Radiographic and clinical effects of core stabilization on cervical pain and sagittal balance in forward head posture: a randomized controlled trial.

Abstract

Randomized controlled trial with a pretest-posttest control group design. To investigate the radiographic and clinical effects of core stabilization exercises (CSEs) on cervical sagittal alignment and pain in individuals with forward head posture (FHP). FHP is a common postural disorder increasingly linked to prolonged screen use. Conventional rehabilitation primarily targets cervical musculature, whereas the role of core stabilization in influencing cervical alignment remains underexplored. Forty patients (aged 20-40 years) with FHP (craniovertebral angle ≤50°) were randomly assigned to two groups: group A received CSEs combined with postural correction exercises (PCEs), and group B received PCEs alone. Interventions were delivered 3 times per week for 6 weeks. The primary outcomes were T1 slope (T1S), spino-cranial angle (SCA), and pain intensity measured using the Pain Rating Scale (PRS). Thirty-six participants completed the intervention. A two-way mixed-design multivariate analysis of variance revealed a significant main effect of time (F =19.461, p <0.001) and a significant time×group interaction (F =9.726, p <0.001), indicating superior improvements in group A. Group A demonstrated significantly greater gains in SCA and PRS scores compared to group B (p <0.05). Both groups showed significant improvements in T1S. CSEs are effective in improving cervical sagittal alignment and reducing cervical pain in individuals with FHP. These findings support the integration of core-focused interventions into clinical rehabilitation programs for postural dysfunction (ClinicalTrial.gov registration number: NCT06160245).