Does your neck or back ever tell you that your mother was right? “Sit up straight.” “Stand up straight.” “Look straight ahead.” Do any of those motherly remarks bring back not-so-fond memories of trying to achieve the posture demanded by teachers in school or moms at the dinner table? If you listened, then you might be one of the few adults who have normal, pain-free, aligned spinal posture. You can walk while balancing a book on your head. Congratulations! If you ignored such sage advice, you might be one of the many adults who exhibit forward head posture. Forward head posture can be described simply as a temporary or permanent position of the head where the ears are aligned forward of the shoulder. There are more biomechanically correct terms for the alignment, but basically, the weight of the head is forward to the trunk, over-stretching nerves, muscles, and other soft tissue in the neck. Chronic forward head posture has been linked to neck pain, loss of motion in the cervical spine, increased fall risk, and poor position sense in the sensory structures that provide the brain with information about where the head is in space. And don’t be fooled into thinking you don’t have forward head posture if you are free from neck pain. Many adults with forward head posture show poor spinal alignment in the neck but have not developed neck pain yet.
You might be thinking that the only group of folks who develop this posture is older adults. While it is more common for older adults to have forward head posture than younger adults, a condition termed “text neck” is emerging in a younger population. Text neck is the term used to describe the malalignment resulting from looking down at your cell phone, tablet, or other wireless devices too frequently and for too long. Symptoms of text neck include pain, muscle strain, loss of neck range of motion, and of course, bumping into objects! And no way can a person with text neck walk with a book balanced on her head! This seems like an easy posture to fix by simply remembering to sit up straight. Unfortunately, any adult, young or old, who habitually practices this poor posture can develop pain, muscle strain, loss of sensory awareness in the neck, and eventually can place the spine in a harmful alignment that becomes “structural” (more permanent and hard to reverse) than functional (more easily returned to normal with practice, exercise, and attention to posture).
Physical therapy faculty at Winston-Salem State University in the Doctor of Physical Therapy program are currently conducting research in this area. Researchers are exploring the relationships between forward head posture, fall risk, and vestibular function (inner ear balance mechanisms). They hope to determine how forward head posture impacts an older adult’s chance of falling and why that may increase with poor posture. Studies in Japan have identified a link between these three factors in young computer programmers who spend many hours staring at a screen, many of whom developed forward head posture at a young age, displayed poorer balance, and were more likely to fall. Answers to these research questions can help therapists develop effective treatment plans for anyone with forward head posture. Current treatment includes education on proper posture, muscle strengthening and stretching for neck muscles, and balance exercises for more chronic conditions. In an article in the Washington Post, Tom DiAngelis of the American Physical Therapy Association described the damage from text neck by stating, “As you stretch the tissue for a long period of time, it gets sore, it gets inflamed. It can also cause muscle strain, pinched nerves, herniated disks and, over time, it can even remove the neck’s natural curve.”
So take the advice of your mom, your teacher, your nun, or whoever asked you to, “Sit up straight, eyes forward, ears over your shoulders.” Self-assess your posture in a mirror or have a friend take a photo from the side of your comfortable sitting posture with your feet flat on the floor. Your ears should line up over your shoulders, not in front of them. If you are already experiencing symptoms that interfere with your normal, daily movement, then seek help from a physical therapist. You only have one spine. Take care of it.