Effectiveness of an exercise program to improve forward head posture in normal adults: A randomized, controlled 10-week trial

Forward head posture (FHP) is most often described as excessive anterior positioning of the head in relation to a vertical reference line, involving increased cervical spine lordosis (head forward, middle cervical spine extended, lower cervical spine flexed) and rounded shoulders with thoracic kyphosis. Although exercise is routinely used to improve FHP, relatively little data exists on efficacy. The present study was designed to examine the impact of a 10-week targeted and progressive home exercise program on improving FHP. As improvement through exercise of postural alignment depends upon participants adhering to the program, we also looked at issues related to exercise compliance. Seventeen control (C) and 23 exercise (E) participants with a FHP deviation were part of this program. Pre- and post-exercise postural measurements of FHP were obtained from the sagittal plane using the Biotonix™ Postural Analysis System; in addition neck flexion range of motion was measured. Participants were randomly assigned to C or E groups. The E group performed neck extensor and pectoralis major stretches and deep neck flexor and shoulder retractor strengthening exercises for the 10-week period. Two-factor (group, pre-test/post-test) analysis of variance models were used to test main effects and interactions. There were no significant differences (p>0.05) between groups on any pre-test measure. For the E group, there were significant differences and interactions (p<0.05) between pre- and post-tests and also between the E and C groups at post-test for range of motion and one postural measurement. The results demonstrate that a short, home-based targeted exercise program can improve postural alignment related to FHP. These results provide a foundation for further development of postural improvement programs that include an exercise component.