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Literature Overview of Forward Head Posture Significance to Health

Forward head posture has been extensively studied and related to a number of conditions
including cervical headache (1), obstructive sleep apnea (2), craniomandibular dysfunction (3),
craniofacial pain (4) and upper limb overuse injuries (5). Cailliet considers forward head
posture as a significant contributor to pain in the neck and arm (6) and also attributes changes
in cartilage, joint capsules, and muscular tissue to prolonged maintenance of this posture.

From a mechanical viewpoint, it makes sense that abnormalities of cervical curvature, espe-
cially forward head posture, would place additional stress on the spine and soft tissues. A
static spinal model has been used by Snijders et al. (7) to show that forward flexion of the head
can produce significant loading on the cervical muscles and increase joint reaction forces. In
the mathematical model, increased loading is due to the position of the center of gravity of the
head relative to the supporting joints. With the head in a flexed position, muscle activity must
be used to counteract the tendency of the head to fall forward; this muscle activity also pro-
duces compression in the cervical joints. In one model, forward flexion beyond 30 degrees
produced joint reaction forces equal to twice the weight of the skull.

Forward head carriage, like forward flexion, would also place the center of gravity of the skull
well forward of the supporting column and produce similar increased loading on the muscles
and joints. Prolonged maintenance of a head-forward posture might take its toll by slowly
wearing the spinal joints and thereby causing cervical spondylosis (8) and dysfunctional aging.

Watson DH, Trott PH. Cervical headache: an investigation of natural head posture and upper
cervical flexor muscle performance. Cephalalgia 1993;13(4):272-284 .
Lowe AA, Ozbek MM, Miyamoto K, Pae EK, Fleetham JA. Cephalometric and demographic
characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis.
Angle Orthod 1997;67(2):143-153.
Gonzalez HE, Manns A. Forward head posture: its structural and functional influence on the
stomatognathic system, a conceptual study. Cranio 1996;14(1):71-80.
Braun BL. Postural differences between asymptomatic men and women and craniofacial pain
patients. Arch Phys Med Rehabil 1991;72(9):653-656.
Greenfield B, Catlin PA, Coats PW, Green E, McDonald JJ, North C. Posture in patients with
shoulder overuse injuries and healthy individuals. J Orthop Sports Phys Ther 1995;21(5):287-
295.
Cailliet R. Neck and arm pain, 3 edition. Philadelphia: F.A. Davis Company; 1991;74-75.
rd
Snijders CJ, Hoek van Dijke GA, Roosch ER, A biomechanical model for the analysis of the
cervical spine in static postures. J Biomech 1991;24(9):783-792.
Parke WW. Correlative anatomy of cervical spondylotic myelopathy. Spine 1988;13(7):831-837