elbows be heavy and nod the chin towards the chest.  Do not pull on the neck, but let the elbows and head be heavy in gravity.

Return the head to upright and press the palms firmly together.  Place your middle fingers underneath the chin and gently press the chin up towards the ceiling.  Repeat each action a few times.

Correcting our Head Posture and Simple Habit Changes

As a culture, we have come to a place where many suffer from the effects of FHP and THP.  We need to get our heads on straight, or the pain and poor posture will only increase.

Though these are exercises to help us reverse the effects that have come from these conditions, there are other habits that can help us prevent or lessen it all together.  It all comes down to daily awareness of how we carry our bodies.  Here are a few simple suggestions:

• Bring your phone to your eye level when using it.  Instead of flexing the neck down, lift your phone up.
• Use your head rest while driving.
• Request a standing desk at work, to bring your computer up to your eye level.
• Take breaks from long periods of sitting down, and stretch out in between.
• Actively practice the exercises for strengthening the deep neck flexors.
• Be conscious of the amount of time you spend consuming media and your posture while doing so.
• Strengthen your core muscles to help support your posture throughout the day.
• Take Pilates classes to gain body awareness.