Information on Head and Shoulder Forward Positions

My experience with my clients is that we have become very much “Shoulder Forwardâ€? and/or “Head Forwardâ€? in our posture. Ideally, there should be a straight line down from our ear to our shoulder joint to our hip joint to our knees then to our ankles. If the Shoulders and/or Head fall in front of that line, the body can end up working too hard to compensate for this difference. 

There are two general rules that apply with muscles:

 1) If a muscle becomes stretched, it will weaken and vastly increases the chance of it going into spasm as it tries to do the job that it is responsible for. Example is that the bicep muscle on the arm is stronger when the elbow is at 90 degrees than when the arm is nearly straight. Give it a try.

2)If a muscle is shortened, it can become congested with waste byproducts that can cause pain, as well as not being able to bring in adequate amounts of oxygen necessary for the muscles to do their work. 

There are  many manifestations of a “Head and Shoulder Forward Positionâ€?  and can include the following:

A shoulder that is turned inwards can increase the risk of “pinchingâ€? of structures at the shoulder joint, during movement, causing local sharp pain. This will reduce the amount that the shoulder can be brought forward and to the side over 70 – 90 degrees, then slowly reducing motion in the shoulder more and more, very often predisposing the client to Frozen Shoulder Syndrome

A shoulder turned inwards will stretch the Rotator Cuff muscles from the back of the Shoulder Blade to the arm. These are very important muscles for stability of the shoulder and arm during movement, and when stretched will become weaker, causing Trigger Points (or hyper-irritable points in the muscle) that can produce pain down the arm as well as spasm during arm movement. 

Shoulder Forward position will shorten and thicken the Pectoralis Major and Minor muscle in the front of the chest. The Nerve that travels down the arm travels underneath this muscle on the way to the arm, and if compressed by the Pec Minor Muscle, will produce pain, weakness and tingling to the arm and hand. 

A head forward position will shorten muscles in the front of the neck.                                                                             -One neck muscle, the Sternocleidomastoid, can remain in the shortened position, causing symptoms like Headaches, nausea and has been tied to Migraine headaches with it’s proximity to the Carotid Artery.           -Another set of muscles called the Scalenes are important breathing muscles , and when shortened can cause pain in the chest, between the shoulder blades, down the arm and can cause headaches. The Scalene muscles can also compress the nerves going down the arm, like the Pectoralis Minor, causing similar pain, numbness and weakness in the arm and/or hand. Similar Trigger Points in the Pectoralis Major (chest muscle)  and Subclavius (muscle just under the collar bone), can produce vague, dull achiness in the shoulder and upper arm. 

The is supposed to be a small curve in the neck area of the spine that is designed to properly take the weight of the head. When the head is forward, it reduces this curvature reducing the efficiency of the lower cervical (neck) spine. With other factors in play, the discs that lay between the lower neck vertabrae can become dysfunctional, impinging on nerves in the neck as the nerve travels out to areas like the shoulder or arm. 

In my experience, our heads are realllly heavy. To have it in a forward position, unnecessarily stretches, weakens and taxes our lower back neck muscles, and forces our upper neck muscles to stay in a tightened, shortened position to pull the head up so that it is level with the horizon. This chronic neck tightening can cause headaches, neck, shoulder and joint pain.

The more that the head is forward, the more our jaw is retracted (pulled back), shortening muscles in the jaw, causing a predisposition to TMJ (jaw pain).

There is a general rule that when a joint is out of neutral position, movement in all planes is reduced. As the shoulder movement is reduced in “shoulder forward positionâ€?, the same applies with reduction of movement in the neck when it is in a forward position. The only issue with this is that other parts of the body nearby have to compensate to complete the desired movement which can start secondary issues. This is especially true with head rotation from left to right. If we are head-forward and there was no compensation, we would be looking down at the ground. To deal with this, the muscles at the top of our neck tighten so that we are looking at the horizon in front of us. Yet also at the top of our neck (C1-C2 vertebrae) is also where at least 50% of our head rotation occurs. If the muscles at that level are tight pulling our head up to look at the horizon, it will affect this important area for head rotation, causing our lower neck to work harder to make up for this lack of rotation at the top of the neck, disposing it to strain, headaches, degeneration ect. 

It has been proven that a person in a Head Forward Position will breath more shallowly and will be more of a chest breather as opposed to a abdominal breather, which can contribute to unnecessary Sympathetic Nervous System Firing. 

In my experience, a person with Head and Shoulder forward position can also experience mid and low back pain as well. Each person is different as to what part of the lower body ends up supporting the upper body. 

In my clinic, prevention is my focus is to help the client to identify the postural misalignments and to help them through treatment and homecare exercises/ alterations in daily activities to achieve a posture that will reduce the possibility of any of the above conditions from occurring. Changing postural alignment issues is difficult because they feel normal. Often I bring the person into alignment and they report that it feels unnatural. This is why it is important to be aware as much as possible. Leave yourself notes everywhere so you become more and more aware of how you are positioned. When you are balance, you reduce joint wear, nerves can travel without compression from surrounding tissue, muscles are balanced so they are stronger, circulation travels to their tissue and the above are key to a strong, flexible, painfree body.

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