Pilates Effects on Forward Head Posture: A Clinical Trial

The craniovertebral angle (CVA), a key metric and a widely used measure for assessing forward head posture (FHP), will be evaluated using standardized digital photogrammetry. Lateral photographs will be captured using a Fujifilm XT-3 mirrorless camera equipped with a 35mm lens. The CVA will be calculated as the angle between a line connecting the tragus and C7 markers and a horizontal reference line parallel to the floor. Higher CVA values will indicate a less severe forward head posture, reflecting better postural alignment.

Neck pain intensity will be assessed using the Visual Analog Scale (VAS), a 10 cm line ranging from 0 (no pain) to 10 (unbearable/most severe pain). Participants will be instructed to rate their neck-specific discomfort on this scale. Lower scores will indicate less pain, while higher scores will indicate more severe pain.

Posture will be assessed using the New York Posture Rating Scale (NYPRS). This method, also known as New York Posture Analysis Method (NYPAY), scores 13 body regions (head, neck, shoulders, back, waist, abdomen, pelvis, and feet) from posterior and lateral views. For each region, postural deviations will be scored observationally: 5 points for good posture, 3 points for moderately impaired posture, and 1 point for severely impaired posture. The body regions assessed include: head, neck, shoulders, back, waist, abdomen, pelvis, and feet. Total scores will be calculated by summing the scores across all 13 regions, resulting in a range from 13 (worst possible posture) to 65 (best possible posture). For interpretation, total NYPRS scores are categorized as follows: ≥45 points "very good", 40-44 points "good", 30-39 points "medium", 20-29 points "weak", and ≤19 points "bad" posture.. Therefore, higher total scores will indicate better overall posture.

Cervical range of motion (ROM), encompassing flexion, extension, lateral flexion, and rotation, will be measured using a standard universal goniometer. Maximum ROM angles will be recorded in degrees. For cervical ROM, higher values will indicate a greater range of motion, which is generally considered a better outcome.

Quality of life will be assessed using the Short Form-36 (SF-36) questionnairea comprehensive questionnaire evaluating different aspects of quality of life (physical, mental, social, etc.). This 36-item scale evaluates participants' health status over the past 4 weeks. The SF-36 includes eight subscales: physical functioning, role-physical, role-emotional, energy/vitality, mental health, social functioning, pain, and general health perceptions. Each subscale yields a score ranging from 0 to 100, where higher scores will indicate better quality of life in the respective domain.

Body mass index (BMI) is a measure of body fat based on height and weight. It is calculated as weight in kilograms divided by height in meters squared (kg/m²). Weight will be measured using a calibrated digital scale, and height will be measured using a stadiometer.

The waist-to-hip ratio is calculated by dividing the waist circumference by the hip circumference (both measured in centimeters).

Waist circumference is measured in centimeters at the level of the narrowest point between the lower rib and the iliac crest using a standard measuring tape. Three measurements will be taken at this point, and the average of these measurements will be recorded.

Hip circumference is measured in centimeters at the level of the widest portion of the buttocks using a standard measuring tape. Three measurements will be taken at this point, and the average of these measurements will be recorded.

Chest circumference is measured in centimeters at the level of the nipples using a standard measuring tape during normal breathing. Three measurements will be taken at this level, and the average of these measurements will be recorded.