Forward Head Posture and it’s effects.

How developing FHP is disastrous to your health

Article by Rene Cailliet MD

First of all, Forward Head Posture (FHP) refers to the head being carried forward of its proper placement over the shoulders and upper body, the center of the external opening of the ear should lie approximately on a line dividing the lateral shoulder in half from front to back.


With the head in this position, the center of mass of the skull is balanced over the body and the muscles of the neck, upper back and chest stay balanced in their activities.

If the head is jutting forward of the shoulders, the weight of the skull — about the weight of an 8 -10 pound bowling ball — is putting a strain on the muscles which are designed to pull it back. This leads to very tight and tender upper back and neck muscles and headaches where the muscles attach at the skull.

Rene Cailliet M.D., director of the department of physical medicine and rehabilitation at the University of Southern California says the following regarding mechanical derangements of the hard and soft tissues of the spine:

  • Incorrect head position, leads to improper spinal function.
  • Both the neck and low back have normal and necessary lordotic curvatures (forward facing curves when seen from the side view).
  • Both proper cervical and lumbar lordoses are necessary for normal function.
  • With a forward extended head (FHP), normal lordosis is lost both in the cervical and lumbar spine.
  • The shoulders are rotated inward and come forward with the head position. (1)

Dr. Cailliet, explains the effects of FHP as follows:

Head in forward posture can add up to thirty (30) pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment.

Forward head posture results in loss of vital capacity of the lungs. Lung capacity is depleted by as much as 30%. This shortness of breath can then lead to heart and blood vascular disease. These breath related effects happen primarily because the loss of the the cervical lordosis blocks the action of the hyoid muscles, especially the inferior hyoid that is responsible for lifting the first rib during inhalation. This rib lifting action is necessary for complete aeration of the lungs. Loss of the cervical lordosis reduces the patients lung and vital capacity up to 30%. (2, 1, 3) Loss of gastrointestinal function: * The entire gastrointestinal system is affected; particularly the large intestine. * Loss of good bowel peristaltic function and evacuation is a common effect of forward head posture.

Forward head posture causes an increase in discomfort and pain because: *Proprioceptive signals from the first 4 cervical (upper neck) vertebrae are a major source of the stimuli which create the body’s pain controlling chemicals (endorphins). (4, 1) * With inadequate endorphin production, many otherwise non painful sensations are experienced as pain. (2, 4) Forward head posture dramatically reduces endorphin production by limiting the range of motion of the cervical spine.(2, 4)

Some Other Important Facts & Factors

Disc Nutrition:

Forward head posture causes loss of normal spinal and body motion which leads to problems other than increased pain.(2, 4) Until age 12, the spinal discs, ligaments and cartilage are fed by the vascular system. By age 12 or so, the blood supply to these structures ‘dries up” — they become ‘avascular’. From then on, it is only “normal” spinal coupled motion that can bring nutrients into and take waste products out of these areas — this occurs through a “pumping” process called nutation.(5)

Because loss of all or part of the cervical lordosis causes a loss of all or part of the normal cervical and thoracic coupling motion, the involved discs receive inadequate nutrition and oxygenation — and, it also results in their being burdened with toxic metabolic products because the waste removal process has been slowed down. (6)

Posture, Disc Compression, Nerve Entrapment, Etc.

Because of FHP and loss of the cervical lordosis, one becomes hunched, with the head thrust forward and rolled back on the neck as reflexive controls bring the eyes up to a horizontal level. This leads to: compression of the facet joints of the neck.

As the head rocks backwards on the top neck vertebra (Atlas, C1) impingement into structures at the head neck junction (suboccipital triangle) is inevitable. A number of painful mechanical and muscular nerve entrapments are produced by this posture if it is allowed to persist. (6, 7, 8)

The entire body becomes rigid and ranges of motion become less. Loss of these motions result in loss of disc height (‘collapsed discs’) along with facet pain and other spinal hard and soft tissue pathologies (such as spurs, bulges, etc.). (9) The better the posture, the better and younger one looks and feels and moves.

In man, neck-spine mechano-receptors dominate the body’s balancing system in combination with the inner ear balancing system (vestibular function mechanism) through reflex regulation of equilibrium (balance) in both static posture and gait. (10,11)

Cailliet also states: “Most attempts to correct posture are directed toward the spine shoulders and pelvis. All are important, but the position of the head is the most important. The body follows the head. The entire body can be aligned by first aligning the head. (1)


1) Cailliet R, Gross L, Rejuvenation Strategy. New York, Doubleday and Co. 1987.

2) Anderson: Statistics of differences in age, gender, social class, and pain localization. Clin. J Pain 1993:9:174-182.

3) Kapandji IA, Physiology of Joints. Vol.. 3. New York: Churchill Livingstone, 1974

4) Wyke B, Workshop, Neurology of Joints. Dallas, TX. 1980

5) Virgin W, Experimental investigation into physical properties of the intervertebral disc. J Bone, Joint Surg. 33B:607,1951.

6) Kopell HP and Thompson WAL, Peripheral Entrapment Neuropathies. New York: Robert Kreiger Publishing Co., 1-11, 147-170, 1976

7) Hoppenfield S, Physical Examination of the Spine and Extremities. New York, Appleton-Century-Crofts. 1976.

8) Rocabado HS, Cebeza Y Cuello Tratamiento Articular, Buenos Aires: Inter-Medica 1979

9) Bernini P, Wiesel SW, and Rothman RH, The Aging Spine, W.B. Saunders Co 1982. 21)Darnell MW, Proposed chronology of events for forward head posture. J. Craniomandibular Practice, 1 (4) :49-54, 1983.

10) Igarashi M, Alford BR, Watanabe T, and Max CM, Role of the neck proprioceptors for the maintenance of dynamic body equilibrium in the squirrel monkey. The laryngoscope,69.(8): 1713-1727, 1969

11) Raymond G, Disturbance of Nervous Function. Vol. 1 Chapter 11 PJ Vinker and GW Brayn (eds) New York: John Willey and Sons.1969

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