Orthopedics · Medical Literature
Effect of pilates exercises plus breastfeeding positioning adjustment on artificial intelligence-assessed craniovertebral angle in breastfeeding women with forward head posture: a randomized controlled trial.
Abstract
Forward head posture (FHP), considered a neuromusculoskeletal disorder, includes those associated with breastfeeding. Pilates is recognized for improving posture, flexibility, and core strength. To investigate the effect of Pilates on craniovertebral angle (CVA), cervical spine mobility, pain, neck disability, fatigue, breastfeeding self-efficacy, quality of life (QOL), and infant anthropometric measurements in breastfeeding women with FHP. Seventy‑four breastfeeding women with FHP were randomized into two equal groups. The control group (n = 37) received breastfeeding positioning adjustment only, while the intervention group (n = 37) received breastfeeding positioning adjustment in addition to Pilates exercises. The Primary outcomes included CVA assessed using Artificial Intelligence Posture Evaluation and Correction System (APECS) and cervical range of motion (ROM), while secondary outcomes included Visual Analogue Scale for pain (VAS-Pain), Neck Disability Index (NDI), Fatigue Severity Scale (FSS), Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), QOL assessed using Short Form-36 Health Survey (SF-36), and infant anthropometric measurements (weight and length). All outcomes were assessed at the Outpatient Clinic of the Physical Therapy Department, Suez Canal Authority Hospital, Port Said, Egypt, at baseline and after the 8-week intervention. Mixed-design MANOVA demonstrated significant improvements from pre- to post-intervention in both groups across all measured outcomes (all p < 0.001). However, the study group exhibited significantly greater improvements than the control group in all outcome measures (all p < 0.001). The magnitude of these effects was large to very large, with partial eta-squared values ranging from 0.621 to 0.990. In breastfeeding women with FHP, Pilates exercises with breastfeeding positioning adjustment significantly improve CVA, cervical spine mobility, breastfeeding self-efficacy, QOL, and infant growth parameters, while reducing pain, neck disability, and fatigue.
Clinical relevance
Forward head posture (FHP) is a prevalent neuromusculoskeletal disorder among breastfeeding women, contributing to cervical pain, neck disability, and fatigue during a physiologically and psychologically demanding postpartum period. This RCT addresses a critical clinical gap by evaluating a structured Pilates-based intervention adjunct to breastfeeding positioning adjustment — a population and intervention pairing rarely studied in high-quality trial design. Clinicians managing postpartum musculoskeletal complaints should be aware that untreated FHP in this cohort may also negatively impact breastfeeding self-efficacy, quality of life, and infant growth trajectories.
Key findings
1. In a mixed-design MANOVA across 74 breastfeeding women with FHP (n=37 per group), the Pilates + positioning group demonstrated statistically significant superiority over positioning-adjustment alone across ALL measured outcomes (all p<0.001) after an 8-week intervention. 2. The primary outcome, craniovertebral angle (CVA) — assessed via an AI-based postural evaluation system (APECS) — improved significantly more in the intervention group than the control group (p<0.001), with effect sizes classified as large to very large (partial η² range: 0.621–0.990). 3. Cervical range of motion (ROM), the co-primary outcome, also showed significantly greater improvement in the Pilates group versus control (p<0.001; partial η² within the reported 0.621–0.990 range). 4. Secondary pain and disability outcomes — Visual Analogue Scale for pain (VAS-Pain) and Neck Disability Index (NDI) — both improved significantly more in the intervention group (p<0.001), with effect sizes in the large-to-very-large range. 5. Patient-reported outcomes including Fatigue Severity Scale (FSS), Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF), and SF-36 quality-of-life scores all favored the Pilates group with statistical significance (p<0.001) and large-to-very-large effect magnitudes. 6. Infant anthropometric measurements (weight and length) were significantly improved in the intervention group compared to control (p<0.001), suggesting a downstream benefit of improved maternal breastfeeding self-efficacy and posture on infant nutritional outcomes. Note: Specific between-group mean differences, 95% confidence intervals, and NNT/NNH were not reported in the abstract.
Practice implications
Postpartum physical therapists and orthopedic clinicians should consider integrating structured Pilates exercise programs alongside standardized breastfeeding positioning instruction for lactating women presenting with FHP, cervical pain, or neck disability, as this combination yields large-magnitude improvements in posture, mobility, pain, and function over 8 weeks. Patient selection should prioritize breastfeeding women with clinically confirmed FHP and associated complaints of cervical dysfunction or fatigue, and AI-assisted postural assessment tools such as APECS may serve as objective, reproducible monitoring instruments for tracking CVA across the treatment course. Given the observed improvements in breastfeeding self-efficacy and infant growth parameters, multidisciplinary collaboration between physical therapists, lactation consultants, and postpartum care providers is warranted to incorporate this intervention into routine postpartum musculoskeletal care pathways.