Many patients I have worked with seem to have forward head posture and dizziness. In this article, I will discuss possible links between posture problems and dizziness, and what to do.

What is Normal Posture?

Normal posture is when your vertebrae stack like a column. Within that vertical spinal column, there are natural spinal curves that you can see from a side view. With a normal posture, your head should stack directly on top of the spinal column. Your ear lobe should be directly above your shoulder joint when you are sitting up or standing up straight.

What to Do About Posture Problems and Dizziness

Correct Your Forward Head Posture

The connection between posture and dizzinessIf someone looked at you from the side while you were standing up, would your head be stacked on top of your spine?

When your head is level but forward in front of your trunk, that is called forward head posture. You can stand normally and ask a friend or family member to take a photo of you from the side.

If your ear lobe is directly over your shoulder, that is considered normal. If your head is sticking out in front of your body, then you most likely have a forward head posture.

With this posture problem, your lower neck is flexed way forward and your upper neck is hyperextended. That hyper flexion of the lower cervical spine and hyperextension of the upper cervical spine allows your head to be level, so your eyes can look straight ahead. This causes a lot of problems, including dizziness!

Forward Head Posture Can Cause Dizziness

Forward head posture while sitting up or standing up contributes to dizziness in several ways. First of all, your spinal proprioception may be altered due to forward head posture. The blood flow to your brain and ears to your brain can be reduced, which can cause dizziness and brain fog.

Forward head posture may contribute to upper cervical dizziness, and can even trigger vestibular migraines. Reduced blood flow to the inner ear may result in recurrent episodes of BPPV, which is the most common inner ear cause of vertigo.

Therefore, patients with forward head posture may experience upper cervical dizziness, recurrent BPPV, and/or more frequent vestibular migraines. Base of the skull pain or tension, along with frequent tension headaches and upper back pain are also common in these patients.

Over time, the wear and tear on the spinal structures from forward head posture can damage spinal structures and contribute to chronic dizziness. I believe that cervical spine problems are a commonly overlooked cause of chronic dizziness in older adults.

How to Correct Forward Head Posture

If your forward head posture goes away when you lie flat, then your prognosis for recovery is better. If not, then it may be difficult to correct.

You can find an orthopedic manual physical therapist or chiropractor to help you get started. If they think you need a spinal x-ray, they will let you know. You will most likely need to learn postural awareness while sitting, standing, and walking to keep your alignment correct.

Exercises for stretching to open the chest area and strengthen the upper back usually help.

Forward head posture can be a huge obstacle to a full recovery from dizziness and vertigo, so it is important to address it as soon as possible.

If your forward head posture does not go away when you lie flat, you may want to consult with an orthopedic doctor for spinal imaging. Some older patients diagnosed with thoracic kyphosis may have underlying compression fractures in their spine, which can be repaired with a surgery called a kyphoplasty.

Look at Underlying Orthopedic Conditions

Various orthopedic conditions can cause underlying problems with spinal alignment and posture that are visible from a front view, such as a leg length discrepancy or scoliosis. Joint replacement surgeries can sometimes alter leg length.

These underlying orthopedic conditions can cause upper cervical problems, which may directly cause dizziness.

What to Do About Your Orthopedic Condition

You can consult an orthopedic physical therapist or chiropractor for evaluation of your overall spinal alignment. They may recommend spinal adjustments, stretching, strengthening, or special footwear as needed.

Normal Activities that may Cause Posture Problems

Improper Ergonomics

Improper ergonomics at a workstation can contribute to posture problems, thereby causing dizziness. Using a phone, laptop, tablet, or desktop computer with a screen below your chin can contribute to posture problems and dizziness.

Straining forward while you are working on a desktop, laptop, or tablet can cause a relative forward head posture. If working on an electronic device creates a relative forward head posture due to leaning forward at the waist with your head level, that can result in all the causes of dizziness I shared above.

Reclining back while using your phone or tablet can cause dizziness and may eventually result in a forward head posture while upright.

People often strain forward, creating a relatively forward head posture while working on their computer, when they need new glasses. This can occur even when the workstation is properly set up.

What to Do

You can begin to make improvements by holding your phone up higher while upright. Your opposite hand can support under your elbow, or you can rest your elbow on a soft surface in front of you like a pillow across your abdomen.

You can also lock your phone into portrait, and lie on your side to look at the phone. This strategy is not recommended for patients who have BPPV.

Your physical therapist, chiropractor, or a certified ergonomics consultant can help make sure your workstation is set up correctly. They can also advise you on any items that you need to purchase to improve your ergonomics.

You can ask a friend or family member to take a picture of you from the side at your computer or workstation, to show to any professional who is helping you with your ergonomic set up.

Some ergonomics consultants will even make house calls or come to your office to assess your set up in person.

If your computer screen is at the proper height, but you still feel yourself leaning forward while you are working on your computer towards the screen, then you may also want to get your eyes checked.

Avoid reclining or lying back while working on your laptop or tablet.

New glasses or an updated prescription for your glasses may help you maintain proper posture at your workstation.

Exercise-Induced Forward Head Posture

Similarly, a relative forward head posture can be temporarily created during exercise by hunkering forward with your trunk while your head is level. Exercise-induced forward head posture frequently occurs while riding a stationary bike at home or at the gym, during a spin class, or biking on a road bike.

Can you picture it?

Leaning forward at the waist while hunkering down with your trunk while riding a bike can cause chronic or recurrent dizziness or vertigo create a temporary forward head posture. That position can contribute to chronic or recurrent dizziness or vertigo for all the reasons I shared above about how forward head posture can result in dizziness.

What to Do

While riding a bike for exercise at home or at the gym, you could choose a recumbent bike with a back support so that your spinal column stays vertically stacked.

To reduce the extreme angle of any forward head posture caused by hunkering down over a bike with your head level, you can improve your awareness of your body position. If you prefer to ride a bike that causes you to lean your trunk forward while riding, you can try to minimize the forward lean of your trunk and try to elongate the back of your head while riding.

For road biking, some patients choose to switch to a cruiser style bike or commuter bike to allow for a more upright spine while riding.

Certain Hobbies

Some posture problems are a result of performing a hobby that causes you to lean forward or continually tilt your head forward or sideways for an extended period. Common hobbies such as video gaming, jewelry making, throwing pottery, drawing, journaling, playing a musical instrument – and even leaning forward for hours with your elbows resting on a bar while watching a sports game on an elevated TV screen – may eventually cause posture problems.

What to Do

If your neck is bothering you while you are doing your favorite recreational activity or hobby, or lounging around your house, then you may need to do some problem-solving. If you are getting a headache or neck tension afterward, your hobby may be causing posture problems.

Would certain new equipment make your posture better while you are doing your hobby or recreational activity?

Can you be more aware of how you are holding your head and straightening up your neck whenever possible?

Is there any other way you can set yourself up so that your spinal column is stacked more vertically?

Can you take breaks to sit up straight every so often? This will support proper blood flow through your neck and take the strain off your neck ligaments and discs.

If you want a professional to brainstorm with you, you might consider consulting with an occupational therapist. They are trained in how to set up for activities of daily living to ensure optimal function.

Sleeping Positions, Lounging, and Relaxing

Bad head positioningSleeping, lounging around, and relaxing in certain positions can contribute to posture problems. For example, watching TV or reading in bed can cause a temporary forward head posture. Using your laptop on your abdomen while lying down on a couch with your head on a pillow can cause a relative forward head posture.

What to Do

In order to get individual guidance for your living situation, you can ask your physical therapist or chiropractor about safe positions for sleeping, lounging, and relaxing.

For more information on common root causes of chronic neck dizziness, click here.

For a detailed discussion on who can help with upper cervical dizziness, click here.

Disclaimer

This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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