Your head sits forward and your breath feels shallow, but the lung test came back normal

Somebody has probably told you that your head sits too far forward, and the advice that follows is always the same. Pull it back. Open the chest. Breathe better. A paper published on 21 August measured all three in the same room, and the measurement that separated nobody is the one worth talking about.

The study came out in the Journal of Manual and Manipulative Therapy (J Man Manip Ther, 2026). A team working across Ankara Yildirim Beyazit University and Hatay Mustafa Kemal University compared 32 adults with forward head posture against 35 without it, sorting the two groups by craniovertebral angle rather than by eye. Then they ran three quite different tests. How long each person could sustain a sound on one breath, the maximum phonation time, which stands in for how well the diaphragm holds its own work. How long each could hold the three McGill trunk endurance positions. And spirometry, the ordinary lung function measurement your doctor would use.

Two of the three came back different, one of them by a lot. Trunk endurance was worse in the forward head group on every test at p less than 0.001, with effect sizes running from 1.31 to 1.73, which in this literature counts as large. Phonation time was shorter too, more modestly, at 0.69 for one sound and 0.61 for the other.

The spirometry found nothing. Not one significant difference between the groups, on any respiratory parameter.

The part that did not show up

This runs against what the earlier work primed people to expect. A 2019 study in the Journal of Physical Therapy Science took fifteen healthy men, asked them to breathe first in a neutral head position and then in a forward one, and reported lower forced vital capacity, lower reserve volumes and a lower peak flow in the forward position (J Phys Ther Sci, 2019). That got summarised, everywhere, as forward head posture reducing your breathing.

Put the two designs beside each other and most of the conflict dissolves. The older study measured what happens when a person deliberately holds their head forward for the duration of a test. The new one compared people who actually live that way against people who do not, and found their lungs measuring the same. Adopting a posture and having one are not the same experiment.

What differed was endurance rather than capacity. Maximum phonation time is not a volume test. It measures how steadily you can meter air out while making a sound, which asks the diaphragm to hold its shape against the abdomen and the vocal folds for as long as the note lasts. How much air you have and how long you can stay organised around it are separate questions, and only the second told these groups apart.

The trunk numbers deserve more attention than the neck ones. An effect above 1.3 across all three McGill positions is a bigger signal than anything measured up at the head, which makes the visible thing look like the smallest part of it.

A case control design also cannot tell you which came first. Did the head drift forward because the trunk was running out, or did the trunk run out because a head carried in front of the body quietly recruits the neck muscles into breathing all day long? The paper does not answer that and the authors do not pretend to. Worth holding beside it: a systematic review of 15 cross sectional studies found that adults with neck pain do sit with more forward head position than pain free adults, a mean difference of 4.84 degrees, though the confidence interval stretched from 0.14 out to 9.54, and in adolescents the association disappeared completely (Curr Rev Musculoskelet Med, 2019). Age was doing a great deal of the work.

What I see in the room

I am a Feldenkrais® practitioner, and the forward head is probably the single most self diagnosed thing people bring me. In June a woman of about sixty two told me she had been doing chin tucks every morning for eleven weeks and her neck was exactly where it started. She was doing them properly. She was also holding her breath through every repetition, which neither of us noticed until I asked her to count out loud while she did one. Eleven weeks is a fair amount of time to give something, and if you are counting weeks yourself, our guide on how long does it take to fix rounded shoulders walks through what those timelines usually look like.

That is the pattern this study brought back to me. If the trunk underneath is already near the end of its endurance, and the neck is quietly helping with the breathing, a corrective hold at the top hands an overloaded system one more job. The head sits on ribs, which sit on a pelvis, and in a Feldenkrais Method® lesson the question is almost never how to hold the head.

In Awareness Through Movement® the range stays small, the pace stays slow, and you only go where it feels easy, pleasant, and comfortable. For people used to being told to correct something, this can be a strange instruction to receive.

What I would actually do with this

There is a small thing you can notice without equipment. Sit as you are sitting now, take an ordinary breath, and make a steady ahh sound for as long as it stays comfortable. Count it. Then lie down for a few minutes with your knees bent and your feet standing, let the floor carry your ribs, and try again. Whatever difference turns up says something about how much of your breathing was going into holding yourself upright. Not a test. A way of noticing.

Gentle movement does not replace clinical care. If your breathing is genuinely restricted, that belongs with your doctor, and this kind of work sits alongside what your physiotherapist gave you rather than in place of it. Yoga, Pilates and the Alexander Technique each work with the head and the ribs through their own mechanism, and each has its own strengths. If you sit at a desk most of the day, our entries on desk posture and chronic neck pain and chronic shallow breathing cover the same ground more slowly.

What stays with me from this paper is which measurement finally separated the two groups. Not how much air anybody had. How long they could keep a sound going before it thinned out and stopped.