Forward Head Posture – When To Get X-Rays

The only reliable means for determining the cause of your forward head posture, is an x-ray. Your practitioner can not, under any circumstance guess the cause of forward head posture with only a physical examination.

Considering the head gains 10 pounds in weight for every inch of forward head posture, it is hardly surprising that your neck and shoulders ache considering you are carrying a watermelon around on top of your shoulders, now is it?

When the head moves forward (forward head posture) our center of gravity moves forward causing an increase in the muscle effort in the back of the neck and upper back. 

But is your forward head posture capable of making you sick? What are the health implications of this type of posture?

Rene Cailliet, an American born physician of French ancestry, was one of the pioneers in physical rehabilitation and is well known for his books on musculoskeletal medicine. 

You can realign your entire body by moving your head … your head held in a forward position can pull your entire body out of line.  Rene Cailliet

He goes on to explain that the vital lung capacity is reduced as much as 30% with forward head posture.

Forward head posture also causes compression in the upper neck joints (which causes pain and irritation). In order to prevent your forward head from falling toward your chest, your muscles sustain continual contraction, which causes nerve entrapment and artery compression. It isn’t hard to see that there exists the potential for neurological and vascular complications as a result of forward head posture.

What causes forward head?


There are many causes of forward head posture and they all require a different treatment approach for best results.

  • Shyness & lost confidence
  • Trauma (causing changes to your ideal neck curve)
  • Osteoarthritis
  • Degenerative disc disease
  • Hyper-kyphosis from Osteoporosis and other spinal conditions
  • Poor posture habits (long-term slouching)

When to x-ray?


By the time forward head posture becomes a confidence issue, it may already be significant. Forward head posture can be improved with a simple chin tuck but, and this is an extremely important but, the type of exercise that is appropriate, should be determined from the cause.

The only reliable means for determining the cause of your forward head posture, is an x-ray. Your practitioner can not, under any circumstance guess the cause of forward head posture with only a physical examination. Because the type of exercises and rehabilitation will differ, depending on the underlying cause of your forward head posture, it is essential to have an x-ray before treatment and/or rehab begins. This, unfortunately is not the typical approach I see in health-care today.



If you’ve already had treatment or exercises for your forward head posture and see no change in your appearance and still have pain, you may need a structural diagnosis and this you obtain through x-ray analysis.

If you think you have forward head posture, I’d love your comments on this – drop them in the comments box below.

How to Avoid Bad Pregnancy Posture

The most common posture type I see during pregnancy is Swayback Posture – when the normal lumbar lordosis (curve) becomes exaggerated and the pelvis tips too far forward.

Recently, while reading a MedHelp Forum, I came across a question about pregnancy posture: “Does anyone else feel like their posture has gotten bad now that they’re pregnant?”

I kept my answer pretty basic and this is what I said:

“This is certainly a common finding. During pregnancy the hormone relaxin ‘softens’ and relaxes ligaments and the walls of the uterus (a very good thing). Relaxin causes less ‘holding’ in the pelvic joints and this can result in kind of hyper-mobility in joints around the lower back and pelvis, resulting in an altered pelvic position.

The most common posture type I see during pregnancy is Swayback Posture – when the normal lumbar lordosis (curve) becomes exaggerated and the pelvis tips too far forward. Often, as a result of the posture being tipped forward, our center of gravity travels forward and the head will also begin to move forward (forward head posture).”

Learning how to do a simple rib tuck is helpful. It is of course preferable to work on body posture prior to becoming pregnant, but I realize that in practice this may not always happen.



It’s never too late to improve posture, just a little more challenging when pregnant. What postural changes have you noticed since becoming pregnant?

Do I Have a Scoliosis – 5 Clinical Signs

The cause of a large proportion of scoliosis is unknown. Approximately 30% of scoliosis appears due to genetic defect (funny shaped vertebra and rib malformations). Many more girls than boys are diagnosed with scoliosis and are usually between the ages of ten and skeletal maturity (around age 21).

Scoliosis is a curvature of the spine that causes both the spine and ribcage to rotate. As a result of this, the shoulders, trunk and hips are often asymmetrical. This can lead to muscular and/or joint pain, loss of confidence and early wear and tear, or osteoarthritis.

Scoliosis comes from the Greek word skolios, meaning twisted or crooked. There are two types of scoliosis – structural (a fixed curve that doesn’t straighten out when bending) and a non-structural scoliosis (a non-fixed curve that straightens with bending and is often due to a leg length deficiency or poor postural habits).

The cause of a large proportion of scoliosis is unknown. Approximately 30% of scoliosis appears due to genetic defect (funny shaped vertebra and rib malformations). Many more girls than boys are diagnosed with scoliosis and are usually between the ages of ten and skeletal maturity (around age 21).

Other causes of scoliosis include nerve or muscle disease, infection, radiation, trauma, tumour and arthritic joint disease. If you are interested, you can read a more detailed account in my best-selling book, The Posture Doctor.

If you are worried that you or your child may have a scoliosis, there are a few signs you should look for:

5 clinical signs of scoliosis


1. One shoulder is noticeably lower than the other. Look in the mirror or have someone else check from behind.

2. Rib prominence causes your shoulder blade to protrude or one breast appears noticeably larger.

3. One hip may appear elevated with asymmetrical body contours.

4. A noticeable difference (asymmetry) in skin creases appear on your flank.

5. Something just doesn’t look right.

I can’t stress this sign enough. So many of my clients come to me asking for a Posture Analysis saying ‘something just doesn’t look right when I look in the mirror.’ Human beings are bilaterians. That means that we are the same (symmetrical) on either side of our central axis or center of gravity. We have two ears, two eyes, two arms, two legs, two kidneys, two ovaries etc. This is nature’s clever design. Symmetry is perceived as being more attractive.

Symmetry has been extensively studied in relation to attractiveness and what we do know is that symmetry is a visual cue for attractiveness. Chances are that if you think something is really wrong with your posture (which shows up as body asymmetry) when you look in the mirror, you are probably right, because it makes you feel less attractive. This is why we like ourselves in some photographs but not in others. The photos that catch our differences in symmetry are the images that make us cringe.

Of course attractiveness is only one of many good reasons to improve our posture. Do you think you have a scoliosis? Please share below.

Can A Reversed Neck Curve Cause MS?

In the 2005 study, there was found to be significant correlation between the angle of the kyphosis (how much the neck curve was reversed) and the amount of spinal cord flattening.

Recently I attended a conference in London, England: Subluxation, Neurology and Health by Dr Dan Murphy and what I learned about neck posture, may shock you.

Why we need spinal curves


Early research by Bagnall in the Journal of Anatomy reported that the cervical lordosis (neck curve) begins to develop at just 9.5 weeks in utero and continues to develop when we first begin to hold our heads upright, at the approximate age of 3 months.

A newborn’s muscle strength is not sufficient to maintain the head in upright posture. Creating a better mechanical advantage in the neck can compensate for this lack of strength. The forward curving of the neck (lordosis) thus provides new muscle attachments and levers that offer a mechanical advantage, necessary to stabilize and move the head.

Reversed neck curves


When the ideal neck curve is lost or reversed (cervical kyphosis) – usually through trauma, there are cellular changes within the spinal cord that occur.

A 2005 study in the journal Spine, found that: “Progressive kyphosis of the cervical spine resulted in demyelination of nerve fibers,” and that these changes were associated with vascular changes in the spinal cord. Let me explain with a picture.

Above you see a cross section of the spinal cord which runs from the base of your brain, down through to the upper portion of your low back. If I were to take a slice out from the cord and look down over the slice, this is what I’d see.

Grey and white matter are both types of nerves. The former  made up mostly of cell bodies and is grey in colour and the latter, made up of paler (more white) nerve fibers with their sheaths (covering) called myelin). It is the loss of this myelin that is associated with Multiple Sclerosis.

In the 2005 study, there was found to be significant correlation between the angle of the kyphosis (how much the neck curve was reversed) and the amount of spinal cord flattening. The greatest compression point was found to be at the apex of the bend (most commonly found on x-ray to be approximately C4-6).

The progression of demyelination


  • trauma can cause a reverse neck curve
  • a reversed neck curve compresses the spinal cord
  • compression degrades the anterior spinal artery
  • reduced blood flow leads to demyelination in the anterior (front) spinal cord, which controls motor function
  • loss of motor control found in MS

There was severe demylination in the anterior funiculus … which controls posture and muscle tone. Shimizu et al.

The conclusion of the study was that a reversed neck curve (a kyphotic deformity) resulted in demyelination of the compressed white matter and affected the front of the spinal cord (supplied by the anterior spinal artery) which controls movement. As compression continued, so did the areas affected in the spinal cord.

Posture Analysis


One of the reasons that I insist on an x-ray analysis before treatment or exercise programs begin, is because of the potential for a reversed neck curve to influence systemic health.

Those of you with forward head posture, neck hump, chronic headaches or neck pain, should get a structural diagnosis (from x-ray) and if warranted, a tailored exercise program should be integrated, to help restore the normal (ideal) neck curve.

What is your experience – have you had any of the following signs or symptoms long-term?

  • headaches
  • neck pain
  • visible fatty neck hump
  • significant forward head leaning
  • tingling/numb fingers or hands
  • unexplained muscle weakness
  • difficulty concentrating
  • brain fog

Help Trivago Guy Find Posture Doctor

Last night I was watching the CBC national evening news and was absolutely inundated by Trivago advertising. Ah, the thrills of North American TV – not!

After reading up on the Trivago Guy, it is apparent that he has become somewhat of a scruffy spokesperson for Trivago, helping to build their brand awareness. Well, I looked him up too, so I guess it’s working!

What really struck me though was the Trivago Guy’s horrible neck posture – poor guy.

What’s up with Trivago Man’s neck? 




There is a lot wrong with his head and neck posture. I did a mini Posture Analysis on the man:

  • Right shoulder inferior to left (very!) – can suggest scoliosis
  • Head translated or shifted right – his right
  • Neck laterally bent left (his left ear sits lower)


This kind of posture pattern in the head and neck could be a compensation for a problem lower down in the pelvis (anatomical short leg for example), but more than likely the Trivago Guy had a past trauma that injured the supportive structures in his neck, causing altered alignment over time.

Common traumas include:

  • car or motorbike accident
  • hit on the head
  • fall from a height (includes horses, off bikes, down stairs)

The Trivago Man or anyone with this kind of asymmetrical head and neck alignment may experience some of these symptoms:

  • headaches
  • tense, painful shoulders
  • neck pain
  • sinus trouble
  • brain fog
  • tingling hands or fingers
  • depression and/or anxiety
  • difficulty concentrating
  • vertigo

Please help Trivago guy find me!

What is your experience of head or neck trauma? 

Upright Posture and Tetter-Totters

Postural distortions like forward head posture, being over-weight or having an anatomical short leg lead to chronic muscular contraction, which leads to tissue ischemia, inflammation, fibrosis (scar tissue) and disability.

Today’s post is all about levers. Remember those from high school physics? If you had to take physics, you definitely covered mechanical levers. If you didn’t but have ever been on a teeter-totter then you will understand the importance of today’s post.

Upright posture, works just like a child’s teeter-totter (aka seesaw for those in Europe). In order to balance, the weight of each child needs to be similar.



If your head sits directly over top of the spine, then the weight of the head (roughly 10 Ibs) requires little muscular effort from your neck muscles. In other words, when you have good posture, your head sits directly over the fulcrum.

Your spine – made up of vertebrae, discs and joints is considered the fulcrum (your center of gravity). Your head needs to sit right on top of your spinal column, or your neck and upper back muscles begin to work overtime, to support the increased load. Let me use a diagram to explain this concept:


Forward Head Posture

In this example a 10 pound head is the weight, the vertebra is the fulcrum and the muscle contraction is the effort needed to support your head.

When the head sits out in front of the body, instead of overtop of the spine where it belongs, we call this forward head posture (fhp).

Further Resources >> How do You Correct a Forward Head?

Using physics we work out the effort required by multiplying the weight (head) by the lever arm (the distance from the fulcrum) – the forward head measurement.

If you have 1 inch of fhp, your muscles require 10 Ibs (10 x 1)of extra effort to maintain your head in this forward position. If you have 2 inches of fhp, your muscles require 20 Ibs (10 x 2) of extra effort.

NOW, DO YOU NOW UNDERSTAND WHY YOUR SHOULDERS ACHE?!

Body weight



If this example the fulcrum once again, is the spine; the weight this time is the extra abdominal fat and the effort, the lower back muscles (the erector spinae muscles).

If you are lean, then your body is directly in line over top of your center of gravity – found in the center of the vertebra – and your body is balanced. This requires minimal muscular effort.

As your body weight increases, gravity pulls your body forward and down (over tipping your pelvis forward). In order to offset the weight the muscular effort increases, often leading to chronic lower back pain.

Short Leg



If you have a long history of one-sided lower back pain, you may have an anatomical short leg (as I do). In the above example, the fulcrum is your sacrum (the triangular bone to which your spine anchors).

The weight is your leaning body caused by a right-sided short leg (the subject is facing you) and the effort is the increased muscular contraction (in green) of the quadratus lumborum muscle (known as the QL). This is a very common source of one-sided lower back pain. This brought me to see my first Chiropractor in my early 20s.

Further Resources: Posture Analysis

So the moral of this posture story? Upright posture is a first class mechanical lever – to use mechanic’s speak. Postural distortions like forward head posture, being over-weight or having an anatomical short leg  lead to chronic muscular contraction, which leads to tissue ischemia (cut off blood supply), inflammation, fibrosis (scar tissue) and disability – reduced range of motion, inflexibility, chronic pain and eventual wear and tear – aka osteoarthritis.

These are only the physical effects. There are also neurological effects. I’ll save that story for another day.  I really want you to understand that poor posture is so much more than how you sit or stand.

The effects are very real. You can’t afford to ignore your poor posture for even one more day.