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

Abstract

Study Design: Randomized controlled trial with a pretest-posttest control group design.Purpose: 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).Overview of Literature: 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.Methods: 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).Results: 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.Conclusions: 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).