Effect Of Deep Neck Flexor Strengthening On Forward Head Posture: A Systemic Review And Meta-Analyses

Aim: This study aimed to systematically review and summarize the best evidence of the efficiency of deep neck flexor (DNF) strengthening for forward head posture (FHP).Material and Methods: A literature search from January 2000 to 2020 was performed using PubMed, Cochrane Library,Science Direct, and PEDro by two authors who independently selected studies. The methodological quality of studies was assessed using the PEDro scale. The primary outcomes were pain, disability, and craniovertebral angle (CVA),and the secondary outcomes were forced vital capacity and forced expiratory volume in 1 second.Results: A total of 7 randomized controlled trials of low-to-moderate quality evidence that compared the short-term effect of DNF strengthening on pain, disability, CVA, and respiratory function with that of another treatment; 4 studies were enrolled in the meta-analyses. In 3 studies that investigated the effect of DNF strengthening on the cervicovertebral angle, the overall effect was statistically insignificant in patients with FHP (mean difference [MD], 0.23; 95% confidence interval [CI], -2.58 to 3.04; P=0.23).In 2 studies that examined the effect of DNF strengthening on pain, the overall effect was statistically insignificant (MD, -0.07; 95% CI, -1.77 to 1.62; P=0.87).Discussion: The findings of this review suggest that the evidence of DNF strengthening in FHP is not sufficient.