Which of the following muscles is considered overactive when scapular winging forward head is noticed during the pushup?

Forward Head Posture (FHP) is where the position of the head is in front of the mid line of the torso.

(It is also referred to as Nerd Neck, Poked Head, Forward Neck Posture and Text Neck.)

Ideally – the ear canal should be aligned with the mid line of the torso.

It involves a combination of lower neck flexion and upper neck extension.

This results in the flattening or loss of the natural curve in the lower Cervical spine.

What causes Forward head posture?

It’s all about your postural habits.

Think about how you sit when you you use computer, mobile phone, driving your car etc:

Are you sitting up tall?…. Or are you letting your head poke forward? 

The body will get used to the positions that you choose to place it in.

Over time – certain muscles will tend to weaken and others get tight.

This muscular imbalance can eventuate into a Forward Head Posture.

What muscles are involved?

There is an imbalance involving all of the following muscles:

(Note: If you are not sure where the following muscles are located, feel free to look them up on Google.)

a) Overactive and/or Tight muscles:

• Anterior Scalene
• Sternocleidomastoid
• Anterior neck muscles (Lower Cervical Spine)
• Sub-Occipital muscles
• Splenius Capitis/Cervicis
• Semispinalis
• Longissimus
• Anterior Upper Trapezius
• Upper Levator Scapulae

b) What muscles are weak in Forward Head Posture?

Deep Neck Flexors:

• Longus Capitis
• Longus Colli

Lower Cervical Extensors:

• Multifidus
• Erector Spinae

(It’s where I share all of my best posture tips!)

How to tell if you have Forward head posture

Here are 3 different tests to determine if your head is poking forwards.

a) Forward Head Posture Test

Instructions:

• Place your back completely flat against the wall.
• Make sure that your pelvis and shoulder blades are in contact with the wall.
• Do not over arch your lower back.
• Do not tilt your head backwards.
• Whilst standing in this position, does the back of your head naturally come in contact with the wall? 

Results: If the back of your head does not naturally come into contact with the wall, then you likely have a Forward Head Posture.

b) Side profile

Instructions:

• Take a side profile photo of yourself.
• Draw a line down the mid line of your torso.
• Draw a line down from your ear canal.
  • This line should be parallel to the mid line of the torso.

Results: If the line from the ear canal is in front of the line of the torso, then you likely have a Forward Head Posture.

c) X-Ray scan

Ask your doctor for a X-Ray scan showing the lateral view of the Cervical spine.

Craniovertebral Angle: This is the angle formed by the lines from the Tragus (part of the ear), C7 Spinous Process and a horizontal line that passes through the C7 vertebra.

A normal value would be considered at approximately 50 degrees.

What is the consequence of a Forward Head Posture?

This is a list of the main symptoms associated with this postural issue:

Symptoms:

Forward Head Posture Exercises

Recommendation: Perform the following exercises 2-3/week to gain a sense of what each exercise feels like.

Over time –  assess how your body responds and adjust frequency and intensity accordingly.

1. Neck releases

The tight muscles that are holding your head in the forward position will need to be released first.

a) Sub-Occipital/Posterior Neck

Instructions:

• Place a massage ball under the back of your neck.
  • Do not place it directly under the spine.
  • You are aiming for the muscles on either side of the spine.
• Apply an appropriate amount of pressure onto the massage ball.
• Gently rotate your head from side to side to emphasize certain areas.
• Make sure to cover the muscle from the base of the skull to the base of the neck.
• Continue for 2-3 minutes on each side.

Alternatively: If you do not have a massage ball, you can use your fingers to apply pressure to the same areas.

Note: If you start to feel dizziness or experience more pain, reduce the amount of pressure that you are applying.

b) Sternocleidomastoid

Instructions:

• Locate the Sternocleidomastoid muscle.
  • (Use Google if you are not sure where it is.)
• You should be able to feel a prominent band of muscle on each side of the neck. (see above)
• Do not to press too deep as you may hit other sensitive structures of the neck.
• Gently massage these muscles with a pinch grip.
• Make sure to cover the entire length of the muscle.
• Duration: 1 minute per side.

(For more stretches like this, see post: Sternocleidomastoid Stretches.)

c) Side of neck release

Instructions:

• Place the flat part of your fist at the bottom of the side of your neck.
• Make sure that you are not pressing onto the structures at the front of the neck.
• Apply a gentle sliding pressure up towards behind the ear region.
• Repeat 5 upwards strokes on either side of the neck.

2. Neck stretches

Stretching out the tight muscles will give the opportunity for the head to adopt the correct posture.

a) Sub-Occipital (Upper Cervical Spine)

Instructions:

• Place your hand at the front of your chin and the other at the back of your head.
• Apply a force to the front of your chin as to gently glide the chin backwards.
• Whilst maintaining this pressure, proceed to pull your head forward/down.
• Aim to feel a stretch at the back of your Upper neck.
• Hold for 30 seconds.
• Repeat 3 times.

b) Posterior neck (Middle neck)

Instructions:

• Gently tuck your chin in.
• Look down.
• Place both hands behind your head and pull your head downwards.
• Aim to feel the stretch at the back of your Middle neck.
• Hold for 30 seconds.
• Repeat 3 times.

c) Front of Neck (Lower Cervical Spine)

Instructions:

• Gently tuck your chin in.
• Slowly look upwards.
• Do not arch your lower back.
• Aim to feel a stretch at the front of your neck.
• Hold for 30 seconds.

d) Sternocleidomastoid

Instructions:

• Gently tuck your chin in.
• Rotate your head towards the side that you want to stretch.
• Tilt your head to the side away from the side you want to stretch.
• Use your hand to pull your head further into the tilt.
• Aim to feel a stretch on the side of your neck.
• Hold for 30 seconds.
• Repeat 3 times.
• Do both sides.

e) Anterior scalene

Instructions:

• Look up and rotate your head to the side.
• Place your hand on the collar bone on the opposite side to which you have rotated to.
• Pull the skin on the collar bone downwards.
• Tilt your head to the side.
• Hold for 30 seconds.
• Repeat 3 times.
• Do both sides.

3. Improve Joint mobility

If the joints in your cervical spine are very stiff, this may limit the required neck movements to perform the following exercises effectively.

a) Decompress the sides of the neck

Instructions:

• Slightly lower your head downwards.
• Tilt your head to the side.
• Place your hand on the side of your head and apply a gentle pressure.
• Aim to feel a stretch on the side of your neck.
• Avoid any pinching sensation on the side you are pulling your head towards.
• Hold for 30 seconds.
• Repeat 3 times.
• Do both sides.

b) Chin tuck with over pressure

Instructions:

• Lie on the floor with your knees bent.
  • Use a thin pillow if required.
• Tuck your chin in.
• Place your hands on your chin apply a downward pressure.
• Hold for 5 seconds.
• Repeat 10 times.

c) Neck mobility

Instructions:

• Tuck your chin.
  • (think about the movement as a book sliding back into the shelf)
• Whilst maintaining this chin tucked position, proceed to look up/down.
• Ensure that you do not poke your chin out excessively during the movement.
• As you look upwards, you should feel a “bruisy” (… but not painful!) sensation at the base of your neck.
  • If it is painful – decrease the amount of looking upwards.
• Repeat 30 times.

d) Self neck traction

(This is a great way to decompress your neck.)

Instructions:

• Tie a resistance band to a stationary object. (Height: ~3-4 feet)
• Lie on the floor with your knees bent.
• Wrap the band under the base of the skull.
• Whilst still holding the band with your hands, slowly shuffle your body away from the anchor point.
• Let go and let the band pull your head.
• Move as far away until you can feel a stretch at the back of your neck.
• Completely relax.
• Hold for 1 minute.

Note: Place a small towel between your head and the band to prevent your hair from being pulled.

4. Chin nods

The following exercises will target the Deep Neck Flexors. These muscles are responsible for maintaining the correct posture of the head and neck.

a) Chin nods (head supported)

Instructions:

• Lie down on the floor with your head supported with a thin pillow.
• Gently perform a chin nod.
• Aim to feel a gentle contraction in the muscles at the back of your throat.
• Relax your neck muscles as much as possible. You should not feel the muscles at the front of your throat tense up.
  • You can try flattening your tongue to the roof your your mouth to help reduce the tension in the neck.
• Hold for 5 seconds.
• Repeat 30 times.

Note: If this exercise is too difficult, start with using a thicker pillow.

b) Chin nod holds (sitting)

Instructions:

• Sit up right.
• Slightly nod your chin downwards.
• Place a closed fist underneath your chin.
• Gently push your chin down onto your fist
• Hold for 30 seconds.
• Aim to feel a gentle contraction at the back of your throat.
• Repeat 2-3 times.

5. Chin Tuck

The following exercises will help position your head into the correct alignment.

a) Chin tuck

Instructions:

• Sit upright
• Gently tuck your chin in.
  • “Make a double chin.”
  • If you experience discomfort as you do this, fixate your gaze slightly lower and re-try tucking the chin in.
• Aim to feel a gentle lengthening sensation at the back of your neck.
• Make sure to keep your eyes and jaw level and move the head horizontally backwards.
  • Think of the movement like a book sliding back into the shelf.
• Hold for 5 seconds.
• Repeat 30 times.

As this exercise becomes easier, challenge yourself with the following exercise progressions…

b) Chin tuck (against gravity)

Instructions:

• Lie down on your stomach with head off the edge of a bed.
• Gently tuck your chin in.
• (Since you are moving your head against gravity, there is a greater challenge on your muscles.)
• Aim to hold for 5 seconds.
• Repeat 10 times.

c) Chin tuck (with resistance band)

Instructions:

• Apply a resistance band around the back of your neck.
• Pull the band forwards as to increase the tension on the band.
• Proceed to do a chin tuck against the resistance band.
• Hold for 5 seconds.
• Repeat 20 times.

6. Chin tuck and Nod

The next step is to combine the Chin Tuck and Nod together.

a) Chin tuck/nod with head lift

Instructions:

• Lie down on your back with your knees bent.
  • (Support your head on a pillow if required.)
• Gently flatten your tongue to the roof of your mouth throughout the exercise.
  • This will help engage the right muscles in the neck.
• Tuck your chin in.
• Nod your chin downwards.
• Whilst keeping your chin in the nodded position, lift your head off the ground.
  • Imagine you are gently squashing an apple between your lower jaw and throat throughout movement.
• Lift as high or as low as you are comfortable.
• Aim to feel the contraction of the muscles at the front of your neck.
• Hold for 5-10 seconds.
• Repeat 10 times.
• Make sure that you DO NOT let your chin jut forward as you lift your head.
• Note: If you find this exercise difficult, support the weight of your head with your finger tips.

7. Elongate your neck!

As you go throughout your day, it is important to practice maintaining your head in a more optimal position.

The aim is to:

• Elongate your neck
• Reduce compression in the Cervical Spine
• Eliminate over-activity of muscles

To achieve this, think about holding your head this way:

“With your chin held in a slightly tucked in position, imagine your head as a balloon that is floating away from your shoulders.”

Aim to keep your neck muscles as relaxed as possible.

Note: Do NOT force your head into a position that it can not naturally hold with minimum effort.

8. Forward Head Posture and breathing

The muscles which are predominantly responsible for pulling the head into the forward position are the Sternocleidomastoid and Scalene.

These muscles are also accessory muscles to your breathing.

During relaxed breathing, it is ideal to have your diaphragm muscle as your main breathing muscle.

However, with breathing inefficiencies, these accessory muscles will tend to be over active… which then can lead to your head poking forwards.

Diaphragmatic breathing

Instructions:

• Assume the position as shown above.
  • Use a pillow for your neck if required.
• Remember to keep your neck completely relaxed.
  • Gently flatten your tongue up to the roof of your mouth.
  • Keep your mouth closed throughout this exercise.
• Breathe in: Breathe and expand into your rib cage without flaring out the bottom of the ribs at the front.
  • (“imagine a ring around the lower portion of your rib cage expanding in a 360 degrees direction.”)
• Breathe out: Slowly push out ALL of the air out of your lungs
  • Your lower ribs should depress and lower back flatten against the floor.
• Repeat 5 times.

9. Extra tips

Here 5 simple tips that you can implement to improve your posture.

a) Use your mobile phone properly

Optimize your head position by bringing your mobile closer up to your eye level.

(Of course – I don’t expect you to use the phone in this position absolutely 100% of the time.)

b) Change position often

Avoid staying in the same posture for too long.

Move in and out of different positions as much as you can.

Sustaining one position over a long period of time may lock your posture into position!

c) Optimize workstation ergonomics

It is next to impossible to sit with good posture if your work station is not properly set up.

It is imperative to set up the following in the correct position relative to your body:

• Position of the computer screen
• Height of the table
• Height of the chair
• Position of mouse and keyboard.

For more information – I have written a free e-book which goes through everything that you need to know.

FREE E-book: How To Set Up Your Workstation.

d) Avoid wearing a heavy backpack

Wearing a heavy backpack will tend to pull your upper torso forwards.

This will lead to the head poking forwards.

e) Minimize breathing through the mouth

Breathing with an open mouth tends to encourage the over-activity of the muscles that are responsible for Nerd Neck.

Keep that mouth closed!

If you have blocked sinuses that make it difficult to breathe through the nose, I would encourage you to get this sorted out as well.

f) Set up your car seat

Many head rests tend to significantly push your head forwards.

(… which I presume is a safety feature of the car?)

It will be challenging… but try your best to adjust your seat to promote a better posture.

10. Address other areas of posture

If you have persisted with the above exercises for at least 3-6 months and have seen minimal improvement in your head position, you may need to consider addressing any of the following postural issues:

a) Dowager’s Hump

The Dowager’s hump is an enlarged prominence that is formed at the lower region of the neck.

(… it’s a big bump that sits at the base of your neck!)

If you have this, it is likely a major factor that is contributing to your Forward Head Posture.

(… and is possibly limiting the effectiveness of the exercises.)

For a detailed guide on how to address this issue:

See post: Dowager’s Hump Exercises

b) Hunchback Posture (Thoracic Kyphosis)

If the thoracic spine (upper back) is hunched forwards, it can cause the head to poke forwards as well.

For a detailed guide on how to address this issue:

See post: Hunchback Posture

c) Rounded Shoulders

Having Rounded Shoulders is when the resting shoulder position is in front of the mid line of the torso.

Rounded shoulders can pull your head forwards into the Nerd Neck position.

For a detailed guide on how to address this issue:

See post: Fix Rounded Shoulders

11. Common Questions

Feel free to leave me a question in the comment section if you need any further clarification with anything mentioned on this blog post.

a) Is Forward Head Posture correctible?

Yes – it definitely is!

(… as long as the joints in your Cervical spine have not fused into position.)

c) How long does it take to fix Forward Head Posture?

You should see some improvements in your head position after 6-12 weeks of performing the recommended exercises on a consistent basis.

In some of you – you may even see immediate improvements in your posture!

c) How to correct Forward Head Posture whilst sleeping?

When sleeping on your back – do not use an overly thick pillow as this will push your head forwards.

At the same time – you do not want the pillow to be too thin either as this will provide no support for your neck. (… and may even cause more issues!)

General guideline: Use the thinnest pillow possible whilst still having your neck comfortably supported.

Conclusion

When fixing Forward Head Posture (Nerd Neck), I suspect a few of you may get a little bit discouraged in the beginning.

(.. and I completely get it!)

Your posture might not change as quickly as you’d like it to.

The plain truth is: It takes time to fix your poor posture.

My intention with this blog post was to provide you with everything that you will ever need to know to completely address this issue.

Be consistent. Stay motivated. And perform the exercises!

I hope it serves you well.

All the best!

1. Any questions?… (Leave me a comment down below.)

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the exercises!

Mark is a Physiotherapist who has been helping his patients fix their posture for the past 11 years. He created the Posture Direct blog in 2015 with the goal of helping people fix their own posture.

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Disclaimer: The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purpose only. Use of the content is at your sole risk. For more information: Medical disclaimer.