Forward head posture: what it is, what the evidence says, and what you can do at a screen

What is forward head posture?

Forward head posture (FHP) means that, seen from the side, the head sits forward of the shoulders instead of over them. A 2019 meta-analysis by Mahmoud and colleagues describes it as the most common cervical postural fault in the sagittal plane, which is the side-on view, and says it appears to varying degrees in almost all populations.⁸

Researchers often measure it with the craniovertebral angle (CVA). A 2021 study by Cote and colleagues defines it as the acute angle between a line from the spinous process of the seventh neck vertebra (C7) to the tragus of the ear, and a horizontal line through C7.¹¹ A smaller angle means the head sits further forward. This page uses the term because it is the one people search for. It is a description of position, not a diagnosis.

Nothing on this page can tell you whether your own head position is a problem. It explains what the research says and what is sensible to do about a screen-heavy day.

Is it a problem? What the evidence says

The honest answer is that the research does not agree. The Mahmoud meta-analysis included 15 cross-sectional studies; ten compared adults with and without neck pain, and across those the overall mean difference was 4.84 (95% confidence interval 0.14 to 9.54), which is statistically significant. In adolescents there was no significant difference.⁸

The same abstract reports correlations between forward head position and neck pain intensity (r = -0.55) and disability (r = -0.42) in adults and older people.⁸ The negative sign is not explained in the abstract. It probably reflects the angle used as the measure, which we have not checked in the full paper, so do not read it as “less forward head, more pain”.

It also says age played an important role as a confounding factor, that no association was found between FHP and most neck pain measures in adolescents, and that the relation seems to be controversial.⁸ Cross-sectional studies compare people at one moment, so they can show association but not cause.

The 2018 Sheikhhoseini meta-analysis covered seven randomised trials with 627 participants, testing corrective exercise for forward head posture. It graded the evidence that exercise may improve neck pain as level 1b, which is moderate, and said the precise relation between FHP and musculoskeletal pain remains to be established.⁹

Common causes: screens, phones and work

No source we read measures what causes forward head posture. What the NHS and Arthritis UK describe is the cause of neck pain, which is a different thing. The NHS lists bad posture, for example when sitting at a desk for a long time, among the most common causes of neck pain.¹ Arthritis UK says neck pain is usually the result of holding your neck in the same position for too long, and that a head bent forward for long periods can stretch the neck and may cause muscle pain.²

For the phone, Arthritis UK advises against cradling the telephone on your shoulder, and says you can ask your employer for a headset.² We found no source with measurements of phone use and head position, so this page says no more.

The HSE describes display screen equipment as covering PCs and laptops.⁶ Its guidance on good posture is the nearest thing to British advice on the subject.

A simple side-view check, and an illustrative calculation

A side-on photo is one way to see your head position, and some people compare photos over weeks. It is a personal record, not a test. We read a study of measuring the CVA from photographs taken through a video-call platform: it included 66 people, 57 of them women. Average CVA was 50.7 degrees (standard deviation 6.3) in a relaxed posture and 55.5 degrees (5.4) in an “ideal” posture. Reliability between trained student raters was 0.88, and within the same rater 0.91.¹¹

Those figures come from one small sample, measured by trained students. They are not British norms, not a cut-off for anything and not a diagnostic threshold. We found no free app or fixed-distance photo protocol described by an institution, so any method you try is unvalidated.

An illustrative example, not a measurement

Suppose the line from C7 to the ear were 15 cm long (5.9 in). That length is an assumption for the example, not a value from any source. The horizontal distance from C7 to the ear is then 15 x cos(angle). At the relaxed average of 50.7 degrees, that is about 9.5 cm (3.7 in). At the “ideal” average of 55.5 degrees, it is about 8.5 cm (3.3 in).

The 4.8-degree gap between the two averages (55.5 minus 50.7) would, on those assumptions, shift the ear by about 1 cm. That is a way to picture the arithmetic. It does not mean 1 cm matters for your neck, and the figures should not be taken as normal values.

Gentle exercises, and what the sources do and do not describe

A “chin tuck” is the exercise most often named for forward head posture. The NHS and Arthritis UK pages we read do not describe it. The NHS gives only the general advice to sit upright, roll your shoulders back gently and bring your neck back, on a page whose review date has passed.¹ So this page does not describe a chin tuck, and does not credit one to the NHS or Arthritis UK.

What those pages do describe are general neck exercises, with their counts. If you have neck pain now, have them confirmed as suitable for you by a GP or other health professional first, because we cannot tell you which exercise suits your neck.

The NHS also says not to do anything that could be dangerous because you cannot move your neck, such as driving or cycling.¹ For a wider set of posture exercises, see how to fix posture.

Desk and phone habits: the HSE advice

The HSE standard set-up puts the top of the screen level with your eyes, about an arm’s length away, with the shoulders relaxed.⁵ On a laptop, the screen should be separate and raised on a stand, with a separate keyboard and mouse.⁵ A document holder may help avoid awkward neck and eye movements.⁶ Arthritis UK says a reading frame often helps to correct your posture for long periods of reading.²

On breaks, the HSE says 5 to 10 minutes every hour is better than 20 minutes every 2 hours.⁷ Over 8 hours at a screen, that is 5 x 8 = 40 up to 10 x 8 = 80 minutes of breaks.

The full set-up is in correct sitting posture and ergonomic desk set-up. Our page on back pain from sitting covers the back and the NHS warning signs.

When to see your GP

The NHS says most neck pain only lasts a few weeks.¹ See a GP if the pain or stiffness has not improved after a few weeks, if painkillers have not worked, or if you have other symptoms such as pins and needles or a cold arm.¹

Arthritis UK also lists pain, tingling, numbness or weakness in your arms or legs, and sudden severe pain after a fall or injury, as reasons to get medical advice.² These are a matter for a health professional, not for a posture check.

Frequently asked questions