Document Type : Research Article (s)


Faculty of Physical Education and Sport Sciences, Allameh Tabataba’i University, Tehran, Iran


Background: Reactive neuromuscular training (RNT) is a training method used in rehabilitation. However, its effectiveness on
forward head posture (FHP) is still unknown. This study aimed to compare the effects of traditional training with 8-week RNT
on the craniovertebral, shoulder, and kyphotic angles in high school students with FHP.
Methods: In this randomized clinical trial, conducted in Urmia city, Iran (2018), we selected a total of 60 male high school
students using a convenient sampling technique. We assigned the subjects to one control group and two experimental groups;
one of the experimental groups performed traditional exercises while the other did RNT. After the pre-test, the training program
performed three days a week under the supervision of a researcher. Posture assessment carried out in two steps: prior to training
(pre-test data) and after eight weeks of training (post-test data). We applied a photogrammetric method to evaluate the sagittal
angles of the neck and shoulder. Moreover, we conducted the ANCOVA test at a significance level of P.
Results: Both training methods improved trunk posture (F=156.07, p <0.001) and the sagittal angles of the neck (F=35.35,
p <0.001) and shoulder (F=23.31, p <0.001); however, RNT was more effective than the traditional type of training (p <0.001).
Conclusion: Eight weeks of traditional and RNT exercises enhanced kyphotic, shoulder, and craniovertebral angles. It seems
that RNT might have a better outcome in the management of high school students with FHP.


1. Meshgin S, Sheikhhoseini R, Balouchi R. The relationship between upper body posture with physical activity, psychological properties and electronic entertainment using measures in female primary students in Tehran. Journal of Ergonomics. 2018;6 (2):0-.## 2. Chiba R, Takakusaki K, Ota J, Yozu A, Haga N. Human upright posture control models based on multisensory inputs; in fast and slow dynamics. Neuroscience research. 2016;104:96-104. ## 3. Page P, Frank CC, Lardner R. Assessment and treatment of muscle imbalance : the Janda approach. Champaign, IL: Human Kinetics; 2010. ## 4. Asadi-Melerdi S, Rajabi-Shamli E, Sheikhhoseini R, Piri H. Association of Upper Quarter Posture with Depression, Anxiety, and Level of Physical Activity in Sixth Grade Elementary School Students of Karaj City, Iran. International Journal of School Health. 2020;7 (1):48-55. doi:10.30476/intjsh.2020.85300.1052. ## 5. Sahrmann S. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. 1 ed.: Mosby; 2010. p. 568. ## 6. Sheikhhoseini R, Sayyadi P, O’Sullivan K, Balouchi R. The Effect of Through-Range Versus Shortened-Length Exercise Training on Upper Quarter Posture Among Students With Forward Head Posture: A Randomized Clinical Trial. Journal of Modern Rehabilitation. 2019;13 (1):49-58. ## 7. Sheikhhoseini R, Shahrbanian S, Sayyadi P, O’Sullivan K. Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis. J Manipulative Physiol Ther. 2018;41 (6):530-9. doi:10.1016/j.jmpt.2018.02.002. [PubMed:30107937]. ## 8. Ruivo RM, Pezarat-Correia P, Carita AI. Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents. J Manipulative Physiol Ther. 2017;40 (1):1-10. doi:10.1016/j.jmpt.2016.10.005. [PubMed:27842938]. ## 9. Moustafa IM, Diab AA. The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study. J Manipulative Physiol Ther. 2015;38 (3):167-78. doi:10.1016/j.jmpt.2014.11.009. [PubMed:25704221]. ## 10. Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil. 2011;26 (4):351-61. doi:10.1177/0269215511419536. [PubMed:21937526]. ## 11. Seidi F, Rajabi R, Ebrahimi I, Alizadeh MH, Minoonejad H. The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle. J Back Musculoskelet Rehabil. 2014;27 (1):7-16. doi:10.3233/BMR-130411. [PubMed:23948845]. ## 12. Kang J-H, Park R-Y, Lee S-J, Kim J-Y, Yoon S-R, Jung K-I. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med 2012;36 (1):98. doi: 10.5535/arm.2012.36.1.98. [PubMed: 22506241]; [PubMed Central: PMC3309315]. ## 13. Fernández‐de‐las‐Peñas C, Alonso‐Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger points in the suboccipital muscles and forward head posture in tension‐type headache. Headache: The Journal of Head and Face Pain. 2006;46 (3):454-60. doi: 10.1111/j.1526-4610.2006.00288.x. [PubMed: 16618263]. ## 14. Diab AA. The role of forward head correction in management of adolescent idiopathic scoliotic patients: a randomized controlled trial. Clin Rehabil. 2012;26 (12):1123-32. doi:10.1177/0269215512447085. [PubMed:22801470]. ## 15. Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC musculoskeletal disorders. 2017;18 (1):525.doi: 10.1186/s12891-017-1889-2. [PubMed: 29233164]; [PubMed Central: PMC5727966]. ## 16. Lee DY, Nam CW, Sung YB, Kim K, Lee HY. Changes in rounded shoulder posture and forward head posture according to exercise methods. J Phys Ther Sci. 2017;29 (10):1824-7. doi:10.1589/jpts.29.1824. [PubMed: 29184298] ; [PubMed Central: PMC5684019]. ## 17. Guido Jr JA, Stemm J. Reactive neuromuscular training: a multi-level approach to rehabilitation of the unstable shoulder. N Am J Sports Phys Ther.NAJSPT. 2007;2 (2):97. [PubMed: 21522207]; [PubMed Central: PMC2953291]. ## 18. Seada Y, Elsayed E, Talat W. Impact of Reactive Neuromuscular Training on Falling in Parkinson’s Disease. Indian Journal of Physiotherapy & Occupational Therapy. 2013;7 (2):65-70. ## 19. Loutsch RA, Baker RT, May JM, Nasypany AM. Reactive neuromuscular training results in immediate and long term improvements in measures of hamstring flexibility: A case report. Int J Sports Phys Ther. 2015;10 (3):371. [PubMed: 26075153]; [PubMed Central: PMC4458925]. ## 20. Singla D, Veqar Z, Hussain ME. Photogrammetric Assessment of Upper Body Posture Using Postural Angles: A Literature Review. J Chiropr Med. 2017;16 (2):131-8. doi:10.1016/j.jcm.2017.01.005. [PubMed:28559753]; [PubMed Central: PMC5446097]. ## 21. Fortin C, Feldman DE, Cheriet F, Labelle H. Clinical methods for quantifying body segment posture: a literature review. Disabil Rehabil. 2011;33 (5):367-83. doi:10.3109/09638288.2010.492066. [PubMed:20568973]. ## 22. Brzycki M. Strength Testing—Predicting a One-Rep Max from Reps-to-Fatigue. Journal of Physical Education, Recreation & Dance. 1993;64 (1):88-90. doi:10.1080/07303084.1993.10606684. ## 23. Salehi S, Akbari M, Jamshidi AA. Effect of Exercise Therapy on Head, Neck Range of Motion, and Craniovertebral Angle in Subjects with Forward Head Posture. J Rehab Med. 2017;6 (2):180-7. doi: 10.22037/jrm.2017.1100312. ## 24. Ruivo RM, Carita AI, Pezarat-Correia P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study. Man Ther. 2016;21:76-82. doi:10.1016/j.math.2015.05.001. [PubMed:26028408]. ## 25. Kang JI, Jeong DK, Choi H. The effect of feedback respiratory exercise on muscle activity, craniovertebral angle, and neck disability index of the neck flexors of patients with forward head posture. J Phys Ther Sci. 2016;28 (9):2477-81. doi:10.1589/jpts.28.2477. [PubMed:27799674] ; [PubMed Central: PMC5080156]. ## 26. Lynch SS, Thigpen CA, Mihalik JP, Prentice WE, Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010;44 (5):376-81. doi:10.1136/bjsm.2009.066837. [PubMed:20371564]. ## 27. Hajihosseini E, Norasteh AA, Shamsi A, Daneshmandi H. The effect of 6 weeks strength training, stretching and comprehensive corrective exercises on forward head incorrect posture. Journal of Modern Rehabilitation. 2016;9 (5):38-48. ## 28. Shavandi n, Shahrjerdi s, Heidarpor r, Sheikh-Hoseini r. The effect of 7 weeks corrective exercise on thoracic kyphosis in hyper-kyphotic students. J Shahrekord Univ Med Sci. 2011;13 (4):42-50. ## 29. Harrison BC, Hart JM. Reactive neuromuscular training in low-back pain rehabilitation: Part one. Athletic Training and Sports Health Care. 2010;2 (6):253-4.doi: 10.3928/19425864-20101029-02. ##