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The Great Forward Head Posture Debate

Forward head posture. Nerd neck. Text neck. You’ve probably heard it by at least one of these names. You’ve probably been told, at some point in your life, to sit up straighter and not to slouch. But why does it matter? Does it make you more likely to have pain or develop an injury?

A recent meta-analysis done by Nesreen Mahmoud and colleagues broke down 15 studies on the relationship between forward head posture and neck pain. In this article, we’re going to break down what they found and what it means for you.

What is Forward Head Posture?

from left to right, image of a man with a red line indicating increasing positions of forward head posture
From left to right, positions of increasing forward head posture.

Forward head posture, the forward placement of the head in relation to the shoulders, has been discussed heavily for the past 20+ years in the scientific community. Some researchers and clinicians theorize that forward head posture can cause neck pain. The thought is that if individuals with this posture sit at a computer for long hours, this “unnatural” position of the neck will eventually lead to pain.

There are a few ways prolonged positioning could cause pain or injury. Some positions might require overuse of some neck flexor and extensor muscles, leading to weakness of other muscles. Some positions might cause tissue inflammation or irritation.

Research on Forward Head Posture

This particular meta-analysis was done by Nesreen Mahmoud and colleagues. The results revealed mixed answers on the association between forward head posture and neck pain. 13 of the 15 study’s results reviewed in the meta-analysis were used. Of those 13 paper’s results, five showed a statistically significant association between forward head posture and neck pain. The majority of those studies showed that individuals with neck pain had increased forward head posture compared to their age group peers.

To break it down a little further: those studies suggest that if someone is currently experiencing neck pain, the position of the head in relation to the shoulders is probably contributing.

One of the main findings of this meta-analysis was that there are differences in neck pain between adolescent and adult populations.

main with neck pain

Adults with forward head posture were more likely to have neck pain compared to adolescents. This isn’t too surprising; we’ve known for a long time that age plays a role in increased risk of neck pain in general. The human body has an incredible ability to adapt to stress (in this case, an aberrant neck position). Younger age allows our muscles, ligaments and bones to adapt and be used for longer periods of time before something goes wrong. As we get older, the adaptability of our bodies decreases, and years to decades of forward head posture can eventually lead to neck pain.

Neck Position and Pain Intensity

Another interesting finding of this meta-analysis was as forward head posture increases, the intensity of neck pain also increased in adults. There’s a few reasons that could be the case.

Over time, the body’s ability to adapt to and overcome stress decreases. If a poor position is maintained for years, the body becomes less capable of recovering from it. Neck pain is also often multidimensional, or the result of multiple factors.

What does that mean for you? It means that while overuse or underuse of certain muscles might happen as a result of forward head posture, it might might not directly cause neck pain.

Something that is very important to understand is that every individual person’s anatomy is unique. Some people, due to anatomical variation, just have a naturally further-forward head position and live their whole lives without neck pain. Others may have minimal forward head position and still develop neck pain. That’s why clinicians are cautious about saying that forward head posture is a direct cause of neck pain. It might be a piece of the puzzle, but not all of it.

What’s the Consensus on Forward Head Posture?

As of right now, there is no consensus among researchers about the impact of forward head posture on neck pain. Here’s what we can say with a reasonable degree of certainty:

For individuals currently experiencing neck pain, forward head posture may be playing a role in the pain. If you currently do not have neck pain, holding your head in a more forward position may make you more likely to have neck pain in the future. Some people naturally have a head position that is more forward in relation to their shoulders. However, that doesn’t necessarily mean that those individuals are destined for neck pain in the future.

One topic not discussed in this meta-analysis was the amount of time spent holding your head in this posture. Do long hours have more of an impact on the development of neck pain? We’ll need more research on this topic to draw the most accurate conclusions.

What Should Esports Athletes Know About Forward Head Posture?

Forward head posture might cause neck pain over time, but it’s not the only cause of neck pain. Neck pain is a complex pathology that is often influenced by a variety of factors. Every individual is unique, and it’s important to address all of the factors causing their pain. Even if you are not having neck pain, some people may benefit from postural education while gaming, which includes everything from head position to proper monitor and desk chair heights to easy stretches/exercises that can be done to keep you performing at your best and game without pain.  



At 1HP we review each athlete on a case-to-case basis. If you’re currently having neck pain or neck stiffness, we can review your case, identify possible causes of this pain, and create a treatment plan to not only alleviate the pain now but reduce the risk of it bothering you again in the future.


Mahmoud, N. F., Hassan, K. A., Abdelmajeed, S. F., Moustafa, I. M., & Silva, A. G. (2019). The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-AnalysisCurrent reviews in musculoskeletal medicine12(4), 562–577. https://doi.org/10.1007/s12178-019-09594-y

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