Effectiveness of McKenzie-Based Exercises for Forward Head Posture and Their Implications for Gastroesophageal Reflux Disease: A Systematic Review

ABSTRACT
Background: Forward head posture (FHP) is a common postural abnormality associated with neck pain, functional
impairment, and altered biomechanics. Emerging evidence indicates that FHP may also influence respiratory
mechanics and gastroesophageal reflux disease (GERD).
Objective: To evaluate the effectiveness of McKenzie-based and related exercise interventions in improving FHP and
to examine their potential physiological relevance to reflux-related mechanisms.
Methods: This systematic review adhered to the PRISMA 2020 guidelines and was registered with PROSPERO
(CRD420261334277). Searches were performed in PubMed, Scopus, and Google Scholar for studies published
between 2010 and 2025. The review focused on adults with forward head posture (FHP) who underwent exercisebased
interventions. The primary outcomes measured were the craniovertebral angle, neck pain, and disability.
Secondary outcomes assessed included respiratory measures and diaphragmatic function. The risk of bias was
evaluated using the RoB 2 and ROBINS-I tools, while the certainty of evidence was determined using GRADE.
Results: A total of 27 studies were included. Exercise interventions significantly improved craniovertebral angle,
reduced neck pain, and decreased functional disability with moderate certainty. Improvements were also noted in
pulmonary function, respiratory muscle strength, and chest expansion, though no studies specifically assessed GERD
severity.
Conclusion: McKenzie-based and similar exercise interventions effectively enhance FHP and musculoskeletal
outcomes. While there may be indirect benefits for reflux mechanisms, direct evidence linking these methods to GERD
is insufficient. Future trials should include reflux-related outcomes.