Correcting the Forward Head Fault

As I'm sure you've heard millions of times before, modern technology isn't doing our bodies any favors. Spending hours a day texting or hunching over a laptop is physically morphing out bodies. We're altering our fascia, compressing our spines, and stretching our muscles in ways that contradict our biology. Our traps are tight, and we're riddled with back pain.

Does your posture resemble that of the guy on the right or on the left?

The farther forward your head gravitates, the more weight your cervical spine (neck) has to support: in a "neutral position," the neck only bears about 12 pounds of load, but if your head juts forward only 2 inches in front of your center of mass, your spine now has to support ~32 pounds of load. When the spine has to work harder, so too, do the muscles that buttress (haha) the neck. If you've ever experienced neck pain, then I would wager that your posture needs improvement.

The "ideal" posture involves the joints to be centered from the top of the head, all of the way down to the lateral malleolus of the ankles. Notice how neither the rib cage nor the chin shift too far in front of the pelvis–these are both common compensatory patterns.

Ultimately, when it comes to addressing this dysfunction, I have a three-pronged approach:

1. Correct postural awareness. Cueing and awareness can go a long way. Forward head posture goes hand-in-hand with rounding of the upper back (kyphosis). Once you show a client where their center of mass is, they have a better understanding of proper alignment, and they're better able to recreate that position on their own.
2. Instil proper breathing mechanics. Chest breathing with an incomplete exhale will only aggravate any postural deviations. Full breaths initiating at the diaphragm with minimal chest expansion will promote optimal bodily function and positioning. Your breath influences every other muscular sequence in your body, and should be the priority of any corrective exercise program.
3. Strengthen the core and the neck flexors. The neck is an extension of the core, and, as such, if you display forward head posture, then we need to look there for answers. Similarly, I often find the neck flexors (sternocleidomastoids) to be weak or lack muscular endurance in these individuals.

Try this test: lay on your back, and pick up your head about 2-3 inches off of the ground. Hold your head up for 30 seconds. If you feel tightness in your neck, or your muscles start to twitch within that time, you need to build up the muscular endurance of your neck flexors. If you failed that test, then you definitely need some work.

Here's a good place to start:

1. Neck flexion
2. Cobra pose
3. Neck retraction against the wall
4. Neck nods
5. Bench neck bridge* (Note: This exercise should be used with caution, as there is the potential to strain your neck extensors. Start with holds of only 5-10 seconds for two sets. Gradually increase the lime you hold this movement.)

I would recommend performing two of these exercises at least two or three times per week. When it comes to improving posture, you have to be consistent and deliberate with your corrective exercises. If you stay on top of your drills, but continue to slouch at your desk, then there's little value to your postural training.

Another thing I've noticed is that the neck is often one of the first places people look to for help. Let's say they're struggling on their last pull-up. What do we see? The neck cranks into hyperextension to inch the chin over the bar. If you're grinding out that final biceps curl, you again see the neck shift forward to the rescue. These patterns are important to be mindful of during your training sessions. Don't use the neck to cheat your reps!

Once you treat your neck alignment, you'll notice that the rest of your spine will assume a better position, and you may even notice fewer incidences of back/neck pain and headaches.

Performing these exercises regularly, along with practicing proper sitting and standing positions will have a lasting impact on how you carry yourself. 

Works Cited:

1. Falla, D., G. Jull, T. Russell, B. Vicenzino, and P. Hodges. "Effect of Neck Exercise on Sitting Posture in Patients With Chronic Neck Pain." Physical Therapy 87.4 (2007): 408-17. Web.
2. Watson, Dean H., and Patricia H. Trott. "Cervical Headache: An Investigation of Natural Head Posture and Upper Cervical Flexor Muscle Performance." Cephalalgia 13.4 (1993): 272-84. Web.
3. Zito, G., G. Jull, and I. Story. "Clinical Tests of Musculoskeletal Dysfunction in the Diagnosis of Cervicogenic Headache." Manual Therapy 11.2 (2006): 118-29. Web.

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Text Neck: Checking Your Phone While Sparing Your Posture

This is not sexy.

Your phone buzzes. You pick it up to see a new text message from your friend. As you read the message, you look down at your hands like the Hunchback of Notre Dame.

Unfortunately, some of us spend the majority of the day in this position, at a computer desk, scrolling through Instagram, or even reading a book. As a result of these recurring movement patterns, the anterior muscles become excessively tight and chronically active, while the posterior muscles are long and under-active. This is the start of neck pain and potential cervical disk herniations down the line. (No bueno.)

Any type of corrective exercise you do to improve your posture will be for naught if you do not change your daily habits, as well.

This is serious business. Don't end up like the last guy.

There are a few different alternatives to combat this and create lasting postural changes. Here are two different ideas of how you can stay "on the grid" while simultaneously sparing your neck!

1. Hold your phone higher, or use a standing work station. Instead of looking down at the screen, you can get a nice little isometric exercise for the shoulders by holding your phone at eye level. If your office allows for it, buy one of those standing desks so that you don't have to slouch in a chair all day.



I prefer to write all of my blog posts in the Cobra pose...

2. Try the Cobra position if you're at home (or if you have a really low key office where your coworkers won't look at you like you're a complete lunatic). This allow you to actually reverse the conventional hunched position and get some extension in the thoracic spine. Plus, this position is great for building a foundation of shoulder stability.

Both of these positions allow you to maintain good posture as you read your e-mails.

Don't spend hours doing hundreds of corrective exercises, expensive physical therapists or chiropractors, and then proceed to look down at your phone all day. You will undo all of your (and your manual therapist's) hard work.

Remember that your body remembers patterns and repetition, so the position in which you spend the majority of your time is the one to which your brain will revert. You can crack your neck and stretch until the cows come home, but none of those changes will have any lasting impact without first considering your day-to-day habits and positions.

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5 Exercises to Strengthen Your Neck

In the prequel to this post, I explained why so many of us carry a lot of tension in the neck. Stress, poor posture, and breathing can all contribute to elevated shoulders and a heavy head. I taught you a few quick movements that will strengthen the muscles of the chest, back and shoulders, and today I want to teach you some more exercises that will emphasize the neck musculature.

Lately, I've initiated my posts with a little bit of an anatomy lesson, so I'd like to continue that trend and talk a little bit more about the prime movers of the neck and their functions. First, we have the sternocleidomastoid muscles. I know, that name has a hell of a lot of syllables. The sternocleidomastoids (say that 10 times as fast as you can) are two big, strips of muscles that are on either side of your throat. They rotate the cervical spine (the neck), flex your neck forward, and also flex it laterally. Next, you have the scalenes. The scalenes are several tinier strands that wrap around the front of the neck. They work in conjunction with the sternocleidomastoids and laterally flex the neck and help you breathe. There are several other muscles in the neck, of course, but these are going to be the few that I discuss for the purposes of this post.

Now, the majority of people spend most of their time in cervical flexion, meaning that they are looking down at a computer, a book, or a smart phone. The upper trapezius are lengthened and over-active, while the sternocleidomastoids (SCM) are shortened and tight. When upright, many people maintain this position, because the body is lazy and doesn't like to recruit any more muscles than it needs for a given task. We walk around all day looking like the hunchbacks of Notre Dame.

The primary role of the head and neck, though, is to maintain joint centration and navigate our centers of mass. If our heads are cranked forward, now the entire system is out of line. Your center of mass has shifted from its ideal position, your "center," directly over your pelvis. Ideally, we want the earlobes in line with the shoulders.

If your center of gravity is too far forward or backwards, all of your movements will be altered from your clean and jerk to your 40 yard time. Alignment = optimal mechanics and balance.

Many coaches of sports like wrestling and football prioritize training the neck to avoid concussions and other potentially traumatic traumas to the head. While many of these teams make use of high-tech machines to isolate the neck, I believe neck training is best done (especially initially) without any added weight. Your head should be more than enough!

Here are 5 of my favorite exercises:

1. Neck flexion

2. Neck Extension

3. Lateral Flexion  

4. Neck Rotation (prone) 

5. Neck Rotation (supine)

Each of these movements can be done for 1-3 sets of 10 repetitions. I recommend starting out with only one or two sets, because you may find that you will be fairly sore after these exercises. The great thing about these movements is that they don't require equipment, and they won't take you long. I recommend my clients do them upon waking up or before bed.

The idea is to realign your center of mass so that you can perform most efficiently. Your balance will improve, you will better your hip and shoulder stability, and all of your muscles will function as they should. Find your center and master your body.


Works Cited:

1. Collins, Christy L., Erica N. Fletcher, Sarah K. Fields, Lisa Kluchurosky, Mary Kay Rohrkemper, R. Dawn Comstock, and Robert C. Cantu. "Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports." J Primary Prevent The Journal of Primary Prevention 35.5 (2014): 309-19. Web.
2. Falla, D., G. Jull, T. Russell, B. Vicenzino, and P. Hodges. "Effect of Neck Exercise on Sitting Posture in Patients With Chronic Neck Pain." Physical Therapy 87.4 (2007): 408-17. Web.
3. Keating, Jennifer. "Predicting Short Term Response and Non-Response to Neck Strengthening Exercise for Chronic Neck Pain." Journal of Whiplash & Related Disorders 4.1 (2005): 43-55. Web.

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Behind the Neck Exercises: Do You Need Them?

For every exercise, there's an equal and opposite, behind-the-neck variation. Behind-the-neck lat pull-downs, pull-ups, push presses, strict presses, are just a few examples of exercises I've seen people try to do behind their necks. Perhaps they're trying to hit the same muscle groups in a new way, or target different muscles altogether. Regardless of the reason, I am not generally a fan of the behind-the-neck training club.

Given the overwhelming number of shoulders stuck in internal rotation and spines stuck in kyphosis for the average desk-worker or sedentary individual, many people already come into the gym with a slew of shoulder restrictions and postural limitations. The shoulder is the most mobile joint in the body. Because of the huge range of motion in the joint, many people have poor stability overhead. Men and women alike suffer from scapular flaring (see below) as a result of lifestyle habits and poor posture.

She may look like she's at peace, but she's forcing her shoulders into an unstable position!

It is often difficult enough for someone to maintain shoulder stability in the traditional variations of a pull-up or strict press. Now, once you start trying to do these movements behind the neck, you're just reinforcing a dangerous position that may lead to pain or injury in the future.

For starters, let's analyze the neck position of someone doing an exercise behind his neck.

If you've read my previous posts, you understand that the position of the neck impacts the position of the rest of the spine. This particular...gentleman is obviously very muscular. Despite this, however, his cervical spine (neck) is flexed, and he is reinforcing the dreaded forward head posture ("chicken head" posture). This exercise may be counterproductive for him as it could potentially lead to some neck pain down the line.

Now, let's move on to what might be happening to the shoulders in a movement like the lat-pull downs in the above photo.

As the result of the neck position, (because the human body works as a chain) his shoulder stability is also compromised. Ideally, his scapula should slide down the ribcage as he pulls the bar towards his traps. However, if the shoulders are internally rotated, the shoulder blade tilts forward and slopes off of the ribcage.

Many Olympic lifting coaches teach jerks or presses behind the neck, because it enables the athlete to keep his torso more upright in the dip. Unfortunately, for most, this might also damage the integrity of the shoulder position in order to maintain a vertical torso.

In an ideal situation, a behind-the neck exercise might be beneficial for an athlete. Unfortunately, the shoulder position is often compromised. If you have had shoulder issues in the past, you more than likely lack mobility or stability in the shoulder joint, and these types of exercises will just exacerbate your issues.

Unless you are certain you can sustain an ideal position in a behind the neck exercise, perhaps your routine is better off without them!

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"Neutral Neck:" How to Avoid Straining the Neck While Lifting

It's relatively common knowledge that during the big lifts, you should keep your back flat--some refer to this as a "neutral spine." Despite this, many people forget about the cervical part of the spine, or the neck.

Ideally, on a clean, snatch, deadlift or squat, the neck should stay in line with the rest of the spine. Once the weight gets heavy, however, one may start to compensate by hyperextending his neck as a lifeline. Instead of engaging larger muscles like the latissimus dorsi and the erector spinae, his cervical extensors are now taking the brunt of the work; compensatory patterns like these can lead to big problems over time.

Do not deadlift like this guy. 

To rectify this, I will have my clients find a spot about 3-4 inches in front of them. I will tell them to focus on this point throughout the entire lift. I will also place a PVC pipe behind their backs to help them find a more neutral position: this cue gives them tactile feedback of where their heads should rest.

Maintaining a neutral position of the head will allow you to properly engage your posterior chain while keeping your neck free from overexertion. Stop cheating yourself and find true strength. Movement efficiency is the key to longevity.

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