Forward head posture is a common postural fault in which the head’s center of gravity rests forward of the sagittal plane, and it’s typically associated with frequent electronic device and screen use. The further the head sits in front of the shoulders, the harder the muscles in the back of the neck, shoulders, and upper back must work to keep the head upright. In addition to pain in the neck, upper back, and shoulders, forward head posture has been linked to headaches, respiratory impairments, and reduced nerve conduction in the cervical spine. Aside from general advice to limit screen time and sit up straight, what treatment options might benefit the patient with forward head posture?

A 2021 randomized trial compared scapular stabilization exercises (SSE) to no exercise in 39 young women with forward head posture. The exercise group performed SSEs using elastic bands at ten reps a set, three sets a day, and three days a week for four weeks. The control group did not perform any exercises. Results showed improvement in forward head posture in only the exercise group.

Another study compared SSE with abdominal control feedback (ACF) in 135 women with forward head posture who were separated into three groups: SSE and ACF; SSE only; and general exercise. The results showed that the individuals in the SSE and ACF group had the best outcomes with respect to posture, pain, balance, and strength.

In 2019, a study compared mobilization therapy of the neck and upper back with deep neck flexor exercises in a group of 31 patients with forward head posture. The results showed the patients in the mobilization group were more than twice as likely (60% vs 25%) to report significant improvements in cervical posture, pain, and respiratory function.

Two years previous, the same research team compared upper thoracic (UT) mobilization with mobility exercises verses upper cervical (UC) spine mobilization with stabilization exercises in 32 participants with forward head posture for four weeks. Outcome assessments showed that 11 of 15 patients in the UT group experienced significant overall improvement compared to 8 of 16 patients in the UC group. Additionally, members of the UT group exhibited greater improvement with respect to cervical posture.

The results from these studies suggest that specific exercises and manual therapies are effective for managing the patients with forward head posture, especially when used together. Doctors of chiropractic frequently use a multimodal approach when managing patients with musculoskeletal disorders in order to achieve the best outcome for the patient.

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