Peak performance: abnormal forward head posture impedes sports performance

Postural pain syndromes and headaches, caused by forward head posture, are common but not normal. Headaches and neck pain are just the tip of the iceberg. Abnormal forward head posture (FHP) is also correlated with diminished balance, speed and strength.

A recent study published in the Journal of Sport Rehab evaluated skill-related differences in physical fitness between two groups of pain-free college athletes that played volleyball, handball or basketball. 50 athletes with abnormal (FHP) were strictly matched with 50 controls with normal head posture.

Abnormal FHP was defined as having a craniovertebral angle (CVA) less than 55°. The craniovertebral angle, A, in the photo is calculated by:

  1. Drawing 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.

Abnormal forward head posture stretches the spinal cord, putting it under tension, reducing the speed of nerve impulse velocity in the spinal cord by 10 – 20 %. 

All the athletes completed four physical fitness skills test: (1) T- test (agility and speed), (2) stork (static balance) test, (3) Y-balance test (dynamic balance) and (4) vertical leap (leg power) and the results of the two groups were compared.


T – test                            Stork test              Y – Balance           vertical leap

Conclusion: College athletes with FHP of less than 55° exhibited less efficient skill-related physical fitness when compared with athletes with normal sagittal head posture. On average athletes with abnormal FHP were 1 second slower in their agility sprint times, their vertical leap was 9 cm lower, their ability hold the stork balance test was several seconds less and their dynamic balance was poorer than athletes with normal head posture.

A FHP of 55° or less on a photograph correlates with an anterior head translation of 25mm or more as measured on x-ray, which is a more accurate and our preferred way of measuring abnormal FHP . A CVA closer to 90 degrees = 0mm of anterior head translation.  There is a linear relationship between the magnitude of FHP and speed, balance and power in healthy pain free athletes. Better posture = better fitness skills outcomes. Other posture studies have shown that bodies heal faster and stronger when their spinal cords are not under tension. Another study showed ocular motor control reaction time, the ability to track an object in space, is slowed with abnormal FHP.

At Doctors of Chiropractic Capalaba we are not limited to treating pain. We can change posture, spinal cord tension and spinal cord nerve impulse velocity which improves sensory processing, speed, balance and power. Correcting and maintaining good posture and spinal mobility is an essential part of health and wellness. You do not have to be an athlete to experience the benefits.

Reference: Journal of Sport Rehab: Comparison of Sensorimotor Integration and Skill-Related Physical Fitness Components Between College Athletes With and Without Forward Head Posture, By Drs. Ibrahim Moustafa, Meeyoung Kim, Deed E. Harrison