Effects of an exercise program on cervical posture and sensorimotor function in persons with forward head posture

Main Article Content

Nontacha Jantoon
Sureeporn Uthaikhup


Background: Forward head posture is associated with impaired musculoskeletal function and sensorimotor system. However, the effects of an exercise program as part of routine activities in persons with forward head posture remain unknown.

Objectives: To investigate the effects of an exercise program on cervical posture and sensorimotor function in persons with forward head posture.

Materials and methods: Sixty university students with forward head posture (aged between 19 and 24 years old) were recruited. Participants were allocated to either experimental or control group. The experimental group received a specific exercise program including postural correction, co-contraction of the cervical muscles and suboccipital muscle stretching, 7 days a week for 4 weeks. The control group continued with their normal daily routine. The outcome measures were the craniocervical (CV) angle, sagittal head tilt (SH) angle, cervical joint position error (JPE), and postural sway during narrow stance with eyes open and closed. The outcomes were measured at baseline and 4 weeks after intervention.

Results: The results showed that the CV angle and JPEs in rotation to the left and right sides were improved significantly in the experimental group compared to the control group after the exercise program (p<0.05). The CV angle, SH angle and JPEs before and after the exercise program were significantly found in the experimental group (p<0.05). There were no significant differences in the total sway area between groups and within group (p>0.05).

Conclusion: The results of this study suggested the 4-week exercise program (postural correction, co-contraction of the cervical muscles and suboccipital muscles stretching) was effective for improving the head and cervical posture and joint position sense.


Download data is not yet available.

Article Details

How to Cite
Jantoon, N., & Uthaikhup, S. (2020). Effects of an exercise program on cervical posture and sensorimotor function in persons with forward head posture. Journal of Associated Medical Sciences, 53(3), 62-71. Retrieved from https://he01.tci-thaijo.org/index.php/bulletinAMS/article/view/239926
Physical Therapy


[1] Grimmer-Somers K, Milanese S, Louw Q. Measurement of cervical posture in the sagittal Plane. J Manipulative Physiol Ther. 2008;31(7):509-17.

[2] Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Phys Ther. 1992;72(6):425-31.

[3] Singla D, Veqar Z. Association between forward head, rounded shoulders, and increased thoracic kyphosis: a review of the literature. J Chiropr Med. 2017;16(3):220-9.

[4] Wani SK, Subrat S, Ostwal P, Quazi R. Prevalence of anterior head translation in patients with neck pain. Int J Curr Microbiol Appl Sci. 2016;9(2):78-83.

[5] Nejati P, Lotfian S, Moezy A, Moezy A, Nejati M. The relationship of forward head posture and rounded shoulders with neck pain in Iranian office workers. Med J Islam Repub Iran. 2014;28(1):26-32.

[6] Nejati P, Lotfian S, Moezy A, Nejati M. The study of correlation between forward head posture and neck pain in Iranian office workers. Int J Occup Med Environ Health. 2015;28(2):295-303.

[7] Goh JYK, O’Leary S, Chow A, Russell T, McPhail S. The relationship between forward head posture and cervical muscle performance in healthy individuals. J Physiother. 2015. doi: 10.1016/j.physio.2015.03.3247

[8] Mayoux-Benhamou MA, Revel M, Vallee C, Roudier R, Barbet JP, Bargy F. Longus colli has a postural function on cervical curvature. Surg Radiol Anat. 1994;16(4):367-71.

[9] Gong W, Kim C, Lee Y. Correlations between cervical lordosis, forward head posture, cervical ROM and the strength and endurance of the deep neck flexor muscles in college students. J Phys Ther Sci. 2012;24(3):275-7.

[10] Kendall FP, Kendall ME, Provance PG. Muscles: Testing and Function, with posture and pain. 5th ed. Baltimore: Lippincott Williams and Wilkins; 2005.

[11] Burgess-Limerick R, Plooy A, Ankrum DR. The effect of imposed and self-selected computer monitor height on posture and gaze angle. Clin Biomech (Bristol, Avon). 1998;13(8):584-92.

[12] Mousavi-khatir R, Talebian S, Maroufi N, Olyaie G. Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females. J Bodyw Mov Ther. 2015;20(2):235-42.

[13] Shimaa T. Abu El Kasem OMK, Neveen A. Abdel Raoof, Ibrahim M. Moustafa. Effect of forward head posture on sensorimotor integration. Int J Phys Ther. 2017;4(2):118-25.

[14] Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train. 2002;37(1):71-9.

[15] Boyd-Clark LC, Briggs CA, Galea MP. Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine J. 2002;27(7):694-701.

[16] Liu JX, Thornell LE, Pedrosa-Domellof F. Muscle spindles in the deep muscles of the human neck: a morphological and immunocytochemical study. J Histochem Cytochem. 2003;51(2):175-86.

[17] Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med. 2012;36(1):98-104.

[18] Silva AG, Johnson MI. Does forward head posture affect postural control in human healthy volunteers? Gait Posture. 2013;38(2):352-3.

[19] Sheikhhoseini R, Shahrbanian S, Sayyadi P, O'Sullivan K. Effectiveness of therapeutic exercise on forward head posture: a systematic review and meta-analysis. J Manipulative Physiol Ther. 2018;41(6):530-9.

[20] Falla D, Jull G, Russell T, Vicenzino B, Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Phys Ther. 2007;87(4):408-17.

[21] Kim BB, Lee JH, Jeong HJ, Cynn HS. Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. J Electromyogr Kinesiol. 2016;30:31-7.

[22] Camitsis A. The effect of craniocervical flexion exercise on cervical postureand cervical range of motion in asymptomatic participants. Durban: Durban University of Technology; 2015.

[23] Gupta BD, Aggarwal S, Gupta B, Gupta M, Gupta N. Effect of deep cervical flexor training vs. conventional isometric training on forward head posture, pain, neck disability index in dentists suffering from chronic neck pain. J Clin Diagn Res. 2013;7(10):2261-4.

[24] Ruivo RM, Pezarat-Correia P, Carita AI. Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents. J Manipulative Physiol Ther. 2017;40(1):1-10.

[25] Hickey ER, Rondeau MJ, Corrente JR, Abysalh J, Seymour CJ. Reliability of the cervical range of motion (CROM) device and plumb-line techniques in measuring resting head posture (RHP). J Man Manip Ther. 2000;8(1):10-7.

[26] Singla D, Veqar Z, Hussain ME. Photogrammetric assessment of upper body posture using postural angles: a literature review. J Chiropr Med. 2017;16(2):131-8.

[27] Van Niekerk S-M, Louw Q, Vaughan C, Grimmer-Somers K, Schreve K. Photographic measurement of upper-body sitting posture of high school students: A reliability and validity study. BMC Musculoskelet Disord. 2008. doi: 10.1186/1471-2474-9-113

[28] Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophysial joint pain syndromes. Med J Aust. 1988;148(5):233-6.

[29] Falla D, O'Leary S, Fagan A, Jull G. Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Man Ther. 2007;12(2):139-43.

[30] Harman K, Hubley-Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: a randomized, controlled 10-week trial. J Man
Manip Ther. 2005;13(3):163-76.

[31] Lee DY, Nam CW, Sung YB, Kim K, Lee HY. Changes in rounded shoulder posture and forward head posture according to exercise methods. Journal of physical therapy science. 2017;29(10):1824-7.

[32] Hazar Z, Karabicak GO, Tiftikci U. Reliability of photographic posture analysis of adolescents. J Phys Ther Sci. 2015;27(10):3123-6.

[33] Lau HM, Chiu TT, Lam TH. Measurement of craniovertebral angle with Electronic Head Posture Instrument: Criterion validity. J Rehabil Res Dev. 2010;47(9):911-8.

[34] Revel M, Andre-Deshays C, Minguet M. Cervicocephalic kinesthetic sensibility in patients with cervical pain. Arch Phys Med Rehabil. 1991;72(5):288-91.

[35] Lord SR, Clark RD, Webster IW. Postural stability and associated physiological factors in a population of aged persons. J Gerontol. 1991;46(3):69-76.

[36] Sremakaew M, Jull G, Treleaven J, Barbero M, Falla D, Uthaikhup S. Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2018;19(1):48-59.

[37] Chiu TT, Ku WY, Lee MH, Sum WK, Wan MP, Wong CY, et al. A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong. J Occup Rehabil. 2002;12(2):77-91.

[38] Yip CH, Chiu TT, Poon AT. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008;13(2):148-54.

[39] Petty NJ, Moore AP. Neuromusculoskeletal Examination and Assessment. 2nd ed. New York: Chuchill Livingstone; 2001.

[40] Meadows J, Armijo-Olivo SL, Magee DJ. Chapter 3 - Cervical Spine. In: Magee DJ, Zachazewski JE, Quillen WS, Manske RC, editors. Pathology and Intervention in Musculoskeletal Rehabilitation 2th ed. St. Louis: W.B. Saunders; 2016.

[41] Yong M-S, Lee H-Y, Lee M-Y. Correlation between head posture and proprioceptive function in the cervical region. J Phys Ther Sci. 2016;28(3):857-60.

[42] Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurol India. 2001;49(4):355-9.

[43] Shumway-Cook A, Woollacott MH. Motor control : theory and practical applications. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001.