Therapeutic Exercise for Forward Head Posture in Neck Pain Patients: A Systematic Review and Meta-Analysis.

Background: Forward Head Posture (FHP) is a prevalent musculoskeletal disorder strongly associated with neck pain and functional disability. Although therapeutic exercise is commonly recommended in clinical practice, there remains a lack of consensus regarding the most effective exercise modalities and optimal intervention duration. This systematic review evaluated the efficacy of therapeutic exercise on posture, pain, and functional outcomes in individuals with FHP, and to identify key factors that may influence treatment effectiveness. Methods: Literature searches were conducted following the PRISMA guidelines to identify randomized controlled trials (RCTs) on therapeutic exercises for FHP. Dates were extracted and pooled using a random-effects model. Prespecified subgroup analyses were performed to examine the influence of exercise modality (single vs combined) and intervention duration (<8 weeks vs ≥8 weeks). Results: Ten RCTs, involving 550 participants were included in the analysis. Compared with control groups, therapeutic exercise significantly improved the craniovertebral angle (MD = 3.38°, 95% CI: 2.10° to 4.65°, p < 0.001; SMD = 0.95, 95% CI: 0.61 to 1.28), reduced pain intensity (MD = -1.42, 95% CI: -2.11 to -0.73, p < 0.001; SMD = -1.72, 95% CI: -2.69 to -0.71), and enhanced neck functional capacity (MD = -5.44, 95% CI: -8.56 to -2.32, p < 0.001; SMD = -1.08, 95% CI: -1.66 to -0.50). Exploratory subgroup analyses suggested potential trends: interventions employing combined exercise modalities and those lasting ≥8 weeks appeared to be associated with greater clinical benefits, although these findings should be interpreted with caution due to limited statistical power and high between-study heterogeneity. Conclusion: Therapeutic exercise may be associated with improved craniovertebral angle, reduced pain intensity, and better neck function in individuals with FHP and neck pain. Exploratory analyses suggested that combined exercise approaches and interventions lasting at least 8 weeks may yield larger improvements, although the overall certainty of evidence remains low to moderate.