Little do most of us realise that our everyday habits such as constant slouching, skipping regular physical activity, and endless hours spent looking down at our phones or poorly positioned computer screens, might be coming at a hidden cost. One that could literally make your head drop forward and stay that way.
This is the uncomfortable reality of Dropped Head Syndrome (DHS), a condition caused by weakness in the neck’s extensor muscles, which can lead to a forward slump of the head until the chin rests on the chest. Left untreated, this posture isn’t just a passing ache, it can become permanent.
And with Malaysians ranking among the world’s top in daily screen time, clocking in an average of eight hours a day, four of which are spent on mobile devices, we might be unknowingly setting ourselves up for it.
THE SPINE DOESN'T LIE
According to Consultant Spine Surgeon Dr Lim Kang Kai from Sunway Medical Centre, a combination of bad habits is contributing to poor spinal health.
“Even simple daily activities such as getting in and out of bed, driving, bending down to wear your shoes, or picking an object from the floor can be damaging if the proper techniques are not observed," he explained.
What’s worse, he added, is how lack of exercise and weak core muscles tend to “drive the nail in the coffin.”
DHS, he explained, is caused by severe weakness or deficiency in the neck’s back muscles, the extensor muscles. This causes the head to involuntarily fall forward, making it difficult to maintain an upright position.
The signs? A head that’s tilted downward, a painless chin-on-chest posture, and a neck that appears elongated. People with DHS often struggle to lift their heads while sitting or standing, although lying down can temporarily relieve the position.
Dr Lim said that DHS is classified as a neuromuscular disease, similar to conditions like Parkinson’s, myasthenia gravis, ALS (amyotrophic lateral sclerosis), polymyositis, and genetic myopathies. It can also be linked to degenerative causes such as cervical spondylosis or age-related muscle loss (sarcopenia).
“When the cause is unknown, it is called isolated neck extensor myopathy,” he added.
While DHS is more common among the elderly, Dr Lim warned that it isn’t age-exclusive. The symptoms may appear suddenly or progress over months and years, depending on the root cause.
“Younger individuals may be affected more rapidly due to immune-mediated neuromuscular conditions or acute neurological causes, compared to older individuals whose cases are often linked to chronic conditions. although the reverse can be true for both age groups.”
TREAT FIRST
Fortunately, DHS can often be managed through non-surgical treatments at the early stage.
“A supportive neck collar coupled with physical therapy may be of tremendous help. In certain inflammatory conditions, medications may be used to reduce muscle inflammation. Immunotherapy or other disease-specific medications may be part of the treatment for DHS,” said Dr Lim.
But in more stubborn or severe cases, surgical intervention like spinal fusion surgery may be necessary to correct deformity and restore proper head posture.
Dr Lim also clarified that DHS should not be confused with everyday neck muscle sprains or trauma, although they might look similar, the underlying causes and treatments differ.
“While both conditions can involve neck weakness, their causes, mechanisms, and treatments are very different,” he said, pointing out that DHS is usually a gradual process linked to neuromuscular issues, while sports injuries happen suddenly and are treated with rest, NSAIDs, and physiotherapy.
When it comes to recovery, age plays a role. “Younger people have the capacity to recover faster, while the elderly heal slower,” Dr Lim noted.
REHABILITATION
For those already battling the condition, Rehabilitation Medicine Specialist Dr Foong Chee Choong, also from Sunway Medical Centre, explained that therapy focuses on restoring flexibility and strength, particularly in the neck extensor muscles, torso, and hips to improve posture.
Patients with severe neck weakness might benefit from wearing a cervical collar to maintain proper head alignment.
“Individuals with DHS who experience neck pain may also benefit from physiotherapy modalities such as heat therapy and electrotherapy for pain relief,” said Dr Foong. However, he cautioned that the effectiveness of these treatments largely depends on what’s causing the condition in the first place.
Those with fixed flexion deformity and failed rehab outcomes may need to consult a spine surgeon for possible corrective surgery.
Echoing Dr Lim, Dr Foong said DHS is mostly triggered by neurological diseases and degenerative spinal issues, both of which are difficult to prevent. But lifestyle matters.
“Excessive use of smartphones and other electronics could aggravate the issue.
“Fixed flexion deformity of the neck is preventable by practising proper body mechanics and regular neck exercises," he said.
Still, he noted, poor posture and improper sleeping positions more commonly cause neck and back pain, rather than full-blown DHS.
Ultimately, whether DHS is reversible or not hinges on its cause, early intervention and proper diagnosis is crucial.
The message is clear: our posture, daily movements, and tech habits can shape or misshape our bodies in lasting ways. While most of us worry about phone addiction, we may be ignoring its physical toll.
So maybe it’s time to straighten up, stretch out, and look up — literally.