Bruegger's exercises vs deep cervical flexor training in asymptomatic participants with forward head posture: a randomised controlled trial

Background/Aims Forward head posture is the most frequent postural deviation in typically healthy individuals and is associated with rounding of the shoulders. Prevention should be considered when it is at the asymptomatic stage by screening and early exercise intervention. The aim of the study was to examine the effects of Bruegger's exercises compared to deep cervical flexor training in asymptomatic participants with forward head posture. Methods This randomised controlled trial included 51 participants with asymptomatic forward head posture, who were allocated to one of three groups. One group undertook Bruegger's exercises with an elastic resistance band, another group performed deep cervical flexor training with a pressure biofeedback unit and the control group performed isometric neck exercises. Outcomes measured were the craniovertebral angle, the craniocervical flexion endurance test and the Pectoralis Minor Index, which were assessed at baseline on day 1 and at the end of the 3-week intervention. Follow-up assessment was undertaken for craniovertebral angle at 6 and 9 weeks from day 1 of the intervention. Statistical analysis included paired t-tests, the Wilcoxon signed-rank test, analysis of variance and the Kruskal–Wallis test. Results All three groups showed improvements in craniovertebral angle and the craniocervical flexion endurance test when compared between pre- and post-intervention. Only those in the Bruegger's exercises group showed an increase in the length of the pectoralis minor according to the Pectoralis Minor Index. Deep cervical flexor muscle endurance increased significantly (P<0.0002) for those in the Bruegger's exercises group and deep cervical flexor training group. At the end of the intervention (week 3) (P<0.0205) and follow up at week 9 (P<0.0029), individuals in the Bruegger's exercises group had maintained the craniovertebral angle correction for longer than those in the deep cervical flexor training and control group. Conclusions Bruegger's exercises with an elastic resistance band was found to be an effective intervention exercise to correct posture from head to scapula and can be included in the treatment of patients with postural head and neck issues.