Clinical efectiveness of a Pilates treatment for forward head posture Sun-Myung Lee, MS 1) , Chang-hyung Lee, MD 2) , DaviD O’SuLLivan, PhD 1) , JOO-ha Jung, PhD 1) , Jung-Jun P ark, PhD 1)* 1) Division of Sports Science, Pusan National University: 2 Busandaehak-ro 63 beon-gil, Geumjeong-gu, Busan 46241, Republic of Korea 2) Division of Meridian and Structural Medicine, Pusan National University School of Korean Medicine, Republic of Korea Abstract. [Purpose] This study compared the effects of pilates and an exercise program on the craniovertebral angle, cervical range of motion, pain, and muscle fatigue in subjects with a forward head posture (FHP). [Subjects and Methods] A total of 28 sedentary females (age 20 to 39 years) with FHP were randomly assigned to pilates (n=14) and combined (n=14) exercise groups. The study was a randomized, controlled, double-blind study with the two groups performing exercise 50 min/day, 3 days/week, with an intensity of 11–15 rating of perceived exertion (RPE) for ten weeks. The main outcome measures were craniovertebral angle, cervical range of motion (ROM), pain levels assessed by visual analog scale (VAS), and neck disability index (NDI). Surface electromyography was also used to measure muscle fatigue. [Results] There were signifcant increases in craniovertebral angle and cervi- cal ROM in the pilates group, but none in the control group. The only signifcant differences in muscle activity were recorded in the sternocleidomastoid muscle in the pilates group. Both exercise programs had positive effects on pain measures, as VAS and NDI were signifcantly decreased. [Conclusion] The results suggest that pilates could be recommended as an appropriate exercise for treatment of FHP in sedentary individuals. Key words: Forward head posture, Pilates, Exercise (This article was submitted Jan. 26, 2016, and was accepted Apr. 7, 2016) INTRODUCTION The increasing use of electronic screens, such as smart phones and personal computers, to an average of about 8 hours per day 1) , has led to an increasing number of people with forward head posture (FHP). FHP is defned as the anterior positioning of the cervical spine 1) and is associated with muscle imbalance, pain, fatigue, and limited motion of the cervical spine 2) . FHP may cause herniated cervical intervertebral discs and other adverse effects, such as chronic low back pain and temporomandibular disorder 3) . The craniovertebral angle (CVA) is defned as the angle of the horizontal line running through the C7 spinous process and the line connecting the C7 spinous process to the tragus of the ear. Yip et al. 4) reported that participants with signifcantly smaller craniovertebral angles had FHP and tended to have increased levels of neck pain. Similarly, Sohn and associates 5) showed that participants with smaller craniovertebral angles tended to have more tension-type headaches, and lower cervical range of motion. Szeto et al. 6) reported a higher frequency of neck and shoulder pain in individuals who spent long periods us- ing computers. Previous research 7–9) suggests that weakened postural muscles should be strengthened and shortened muscles should be lengthened in order to improve postural alignment and alleviate FHP. A variety of therapeutic exercises designed to mitigate the symptoms of FHP have been examined 4, 10) . The majority of treatments have focused on the deep neck fexors, as they play a major role in stabilizing the alignment of the cervical J. Phys. Ther. Sci. 28: 2009–2013, 2016 *Corresponding author. Jung-Jun Park (E-mail: jjparkpnu@pusan.ac.kr) ©2016 The Society of Physical Therapy Science. Published by IPEC Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License <http://creativecommons.org/licenses/by-nc-nd/4.0/>. Original Article