Head forward

Because of the rising popularity of media devices such as smartphones and computers, frequent users often exhibit incorrect posture.
Forward head posture (FHP) is a poor habitual neck posture. It often co-exists with Upper Crossed Syndrome
Defined by hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae.
Thoracic Kyphosis is a complication of the combination of slouched-forward shoulders and rounded upper back.
Can lead to a painful shortening of the muscles of the back of the neck, as well as compression of the cervical vertebrae—the uppermost portion of the spine that supports the head and protects the spinal cord.

Due to the increased compressive forces through the neck joints and increased muscle tension, pain is the common outcome. Some of the types of problems associated with FHP are:
Neck discomfort
Muscle tension in the neck and shoulders
Discomfort in the mid back
Chest pain
Pain, pins & needles and numbness in the arms and hands
Many people develop chronic or recurrent problems because they receive treatment for the pain (e.g. pain killers or anti-inflammatory medication) but never receive treatment for the underlying cause which is their FHP.
FHP evaluation is clinically important for diagnosis and rehabilitation treatment.
FHP increases compressive loading on tissues in the cervical spine, particularly the facet joints and ligaments.
Studies have reported that symptoms including neck pain, headache, temporomandibular pain, and musculoskeletal disorders are related to FHP
FHP greatly influences respiratory function by weakening the respiratory muscles.
FHP can have a negative impact on static balance.
Forward head and round-shoulder postures (FHRSP) can result in shoulder pain and dysfunction because of altered scapular kinematics and muscle activity and consequently, placing increased stress on the shoulder.
In the posterior cervical muscles there is stretching and weakness of Semispinalis cervicis and overaction with ultimate shortening of Semispinalis capitis. The corresponding flexor muscles in front, namely, Longus cervicis and Longus capitis shorten and lengthen respectively.
There is newly evidance that there is no relation between FHP and neck pain, additionally individual with neck pain had lower ROM and slower neck movement.

Epidemiology/ Etiology
The overall prevalence of neck pain in the general population is high, reaching 86.8%.
Risk factors associated with forward head posture include female gender, older age, being an ex-smoker, high job demands, and low social or work support.
Etiologies include:
Occupational posture: forward or backward leaning of head for long durations, slouched or relaxed sitting, faulty sitting posture while using computer or screen.
Effect of gravity: slouching, poor ergonomic alignment.
Other faulty postures like pelvic and lumber spine posture.
Sleeping with head elevated too high.
Poor posture maintained for long durations.
Lack of development of back muscle strength.
Clinical Findings
Muscle ischemia, pain and fatigueHead 
Decreased range of motion of cervical spine
Early disc degeneration and osteophyte formation
Temporomandibular joint pain and inflammation
Tension Headache
Increase in dorsal kyphosis and decrease in height
Decrease in vital capacity and range of motion of shoulder and arm
Possible protrusion of nucleus pulposus and nerve compression
Mobility impairment in the muscles of the anterior thorax (intercostal muscles), muscles of the upper extremity originating on the thorax (Pectoralis major et minor, Latissimus dorsi, Serratus anterior), muscles of the cervical spine and head that attached to the scapula and upper thorax (Levator scapulae, Sternocleidomastoid, Scalene, upper Trapezius), and muscles of the suboccipital region (Rectus capitis posterior major and minor, Obliquus capitis inferior and superior).
Impaired muscle performance due to stretched and weak lower cervical and upper thoracic erector spinae and scapular retractor muscles (Rhomboids, middle Trapezius), anterior throat muscles (suprahyoid and infrahyoid muscles), and capital flexors (Rectus capitis anterior and lateralis, superior oblique Longus colli, Longus capitis).
With temporomandibular joint symptoms, the muscles of mastication may have increased tension (Pterygoid, Masseter, temporalis muscles).

Assessment of FHP is important to assess the impact of the therapeutic interventions.
Clinical assessment of FHP is done through observation of the position of the head relative to the reference anatomical landmarks.
Radiographic techniques can be used to measure postural angles, but it is not always practical.
The craniovertebral angle is one of the most reliable methods and common angles for evaluating the FHP. It examines head status relative to the seventh cervical vertebrae (C7). 
Pain management advice
Postural Alignment, Balance and Gait:
Cervical Retraction
Scapular Retraction
Balance Training ( If dysfunction presents)
Range of Motion, Joint Mobility and Flexibility[14]
Cervical Range of Motion Exercises
Shoulder Range of Motion Exercises
Cervical Traction
Thoracic Manual Techniques and exercises
Stretching Exercises of tight structures- Trapezius, Scalenes, SCM, Pectoralis Major and Minor.
To reduce spasm
Myofacial release
Ischemic Compression
Positional release technique (to relieve tension headache)
Muscle Strength and Endurance
Cervical isometric strengthening exercises (initial phase) progressing to isotonic and dynamic strengthening exercises.
Strengthening exercises for scapular retractors (Rhomboids, middle Trapezius).
strength neck ex
Ergonomic Advice
correct number of pillows used
postural corrections
When to contact a doctor
A person should seek guidance from a healthcare professional if they experience continued neck pain or stiffness.
In some cases, doctors can help identify potential causes and recommend new treatment options.
Doctors can also help determine whether there are any underlying conditions causing the FHP. If any exist, doctors can recommend a course of treatment to address the underlying condition. They may also be able to recommend a specialist to provide further help.
If pain or stiffness is disrupting everyday tasks and a person’s quality of life, doctors may prescribe muscle relaxants or stronger pain medication in addition to other therapies.

FHP occurs when a person holds their head out in front of their body, out of neutral alignment with their spine.
People often shift their posture when using cell phones, computers, and other electronic devices. However, other factors can also lead to FHP.
Over time, it can become a chronic posture issue that causes symptoms such as pain and stiffness in the neck and back.
A person can treat FHP with stretching, exercises, and other therapies, including medication and physical therapy.
A person should speak with their doctor if they experience pain or stiffness that affects their daily life. A doctor can help check for underlying conditions and recommend most suitable treatment.