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A Patient's Guide to Forward Head Posture

At Kleefeld Chiropractic patients frequently present with neck and upper back pain secondary forward head posture.  In today’s computer age this one of the most common clinically seen patterns of muscle and joint dysfunction.  The medical term for this is Upper Crossed Syndrome.  The health-care community including Dr. Kleefeld is of the opinion that if your dominant activity through the day involves sitting, driving, or standing with your head bent down at a task, this could be an issue.

Forward head posture or Upper Crossed Syndrome describes a compromise in the musculoskeletal system characterized by tight chest (pectoral), neck (scalene and sternocleidomastoid) muscles, primarily in the front of your body. Weakness occurs in your upper back (mid trapezius) and shoulder blade muscles.

Dr. Kleefeld advises that stretching the tight muscles and strengthening the weak muscles is a necessary part of the treatment process to combat pain in your neck and upper back associated with forward head posture.  This is especially important when you are job or activities of daily living require prolonged sitting and keyboarding.

Basic Guidelines

Stretches for upper cross syndrome are like other stretches in that the muscles are best stretched warm. Perform stretches after a five-minute aerobic warm-up. Stretching cold muscles is not advised because injury is more likely. Hold each of the following stretches for 15 to 20 seconds at a minimum or they are not as effective.

Pectoralis Stretch

The pec major is the bigger of the two chest muscles, and it is actually two muscles: the clavicular portion on top and the sternal portion on the bottom. To stretch the clavicular portion, stand in the corner of a room and place your palms and forearms on each wall. Slide the arms up so that, with them at 90-degree angles, your elbows align with your armpits. Lean forward until you feel a stretch.

The pec major sternal portion is bigger than the clavicular portion. The clavicular stretch is more common than the sternal stretch, yet both are important. To perform this stretch, stand in the corner with the arms against the walls as in the other stretch. Open the forearms outward to point at 45-degree angles away from the body. Lean forward until the stretch is felt, and hold.

Scalene Stretch

Sit upright in a chair and place your hand on top of your head with your elbow out to the side.  Slowly bend your head and neck towards your shoulder.  Grasp the chair your sitting on with the opposite arm and lean your body towards the shoulder that your head is pointing to slowly increasing the stretch.

Rhomboid Strengthening

Begin with the basic rhomboid strengthening exercise. Once this is too easy, progress to the intermediate rhomboid exercises and eventually, the advanced rhomboid exercises.

Shoulder Blade Squeeze

Begin this exercise standing or sitting with your back straight. Your chin should be tucked in slightly and your shoulders should be back slightly. Slowly tighten your rhomboids by squeezing your shoulder blades together as hard and far as possible provided the exercise is pain free. Hold for 5 seconds and repeat 10 times.


Begin this exercise lying on your stomach with your arms by your side. Tighten your rhomboids by squeezing your shoulder blades together and slowly lifting your arms and chest off the ground, keeping your neck straight. Hold for 2 seconds at the top of the movement and then slowly return to the starting position. Perform 3 sets of 10 repetitions provided the exercise is pain free. This exercise may be performed with palms facing up or down.

Resistance Band Pull Backs

Begin this exercise in standing or kneeling with your back straight and holding a resistance band and slowly pull your arms backwards, tightening your rhomboids by squeezing your shoulder blades together as shown. Hold for 2 seconds and then slowly return to the starting position. Perform 3 sets of 10 repetitions provided the exercise is pain free. 

Treatment Protocol

At Kleefeld Chiropractic, Dr. Kleefeld recommends to chronic shortening and weakness in the primary stabilizers of the neck, upper back, muscular adhesions and trigger points develop that should be removed before active/passive stretching.

  • Performing four to six sessions of myofascial release and trigger-point therapy usually is sufficient to settle any acute symptoms.  Spinal manipulation is utilized for any joint restrictions.  Ultrasound of the painful area can be beneficial.  Graston® technique performed about the scapular muscles can also be very helpful.
  • At-home treatment consists of activity modification, ice and heat.  A self massage can be performed rolling on a tennis ball searching for any tender points about the neck, upper back and shoulder blade region.  This can be extremely beneficial for breaking up active/latent trigger points.

Most patients will be asymptomatic or significantly improved within 6 visits.  If you require any further information Dr. Kleefeld can be contacted at 530-722-9010!

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