How to Measure and Fix Forward Head Posture

When poor posture causes neck pain, a diagnosis may be made by a doctor or other health professional based on a physical exam and the patient’s medical history. As part of the physical exam, forward head posture might be measured in order to quantify the severity of the condition, as well as to give a baseline for evaluating future progress.

Common Methods for Measuring Forward Head Posture

Two of the more common methods for measuring forward head posture include:

• Ruler measurement. This method involves the patient standing with his or her back to a wall, then the practitioner uses a ruler to measure how far the back of the head is from the wall. If the head touches the wall while naturally standing up straight, there is no forward head posture. The further the head is from the wall, the greater the degree of forward head posture.
• Craniovertebral angle measurement. This method involves measuring the forward-facing angle at the base of the neck formed by a horizontal line and a line that goes up to the ear. While more complicated to measure, multiple studies have found the craniovertebral angle to be a particularly useful measurement that more closely correlates to neck pain and other symptoms related to forward head posture.¹Salahzadeh Z, Maroufi N, Ahmadi A, et al. Assessment of forward head posture in females: observational and photogrammetry methods. J Back Musculoskelet Rehabil. 2014;27(2):131-9.^,2Yeom H, Lim J, Yoo SH, Lee W. A new posture-correcting system using a vector angle model for preventing forward head posture. Biotechnol Biotechnol Equip. 2013; 28(sup1):S6-S13.^,3Talati D, Varadhrajulu G, M Mandar. The effect of forward head posture on spinal curvatures in healthy subjects. Asia Pacific Journal of Health Sciences. 2018; 5(1):60-63.

Many other measurements to assess forward head posture exist but are less commonly used.

How to Measure the Craniovertebral Angle

The craniovertebral angle can be visualized from a person’s side as follows:

1. Draw an imaginary horizontal line that goes through the C7 spinous process, which is the back of the vertebra at the bottom of the neck.
2. Draw a second imaginary line from the C7 spinous process up to the tragus, which is the pointed part in front of the earhole.
3. Where these two lines join together at the C7 vertebra forms the craniovertebral angle.

A popular method used in clinical practice to measure the craniovertebral angle is photogrammetry. This method involves taking a lateral photo of the patient (from the side) and then having software analyze the photo to calculate the craniovertebral angle. Before using photogrammetry to measure the craniovertebral angle, small adhesive markers are typically placed on the patient in a few key spots, such as the tragus and the C7 spinous process, to better visualize the angle.

Several other methods for measuring the craniovertebral angle exist, such as using a lateral radiograph (x-ray). Photogrammetry does not involve radiation, which makes it preferable to radiography to reduce radiation exposure.

What the Craniovertebral Angle Means

As the head drifts forward, so does the tragus of the ear relative to the base of the cervical spine (C7 spinous process), which is what the craniovertebral angle measures. The smaller the craniovertebral angle, the more severe the forward head posture.

There is currently no consensus regarding what constitutes the cutoff between a normal and abnormal craniovertebral angle. A review of the medical literature suggests that a craniovertebral angle of less than 50 degrees while standing is commonly considered forward head posture.⁴Kim S-Y, Kim N-S, Kim LJ. Effects of cervical sustained natural apophyseal glide on forward head posture and respiratory function. J Phys Ther Sci. 2015; 27(6):1851-54.^,5Fernandez-de-las-Penas C, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility and forward head posture in unilateral migraine. Cephalalgia. 2006; 26(9):1061-70.

The craniovertebral angle can be measured while the patient is seated or standing. Some research indicates that measuring the craniovertebral angle while standing may provide a more useful result because true forward head posture is less noticeable when sitting.⁶Shaghayegh-Fard B, Ahmadi A, Maroufi N, Sarrafzadeh J. Evaluation of forward head posture in sitting and standing positions. European Spine Journal. 2016; 25(11):3577-82.

How to Fix Forward Head Posture

It is important to note that what is considered normal head posture for one person may be significantly different for another person. Unless pain or other symptoms are present, it is typically not advisable to diagnose or treat a perceived forward head posture.

In cases where forward head posture and pain have developed due to poor postural habits, a combination of the following may help to correct it.

• Exercise regularly. Exercises that are focused on strengthening the weak muscles and stretching the tight muscles of the neck, chest, and core can train the body to better hold healthy posture. In the beginning, it may help to have a physiatrist, physical therapist, chiropractor, or other trained health professional who can design an exercise program that is specific to the patient’s needs.

  See Neck Exercises for Neck Pain

• Maintain good posture. Whether it is while eating a meal, commuting, performing at work, or watching a show, remembering to practice good posture throughout the day can help reduce stress on the cervical spine over time.

  See Posture to Straighten Your Back

Improvements in forward head posture typically do not happen overnight. It takes a long-term commitment to exercises, stretches, and consistently using good posture over the course of several weeks or months before significant benefits may be observed.

Read more: 3 Ways to Improve Forward Head Posture