Craniovertebral Angle and Postural Control in Forward Head Posture: A Narrative Review

Abstract

Background: Forward head posture (FHP) is a common postural disorder characterized by altered cervical alignment that may impair neuromuscular function and postural control. Craniovertebral angle (CVA) is widely used as an objective indicator to quantify FHP severity.
Objective: To analyze the relationship between CVA and postural control and to identify patterns and research gaps in the literature.
Methods: A narrative literature review was conducted using PubMed and ScienceDirect to identify studies published between 2015 and 2025. Eligible articles were original human studies involving individuals with FHP that reported CVA measurements and postural control outcomes. Included study designs comprised randomized controlled trials, cross-sectional studies, and case–control studies. Data were synthesized descriptively.
Results: Nine studies were included (five randomized controlled trials, two cross-sectional studies, and two case control studies), involving 26–160 participants. Individuals with FHP consistently demonstrated smaller CVA values (approximately 41°- 46°) compared with controls (approximately 53°-55°). Smaller CVA values were associated with increased postural sway, higher overall stability index, and greater cervical proprioceptive error. Intervention studies showed that improvements in cervical alignment were accompanied by increases in CVA and clinically meaningful improvements in balance, trunk control, and proprioception. In addition, one case-control EEG/EMG study reported increased corticomuscular coherence during challenging balance conditions, indicating compensatory neural strategies in individuals with FHP.
Conclusion: Reduced CVA is consistently associated with impaired postural control. Improving cervical alignment may enhance balance and neuromuscular function, supporting the relevance of CVA in postural assessment and rehabilitation