Effect of Head Posture Education and Chin tuck Exercises on Head and Neck Alignment of Students with Forward Head Posture

Document Type : Original Article

Authors

Department of Sport injury and Corrective exercise, Faculty of Physical Education and Sports Sciences, University of Guilan, Rasht, Iran

Abstract

Purpose:
Maintaining proper posture during childhood contributes to the preservation of postural patterns into adulthood. The aim of this study was to compare the effects of head posture education and chin-tuck exercises on head and neck alignment in students with forward head posture.
Methods:
This semi-experimental and applied study followed a pre-test/post-test design. A total of 42 female elementary school students were selected and randomly assigned equally into three groups: (1) head posture education (n = 14), (2) head posture education combined with chin-tuck exercises (n = 14), and (3) control group (n = 14). The intervention groups participated in training sessions three times per week for two months. Head posture angle and body awareness were assessed before and after the intervention using photogrammetry and a body awareness questionnaire, respectively. Data were analyzed using one-way ANOVA for group mean comparisons, LSD test for pairwise comparisons, and repeated measures ANOVA controlling for potential confounders.

Results:
The results showed a significant difference between the pre-test and post-test in both the head posture education group and the combined intervention group regarding the forward head angle and body awareness (P = 0.001). The combined intervention (head posture education with chin-tuck exercises) had a greater effect compared to head posture education alone, resulting in a significant improvement in head posture angle (P = 0.001). There was no significant difference in body awareness between the two intervention groups (P = 0.245); however, a significant difference in body awareness was found between the combined intervention group and the control group in the post-test (P=0.001).

Conclusion:
Both interventions—head posture education alone and in combination with chin-tuck exercises—can be effective techniques for improving forward head posture and body awareness in students. However, head posture education combined with chin-tuck exercises may yield more favorable results and could be recommended to corrective movement specialists.


Keywords

References

  1. Ningthoujam R. Postural deformities in lower extremities among school children. Int J Phys Educ Health Sports Sci 2014; 3(01): 78-84.
  2. Azlan CA, Wong JHD, Tan LK, Huri MSNA, et al. Teaching and learning of postgraduate medical physics using Internet-based e-learning during the COVID-19 pandemic–A case study from Malaysia. Phys Med 2020; 80: 10-16.
  3. Hertling D, Kessler RM. Management of common musculoskeletal disorders: physical therapy principles and methods: Lippincott Williams & Wilkins; 2006.
  4. Kendall F, McCreary E, Provance P. Muscles, testing and function. Med Sci Sports Exerc 1994; 26(8): 1070.
  5. Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil 1997; 78(11): 1215-1123.
  6. Vidal J, Borras P, Ortega F, Cantallops J, et al. Effects of postural education on daily habits in children. Int J Sports Med 2011; 32(04): 303-308.
  7. Barra-López ME. The standard posture is a myth: A scoping review. J Rehabil Med 2024; 56: 41899.
  8. Carini F, Mazzola M, Fici C, Palmeri S, et al. Posture and posturology, anatomical and physiological profiles: overview and current state of art. Acta Biomed 2017; 88(1): 11.
  9. Boudreau SA, Farina D, Falla D. The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Man Ther 2010; 15(5): 410-414.
  10. Maekawa M, Yoshizawa E, Hayata G, Ohashi S. Physical and psychological effects of postural educational intervention for students experienced school refusal. Curr Psychol 2023; 42(5): 3510-3519.
  11. Halabchi F, Ahmadinejad Z, Selk-Ghaffari M. COVID-19 epidemic: exercise or not to exercise; that is the question. Asian J Sports Med 2020; 11(1): e102630.
  12. Han JW, Kim KH, Bae TS, Blaikie K. Biomechanical analysis of chin tuck exercise with a subject-specific neck model for the forward headed. Int J Precis Eng Manuf 2018; 19: 587-592.
  13. Onyema EM, Eucheria NC, Obafemi FA, Sen S, et al. Impact of Coronavirus pandemic on education. J Educ Pract 2020; 11(13): 108-121
  14. Foltran FA, Moreira RF, Komatsu MO, Falconi MF, Sato TO. Effects of an educational back care program on Brazilian schoolchildren's knowledge regarding back pain prevention. Braz J Phys Ther 2012; 16: 128-133.
  15. Geldhof E, Cardon G, De Bourdeaudhuij I, De Clercq D. Back posture education in elementary schoolchildren: a 2-year follow-up study. Eur Spine J 2007;16: 841-850.
  16. Kovacs F, Oliver-Frontera M, Plana MN, Royuela A, et al. Improving schoolchildren's knowledge of methods for the prevention and management of low back pain: a cluster randomized controlled trial. Spine 2011; 36(8), 505-512.
  17. Lee M-Y, Lee H-Y, Yong M-S. Characteristics of cervical position sense in subjects with forward head posture. J Phys Ther Sci 2014; 26(11): 1741-1743.
  18. Seidi F. The effect of a 12-week corrective exercises program on Forward head and shoulder deformities. Stud Sport Med 2014; 5(14): 31-44.
  19. Saad KR, Colombo AS, João SMA. Reliability and validity of the photogrammetry for scoliosis evaluation: a cross-sectional prospective study. J Manipulative Physiol Ther 2009; 32(6): 423-430.
  20. Saad KR, Colombo AS, Ribeiro AP, João SMA. Reliability of photogrammetry in the evaluation of the postural aspects of individuals with structural scoliosis. J Bodyw Mov Ther 2012; 16(2): 210-216.
  21. Santos NBd, Sedrez JA, Candotti CT, Vieira A. Immediate and follow-up effects of a posture education program for elementary school students. Rev Paul Pediatr 2017; 35:199-206.
  22. Vieira A, Treichel TdL, Candotti CT, Noll M, Bartz PT. Effects of a Postural Education Program for students of the third year of Elementary School in a State School in Porto Alegre, state of Rio Grande do Sul state, Brazil. ,Fisioter Pesqui 2015; 22: 239-245.
  23. Dolphens M, Cagnie B, Danneels L, De Clercq D, et al. Long-term effectiveness of a back education programme in elementary schoolchildren: an 8-year follow-up study. Eur Spine J 2011; 20: 2134-2142.
  24. RiasatyF RR, Sh Z, Seidi F. Comparative effect and sustainability of eight weeks of corrective exercises, postural reeducation, and combined program on lumbar hyperlordosis in young females. J Rehab Med 2020; 9(1): 88-101
  25. Menor-Rodríguez MJ, Rodríguez-Blanque R, Montiel-Troya M, Cortés-Martín J, Aguilar-et al. editors. Educational Intervention in the Postural Hygiene of School-Age Children. Healthcare 2022; 10 (5): 834.
  26. Bakhtiary A, Hajihasani A, Hedaiati R, Aminianfar A. Investigation on the effect of stabilizer exercises on the forward head posture correction. J Bodyw Mov Ther 2012; 16(3): 427-431.
  27. Brzęk A, Dworrak T, Strauss M, Sanchis-Gomar F, et al. The weight of pupils’ schoolbags in early school age and its influence on body posture. BMC musculoskelet disord 2017; 18: 1-11.
  28. Brzek A, Plinta R. Exemplification of movement patterns and their influence on body posture in younger school-age children on the basis of an authorial program “I Take Care of My Spine”. Medicine 2016; 95(12): e2855.
  29. Oh D-H, Park H-S, Kim G-E. Effects of the chin-tuck maneuver on anatomical changes and angles during swallowing: a systematic review. J Korean Dysphagia Soc 2022; 12(1): 1-13.
  30. Murugesan R, Balamurugan J. Immediate Effect of Chin Tuck Exercises on Craniovertebral Angle and Shoulder Angle Among Collegiates with Forward Head Posture. Biomed Pharmacol J 2021; 14(4): 2163-2170.
  31. Lee JH, Kim MK. Biomechanical analysis of chin tuck exercise with a subject-specific neck model for the forward headed. Int J Precis Eng Manuf 2018; 19: 587–592.
  32.  Craik FI, Lockhart RS. Levels of processing: A framework for memory research. J Verbal Learn Verbal Behav 1972; 11(6): 671–684.
  33. Oakley PA, Moustafa IM, Haas JW, Betz JW, Harrison DE. Two methods of forward head posture assessment: Radiography vs. posture and their clinical comparison. J Clin Med 2024; 13(7): 2149.
  34. Mahmoudi F, Shahrjerdi S, Golpayegani M. Changes in Pain and Kyphosis Angle Following a Corrective Exercise Program in Elderly Women: A Randomized Controlled Trial. J Rafsanjan Univ Med Sci 2017; 15 (9) :849-860
  35. Aghazadeh E, Taghian F, Ghasemi Gh. Thera Band’s exercises on the forward head, power and range of motion in blinds and low visibility boys. Motor Educ J Disabil Stud 2019; 9: 35.
  36. Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M.M., & Romani, W. A. Muscles: Testing and function with posture and pain (5th ed). Baltimore: Lippincott Williams & Wilkins.2005.
  37. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. GPower 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 2007; 39(2): 175-191.
  38. Harman, K., Hubley-Kozey, C. L., & Butler, H. Effectiveness of an exercise program to improve forward head posture in normal adults: A randomized controlled 10-week trial. Journal of Manual & Manipulative Therapy 2005; 13(3): 163–176.
  39. Falla, D., Jull, G., Russell, T., Vicenzino, B., & Hodges, P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Physical Therapy 2007; 87(4): 408–417.
Journal of Paramedical Sciences & Rehabilitation
Volume 14, Issue 3
November 2025
Pages 42-53

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