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Hold Your Head Up High, Not Forward!

Hold Your Head Up High, Not Forward!

By Megan Piersol, DPT

In my last blog, Shrugging It Off, I discussed shoulder posture. I now want to follow up with the neck’s role in making (or breaking) good posture. As I stated in the shoulder blog, most of the muscles of the neck attached to a part of the shoulder complex. It usually goes without saying that a therapist will look at the neck and back when someone presents with a shoulder or elbow problem. This is because it is all connected and usually contain components (like joints, ligaments, muscles) associated with each other.

A very common issue with people is the forward head posture. It mimics that of a turtle sticking its head out of its shell. As the weight of your head goes forward and your neck moves further out of a stacked position, a good amount of excess pressure is being placed down the spine. Think of a golf ball (in this case, your head) resting on a toothpick (i.e. your neck). There will be better stability if the toothpick is straight up and the golf ball is directly in line with the toothpick. Now, bend the toothpick forward and try to support the golf ball. It’s impossible. The toothpick will begin to bend even further or just completely give. Your neck needs to be in a good alignment to be able to support and hold up the weight of our head.

The forward head position over stretches and strains ligaments along the neck that provide support for the bones that make up the neck and support for the head (which isn’t lightweight). This position not only eventually creates an instability of spine segments over time, it also creates an imbalance of muscles of the neck, back, and shoulder complex. Over time, the deep neck muscles that help us keep a good head posture and stabilize our neck weaken and we get further and further away from being able to have the strength to “hold up our head.” If that isn’t enough, it also creates a closure of the spinal segments causing more potential for “wear and tear” of the bones and also decreases the space where nerves exit. Nerves are essential for providing communication to muscles and feedback to and from the brain. Nerves that exit the neck go down through the arms. Any compromise (pinching, pressure, etc) to a nerve can create improper firing of muscles, decreased muscle power and strength, muscle wasting, and/or sensory changes. Thus, you can see the importance of keeping a good neck posture and position to avoid aggravating the bones, nerves, muscles, and ligaments.

It is often that when the human body bends forward or is doing things out in front of the body, the head turns up and out (the whole turtle head out of the shell). When we read or work on the computer, the head goes forward and depending on the where the book or screen is, it usually tips up. As we drive, watch TV/movies, sit, cook, pull laundry out of the dryer, wash dishes, bend down to tie our shoes or pick things up off the floor the last thing on our minds is usual: “is my head too far forward?” I’ll even notice my head wanting to go forward and stick out when I am doing squats, deadlifts, running, biking, and other portions of my work out or daily routines. It’s a conscious effort to prevent this from happening. Even sleeping positions and the number of pillows we use can play a role in our neck health. We compensate so well in our life that it becomes a norm and we don’t notice we are even doing behaviors or placing ourselves in postures that could be detrimental to our health. All of the above activities are just a few examples of everyday occurrences that usually tend to create a forward, protruding head posture without our awareness. Now, think about how long and how many times you spend doing these types of activities a day. Then further think about what we discussed regarding your shoulder placement that can further add strain to the neck. The neck never gets to rest!

At this point, I imagine you might be thinking, this is all great information, but how do I become more aware of my head posture and more importantly, how do I fix it? I want you to start by doing a little “trick.” Make an “L” with your thumb and index finger. Place your thumb in the notch that is in the middle of your neck, between your two collarbones. Relax your thumb some, so it fits at the bottom of the notch and rests lightly on your chest. Keeping the “L,” your index finger should be pointing straight up. Move your head to where the front part of your chin is touching the tip of your index finger (you will most likely have to drop your chin down and bring it back find your index finger. Make sure our mouth stays closed and your tongue rests on the roof of your mouth. You may feel a stretch in the back of the neck and some tightness in the front of the neck as you do this. You should be able to comfortably swallow still. Keeping this position, try leaning forward as if picking something off the ground or tie your shoe. Do not lose the head position (front of chin should be touching tip of index finger). As you go forward and maintain the position, you should feel the back of the neck gently tensing (activating). Try to keep your chin from leaving the index finger and you go forward. Practice this when tying your shoes or bending down to pick something up off the floor.

Here are a few pointers to help with keeping better head posture:

  1. Your chin should be parallel to the floor (you may have to tip your head up or down to achieve this)
  2. Your ears should be in line with your shoulder (or fairly close to it)
  3. Your chin should be slightly pulled back
  4. Your head should be elongated up as if someone was lifting the base of your skull/head upward (like someone pulling a string up from the top, back portion of your head)
  5. Remember your shoulders: relaxed! They should be down and not hiking towards your ears.
Check out Dr. Tamer Issa's book, Freedom From Neck & Back Pain- Learn to Live an Active Life Without Fear of Pain