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

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.