Global Postural Re-Education Versus Deep Neck Flexor Activation on Chronic Nonspecific Neck Pain with Forward Head Posture

Background and Objectives: Chronic nonspecific neck pain (NSNP) is among the most common musculoskeletal disorders. Global postural re-education (GPR) might be effective in decreasing neck pain (NP) and dysfunction and improving forward head posture (FHP) by recovering muscle chains and reducing postural alteration. Deep neck flexor activation (DNF) might also decrease NP and improve FHP by improving DNF endurance. This study aimed to compare the effects of GPR versus DNF activation on pain, dysfunction, FHP, and DNF endurance. Materials and Methods: Forty-six physiotherapy students with chronic NSNP participated in this non-randomized comparative study and were allocated into two equal groups based on their availability and preference regarding session duration. Group A underwent GPR exercises combined with active neck exercises, whereas group B received DNF activation in addition to active neck exercises. All participants were assessed pre- and post-intervention for pain intensity using a visual analog scale (VAS), neck disability using the Arabic version of the neck disability index (NDI), FHP via a photometric method with Kinovea software, and DNF endurance using pressure biofeedback. Results: A significant effect of both treatments was reported on reducing pain intensity, improving the FHP and enhancing the neck functional status with no substantial differences between both groups. A significant improvement in DNF endurance was observed in both groups, with substantially higher values between groups in favor of the DNF group. Conclusions: Both GPR and DNF activation exercises were associated with reductions in pain and improvements in neck disability among physiotherapy students with chronic NSNP and FHP. Also, both CVA and DNF endurance improved, with more improvement observed in DNF endurance in the DNF group compared with the GPR group.