Impact of therapeutic exercise on craniovertebral angle in forward head posture: a systematic review and...

Forward head posture (FHP) is one of the most frequently reported postural deviations in contemporary populations. Therapeutic exercise has been associated with improvements in FHP, rounded shoulders, and thoracic kyphosis. However, it remains unclear whether exercise programs targeting the neck region differ in their effects from those that also include the thoracic spine compared with control conditions.

A systematic review with meta-analysis was conducted following a comprehensive search of the Cochrane Library, PubMed, PEDro, and Web of Science databases from inception to 9 February 2026. Eligible studies were randomized controlled trials investigating therapeutic exercise interventions in patients with FHP. The intervention had to be based on therapeutic exercise. Studies were required to compare the intervention with a control group. Methodological quality was assessed using the PEDro scale, and the certainty of the evidence was evaluated according to the GRADE guidelines.

Thirteen randomized controlled trials involving 819 participants were included in qualitative synthesis and meta-analysis. Both neck-focused exercise and combined neck - thoracic exercise programs showed statistically significant short-term improvements in craniovertebral angle and neck disability compared with control conditions. Combined neck - thoracic exercise programs demonstrated significant reductions in pain intensity post-intervention. The certainty of the evidence ranged from low to very low.

Therapeutic exercise programs targeting the neck region, alone or combined with thoracic exercises, may improve craniovertebral angle and neck-related outcomes in individuals with FHP. However, the certainty of the evidence ranged from low to very low and the findings should be interpreted with caution.

PROSPERO registration ID CRD420261304664.