Physiotherapy Approaches for Cervical Myofascial Pain Syndrome with Forward Head Posture (Reduced CVA); A systematic review of passive/manual interventions
DOI:
https://doi.org/10.63163/jpehss.v3i4.756Keywords:
myofascial pain syndrome, forward head posture, craniovertebral angle, manual therapy, myofascial release, IASTM, dry needling, cupping, TENS, passive physiotherapy.Abstract
Background: Cervical myofascial pain syndrome (MPS) frequently co-occurs with forward head posture (FHP), operationalized by a reduced craniovertebral angle (CVA). In clinical practice, patients often receive passive/manual physiotherapy techniques to modulate pain, improve CVA and normalize soft tissues before engaging in active rehabilitation.
Objective: To conduct a systematic review of randomized controlled trials (RCTs) and metanalyses/systematic reviews (SRs) on passive/manual physical therapy interventions for cervical Myofascial Pain Syndrome (MPS).
Methods: Following PRISMA guidance, we searched PEDro and PubMed/MEDLINE (January 2015–February 2025). Studies which included adults with clinically confirmed cervical MPS (trigger points with characteristic pain pattern), interventions restricted to passive/manual physiotherapy, outcomes including pain (VAS/NPRS), disability (NDI), CVA, ROM, pressure-pain threshold (PPT), soft-tissue compliance, and subcutaneous hemodynamics. Risk of bias for RCTs was appraised via PEDro; SRs via AMSTAR-2.
Results: Twenty-five studies met criteria (18 RCTs, 7 SR/MA). Manual therapy (including suboccipital techniques) consistently reduced pain and disability; several trials reported modest CVA improvements. Myofascial release/IASTM improved pain and PPT with emerging signals for posture change. Dry needling yielded short-term analgesia; disability improvements while CVA effects were mixed. Cupping/vacuum approaches produced immediate pain relief and improved soft-tissue compliance; durability remains uncertain. Electrotherapy (e.g., TENS) provided short-term analgesia. Most included RCTs were moderate-to-high quality (PEDro ≈7–9/10).
Conclusions: Passive/manual physiotherapy offers clinically meaningful short-term benefits for pain and disability in cervical MPS with FHP, with early evidence of posture (CVA) change especially following suboccipital/upper cervical techniques. Standardized CVA protocols and longer follow-ups are needed to determine durability and optimal dosing.
