Head Righting Reflex

Head Righting Reflexes are a set of midbrain-driven postural responses that begin emerging around 2–3 months of age and remain active throughout life, albeit in a more refined and voluntary form. These reflexes govern the body’s ability to maintain head and eye alignment with the horizon—a prerequisite for balance, coordinated movement, and autonomic regulation.

They are not primitive reflexes in the traditional sense, but rather transitional postural reflexes that replace primitive patterns like TLR, ATNR, and STNR. Their presence indicates maturation of vestibular–ocular–spinal coordination and the emergence of cortical control over postural tone.  

In the last two decades—especially since COVID—we’ve seen a dramatic rise in retained Head Righting reflexes in teens and young adults. Most present with fascial rigidity from T3 upward, compromising cervical rotation, vagal tone, and in severe cases, carotid and sympathetic ganglia function. 

Tonic Labyrinthine Reflex (TLR): Foundational Flexion–Extension Drive and Gravitational Orientation

The Tonic Labyrinthine Reflex (TLR) is one of the earliest reflexes to appear in human development, emerging in utero and typically integrating by 4–6 months of age, though postural traces often persist in clients with dysregulation. It establishes the infant’s first global response to gravitational orientation, mediated not by surface contact but by vestibular input from the otolith system, which senses head position in space. When the infant’s head tilts

forward (into flexion), the body reflexively moves into total flexion; when the head tilts backward (into extension), the body extends. These total-body tone shifts form the first flexor–extensor map across the fascial and muscular systems, organizing anterior–posterior tone in both prone and supine positions.

Landau Reflex: The Postural Bridge Between Core Extension and Spatial Autonomy

The Landau Reflex emerges around 3–4 months of age and typically integrates between 12–24 months, depending on trunk tone maturity and the resolution of earlier primitive reflexes. It appears only after foundational flexor patterns—particularly the Tonic Labyrinthine Reflex (TLR), Asymmetrical Tonic Neck Reflex (ATNR), and residual Moro activity—have begun to recede. This staged emergence reflects the infant’s growing ability to sustain antigravity postural extension.