Adaptation of Forward Head Posture following Temporomandibular Joint mobility, Diaphragmatic Breathing and Neck Stability Exercise among Digital Screen Users Multimodal Intervention for Forward Head Posture

Abstract

Background: Forward Head Posture (FHP) is associated with altered cervical alignment, temporomandibular joint (TMJ) dysfunction, impaired respiratory mechanics, and neck-related disability. Multimodal rehabilitation strategies may offer superior outcomes compared to isolated interventions.
Objective: This study aimed to evaluate the effects of combined TMJ mobility, deep breathing, and neck stability exercises on postural alignment and functional outcomes in individuals with and without neck pain.
Methods: A pre-post quasi-experimental study recruited fifty participants were non-randomly allocated into four groups: neck stability, diaphragmatic breathing, TMJ mobility, and combined intervention. All participants completed baseline and post-intervention assessments following a four-week exercise program. Outcomes included CVA, Neck Disability Index (NDI), maximal TMJ opening, chest expansion, and pain intensity. Data normality was assessed using Shapiro–Wilk tests and Q–Q plots. Within-group changes were analyzed using paired t-tests, and between-group effects were examined using two-way repeated measures ANOVA, with post-hoc comparisons where applicable.
Results: The combined intervention group demonstrated significant improvements in CVA (+5.1° ±3.9), TMJ opening (+1.6 ±1.2 mm), and NDI reduction (−18.6 ±8.0), along with increased upper (0.21 ±0.19 in) and lower chest expansion (0.16 ±0.17 in). Neck stability training showed the greatest reduction in disability (−25.0 ±7.5), breathing exercises produced largest improvement in lower chest expansion (0.28 ±0.30 in). The combined protocol produced the most consistent improvements across outcomes (p < 0.05).
Conclusion: A multimodal exercise program integrating TMJ mobility, breathing, and neck stability exercises is more effective than single-intervention approaches in improving posture, reducing disability, enhancing respiratory function, and optimizing TMJ mobility.