Impact of forward head posture correction on craniovertebral angle, neck disability, and spinal electromyography: A randomized controlled trial

Background: Forward head posture (FHP) is a common malalignment affecting the cervicothoracic spine. This deviation is associated with neck disability and muscle imbalance. Objective: This study aimed to investigate the efficacy of FHP correction using regional versus comprehensive spinal programs on the craniovertebral (CV) angle, neck disability, and spinal muscle activity. Methods: Sixty participants with FHP were randomly assigned to receive either a cervicothoracic correction program (control group) or a cervicothoracic plus lumbopelvic program (experimental group). The CV angle, neck disability index (NDI), and normalized electromyography as a percentage of maximum voluntary isometric contraction (%MVIC) from spinal muscles were measured before and after the intervention. Results: Post-intervention, both groups showed significant improvement across time in CV angle and NDI (p < 0.001, p = 0.002). However, the between-group comparison was not statistically significant. The NDI showed significant improvement only in the experimental group (p = 0.005). The minimal clinical important difference (MCID) obtained was 6.44 for the NDI. A reduction in %MVIC over time was observed in both groups for cervical erector spinae (Right, p = 0.006, Left, p = 0.001). The between-group comparison of spinal muscle activation was not significantly different. Conclusion: The study suggested that FHP management using a cervicothoracic or cervicothoracic plus lumbopelvic protocol could improve cervical posture and lower cervical muscle demand. Incorporating a lumbopelvic into the cervicothoracic protocol was more effective in reducing short-term neck pain and disability than a cervicothoracic protocol alone. A comprehensive spine program may be a clinically beneficial rehabilitation protocol for FHP to improve neck pain and disability.