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New Global Study Reveals Forward Head Posture Impairs Neck Pain Recovery

The magnitude of sagittal head posture displacement and patient demographics predict rehabilitation outcomes in patients with chronic nonspecific neck pain

Ghydaa Anwar, Ibrahim M. Moustafa, Amal Ahbouch, Abdulla Alrahoomi & Deed E. Harrison

Highlights

 Greater forward head posture (sagittal head translation) was the most significant postural factor negatively affecting treatment outcomes.

 Each unit increase in anterior head displacement reduced the odds of treatment success by 13%.

 Younger age and female sex were associated with significantly greater odds of long-term recovery.

Eagle, ID – May 30, 2025 — A newly published, multi-center research study co-authored by Chiropractic BioPhysics® (CBP) Non-Profit and the University of Sharjah has identified a significant link between abnormal sagittal head posture and poor treatment outcomes in patients with chronic neck pain. The study appears in Scientific Reports, a prestigious Q1-ranked, Nature-affiliated journal and one of the top five most-cited multidisciplinary research journals in the world!

This project was conducted as part of Ghydda Anwar’s graduate thesis for her Master of Physical Therapy degree at the College of Health Sciences, University of Sharjah (UAE). The study was led by Professor Ibrahim Moustafa, with collaborative contributions from co-authors Amal Ahbouch, Abdulla Alrahoomi, and Dr. Deed Harrison, who also serves as President of both Chiropractic BioPhysics® Technique and the CBP Non-Profit research foundation.

The study examined 86 patients with chronic nonspecific neck pain (CNSNP) over an 8-week, multimodal conservative treatment protocol. Using a prospective consecutive case series design across five physiotherapy clinics in the UAE and Egypt, the study found that:

 Greater forward head posture (sagittal head translation) was the most significant postural factor negatively affecting treatment outcomes.

 Each unit increase in anterior head displacement reduced the odds of treatment success by 13%.

 Younger age and female sex were associated with significantly greater odds of long-term recovery.

While corrective care was not applied in this intervention, the findings revealed that unaddressed cervical postural abnormalities significantly limited patient improvement across all domains measured—including pain, fatigue, distress, and interference—as assessed using the validated Patient-Centered Outcome Questionnaire (PCOQ).

“Even when patients receive high-quality multimodal conservative care, structural misalignments such as forward head posture can strongly predict who will and won’t respond well to treatment,” said Dr. Deed Harrison, co-author and CBP NonProfit President. “This study underscores the clinical value of measuring and addressing cervical spine alignment before initiating care.”

Additional Key Findings:

 Females had nearly 3x higher odds of successful outcomes than males.

 Younger patients had better response rates, with increasing age reducing likelihood of success.

 Greater forward head posture (FHP) consistently reduced the odds of improvement across pain, fatigue, distress, and functional interference domains.

 Principal Component Analysis revealed that postural variables—especially FHP—are interrelated and account for 85% of patient presentation variance.

 Smoking and marital status were not statistically significant predictors of outcome.

This research adds to a growing body of literature affirming that cervical spine posture is a critical biomechanical factor in predicting patient prognosis—especially when left uncorrected.

The project was partially funded by the ICA FACTS Committee via a generous donation to CBP Non-Profit, enabling Dr. Harrison’s participation and support of international research collaboration.

About CBP Non-Profit

CBP NonProfit is a 501(c)(3) research foundation dedicated to the advancement of spine rehabilitation through high-quality, peer-reviewed chiropractic and physiotherapy research. With over 350 published studies to date, CBP NonProfit is a global leader in evidence-based spinal care innovation.