Forward Head Posture Correction on Cerebral Oxygenation During Dual-task in Symptomatic Subjects

Effects of Forward Head Posture Correction on Prefrontal Cerebral Oxygenation During Cognitive-Motor Interference in Symptomatic Subjects With Forward Head Posture: A Randomized Controlled Trial

This study aims to investigate the effects of forward head posture correction on neck pain, brain activity, and cognitive-motor performance. Forward head posture is a common postural problem, especially among young adults who spend long hours using smartphones and computers. It is frequently associated with neck pain, reduced mobility, and functional limitations. Emerging evidence also suggests that this postural deviation may influence brain function and increase the mental effort required during tasks that involve both thinking and movement.

Participants with forward head posture and neck pain will be recruited and randomly assigned to one of three groups: an intervention group using a cervical traction device (Denneroll), a sham group using a towel roll, or a control group receiving no intervention. The intervention will be performed at home over a six-week period, with sessions conducted five times per week. The duration of each session will gradually increase based on participant tolerance to ensure safety and comfort.

All participants will undergo assessments at baseline and after the intervention period. Pain intensity will be measured using a standardized pain scale. Brain activity will be assessed using a non-invasive technique called functional near-infrared spectroscopy (fNIRS), which measures changes in oxygen levels in the brain. Participants will also perform balance tasks under single-task and dual-task conditions, where they will be asked to maintain balance while performing simple cognitive tasks. In addition, cognitive function will be evaluated using standardized tests of attention, memory, and overall cognitive performance.

This study will help determine whether correcting forward head posture can reduce pain and improve brain and cognitive function. The findings may provide valuable insights into the relationship between posture, pain, and brain activity, and may contribute to the development of more effective and comprehensive rehabilitation approaches for individuals with forward head posture.

Forward head posture (FHP) is a common postural deviation associated with neck pain, impaired sensorimotor control, and functional limitations. In addition to musculoskeletal effects, emerging evidence suggests that FHP may influence cortical activity, particularly within prefrontal regions involved in attention and cognitive-motor integration. Individuals with FHP have demonstrated increased cognitive-motor interference during dual-task performance, indicating greater reliance on cortical resources and reduced motor automaticity. However, it remains unclear whether correcting FHP can reduce pain and modify these neurophysiological responses.

This study aims to investigate the effects of forward head posture correction on pain intensity as a primary outcome, alongside task-evoked cerebral oxygenation and cognitive-motor interference. A prospective, single-blinded, randomized controlled trial design with three parallel groups will be used. Participants with symptomatic FHP will be randomly allocated to an intervention group receiving Denneroll cervical traction, a sham group receiving a non-therapeutic towel roll intervention, or a control group receiving no intervention.

The intervention will be conducted over six weeks, with participants in the intervention and sham groups performing home-based sessions with gradual progression in duration to ensure safety and tolerance. All participants will undergo assessments at baseline and post-intervention.

Pain intensity will be evaluated using the Visual Analog Scale (VAS). Neurophysiological outcomes will be assessed using functional near-infrared spectroscopy (fNIRS) to measure changes in oxygenated and deoxygenated hemoglobin in the prefrontal cortex during rest, single-task, and dual-task conditions. Cognitive-motor interference will be examined using dual-task paradigms that combine balance tasks with cognitive demands. Cognitive function and balance performance will also be evaluated using standardized assessments.

The procedures used in this study are non-invasive and associated with minimal risk. The fNIRS device does not emit radiation, and the intervention may cause only mild and temporary discomfort, which will be minimized through gradual progression and monitoring. Participants will be informed of their right to withdraw at any time without consequences.

By integrating clinical, cognitive, and neurophysiological outcomes, this study aims to provide a comprehensive understanding of the effects of forward head posture correction. The findings may contribute to the development of more effective, mechanism-based rehabilitation strategies targeting both pain and brain function in individuals with forward head posture.

Inclusion Criteria:

• Young adults of both sexes aged 18-35 years
• Individuals with forward head posture (a craniovertebral angle (CVA) < 50°)
• Presence of neck pain with an intensity of ≥3 on the Visual Analog Scale (VAS)
• Ability to understand and follow basic English instructions
• No cognitive impairment (score >18 on the Montreal Cognitive Assessment (MoCA))

Exclusion Criteria:

• History of cervical spine surgery or significant cervical trauma
• Currently receiving physiotherapy or rehabilitation for cervical spine conditions
• Individuals on medications (diagnosed neurological disorders)