Pilates Effects on Forward Head Posture: a Clinical Trial

This study aims to investigate and compare the effects of 8-week Pilates exercises and cervical stabilization exercises on pain, posture, range of motion, quality of life, and body composition in individuals with forward head posture (FHP). FHP is a common postural disorder characterized by the anterior displacement of the head relative to the cervical spine. This condition can lead to neck pain, muscle tension, and limited movement.

The study will include participants aged 18-50 years with FHP. Participants will be randomly assigned to one of two groups: the Pilates group or the cervical stabilization exercise group. The Pilates group will participate in Pilates exercises twice a week for 8 weeks under the supervision of a physiotherapist. The cervical stabilization exercise group will perform cervical stabilization exercises at home for the same duration.

The primary objective of this study is to compare the effects of Pilates and cervical stabilization exercises on FHP. Participants' posture, neck pain, range of motion, quality of life, and body composition will be measured before and after the 8-week intervention. These measurements will be used to evaluate and compare the effectiveness of the two exercise methods on FHP.

This study seeks to investigate the effectiveness of Pilates in the treatment of FHP and contribute to the scientific literature in this field. The findings may help determine the most appropriate exercise method for individuals with FHP.

This study will be designed as an 8-week randomized controlled trial (RCT) to compare the effects of Pilates and cervical stabilization exercises (CSE) on forward head posture (FHP) in adult participants. Based on the understanding that proper posture is essential to maintain musculoskeletal balance and minimize excessive mechanical strain, the study will address the increasing prevalence of FHP-a problem exacerbated by sedentary lifestyles, prolonged screen use, and occupational demands. In FHP, the head is displaced forward relative to the cervical spine, disrupting the natural spinal curvature, which can lead to neck pain and altered muscle activation patterns.

The trial will be conducted in a controlled clinical setting at a physiotherapy center in Antalya, Turkey, in accordance with CONSORT 2010 guidelines. Robust randomization and blinded outcome assessments will be employed to ensure methodological rigor, and quality assurance protocols-such as regular equipment calibration and data audits-will be implemented to maintain data integrity.

Participants randomized to the Pilates intervention will participate in supervised sessions twice per week, each lasting 60 minutes, consisting of a 10-minute warm-up, a graduated main exercise phase, and a 10-minute cool-down. During the first four weeks, sessions will emphasize mat-based exercises focusing on core engagement, controlled breathing, and alignment. Beginning in Week 2, additional equipment (e.g., Pilates balls and 1-kg dumbbells) will be introduced, with resistance bands incorporated from Week 4 and further modified in Week 6 to progressively challenge participants. The control group will perform a daily CSE regimen (including chin tuck, cervical extension, shoulder elevation, and scapular retraction) structured into two sets designed to support neuromuscular control and postural stability. Both groups will receive ergonomic guidelines for daily posture management.

Data collection will be managed by trained physiotherapists who will adhere to strict protocols and perform regular device calibrations. Data analysis will be conducted using IBM SPSS Statistics (v29.0), employing appropriate statistical tests and calculating effect sizes, with a 95% confidence interval (p \< 0.05) determining statistical significance. A comprehensive quality assurance plan-including regular audits, predefined data validation rules, and a maintained data dictionary-will further ensure the robustness and reliability of the findings.

Eligibility Criteria:
Inclusion Criteria:

* Adults aged 18-50 years.
* Craniovertebral angle (CVA) \< 54°
* Sedentary lifestyle

Exclusion Criteria:

* History of spinal surgery (cervical/thoracic/lumbar) or neurological disorders.
* Acute or severe cervical trauma (e.g., fractures, whiplash injuries).
* Spinal deformities (e.g., scoliosis, kyphosis).
* Recent physiotherapy/manual therapy (within the past 6 months).
* Regular use of analgesics, muscle relaxants, or steroids.
* Active participation in regular exercise