Assessing Vestibular Contributions to Balance Deficits in Patients with Forward Head Posture
Abstract
Background: Forward head posture (FHP) is a common postural alteration characterized by anterior displacement of the head relative to the trunk. Changes in cervical alignment may influence cervical proprioceptive input and sensorimotor control and may affect postural stability. However, vestibular-related postural responses and balance performance in individuals with FHP remain insufficiently characterized. Objective: To assess vestibular-related postural orientation and balance performance in adults with Forward Head Posture. Methodology: This cross-sectional study included 311 adults aged 18-40 years with symptomatic or asymptomatic FHP. FHP was assessed using the Wall Test and 3-Point Alignment Check Method. Vestibular-related postural performance was evaluated using the Fukuda Stepping Test, while balance was assessed using the Sharpened Romberg Test. One-sample comparisons were performed against the reference values used in the analysis, with statistical significance set at p < 0.05. Results: The mean angular deviation during the Fukuda Stepping Test was 61.10±22.13°, significantly greater than the 45° reference value (t(310) = 12.84, p < 0.001). Mean forward displacement was 88.41±43.46 cm, significantly greater than the 50 cm reference value (t(310) = 15.59, p < 0.001). The mean Sharpened Romberg time was 32.96±18.56 seconds and was significantly different from the 30-second reference value (t(310) = 2.82, p = 0.005). Conclusion: Adults with FHP demonstrated greater angular deviation and forward displacement during the Fukuda Stepping Test compared with the reference values used in the analysis, suggesting altered postural orientation during the stepping task. The Sharpened Romberg performance was statistically different from the reference value but should not be interpreted as impaired balance because the observed mean was above 30 seconds. Objective vestibular testing is needed to determine whether vestibular dysfunction directly contributes to these findings.