The purpose of the current study was to examine how Pilates exercises affect breastfeeding women\u2019s FHP using CVA, NDI, VAS, cervical ROM, FSS, (BSES-SF), SF-36, weight, and length of the infant. The present study\u2019s main finding showed that both Pilates and breastfeeding positioning adjustment groups had statistically significant improvements from baseline to 8 weeks post-intervention, as there was a significant increase in CVA, ROM of cervical, BSES-SF, SF-36, weight, and length of the infant, also, there was a significant reduction in VAS, NDI, and FSS post-treatment in study group more than control group.<\/p>\n
The substantial effect sizes observed in the present study may be attributed to several methodological and clinical factors, including the clinically meaningful baseline impairments, the relatively homogeneous study population resulting from the strict eligibility criteria, and the use of well-validated, responsive outcome measures. In addition, the use of a non-active control group may have contributed to larger between-group effect size estimates through non-specific effects such as therapist attention and supervised intervention. Therefore, the observed effect sizes should be interpreted within the methodological context of the present study.<\/p>\n
The current study revealed a significantly higher improvement in the study group, reflecting the beneficial effect of Pilates exercise in treating FHP, this result was supported by Lee et al.13<\/a>, who investigated the clinical effectiveness of a Pilates treatment for FHP, the study found that there were significant increases in CVA and cervical ROM and decreased VAS and NDI in the Pilates group. Similarly, Shah and Soni32<\/a> examined the influence of Pilates in conjunction with a traditional training program in individuals with text neck syndrome. They found that, in comparison to the conventional exercise program alone, there was a noticeably higher improvement in pain reduction, neck disability, and cervical muscle strength and endurance.<\/p>\n The prevalence of breastfeeding-related neuromusculoskeletal problems as cervical pain, is high up to more than 50% across different populations, as shown by previous studies 33<\/a>,34<\/a>. The repeated forward-leaning postures adopted while breastfeeding can significantly exacerbate FHP and contribute to these high prevalence rates33<\/a>. Additionally, pregnancy-related alterations in sagittal spinal alignment, particularly increased thoracic kyphosis and lumbar lordosis, may persist beyond childbirth and have been associated with reduced craniovertebral angle, neck pain, and functional limitations35<\/a>,36<\/a>. The biomechanical demands of breastfeeding may further amplify these changes, as prolonged and repetitive feeding postures have been linked to sustained activation of the cervical and shoulder muscles37<\/a>. Moreover, the combined influence of residual postpartum adaptations and the physical demands of infant care may increase susceptibility to postural disorders such as upper crossed syndrome among lactating women38<\/a>,39<\/a>. Interpreting these findings within the postpartum period highlights the multifactorial nature of maternal musculoskeletal strain, arising from the interaction between persistent post-pregnancy anatomical adaptations and the considerable physical demands of infant care40<\/a>.<\/p>\n Within this postpartum and breastfeeding framework, the present findings extend the existing evidence by suggesting that a Pilates program emphasizing lumbopelvic and scapular stabilization, delivered alongside breastfeeding positioning counseling, may help improve FHP and associated musculoskeletal complaints in breastfeeding women. The results are supported by Li et al.12<\/a>, who observed that Pilates techniques improve QOL, pain alleviation, function, and fitness while also effectively correcting posture and spinal abnormalities. Additionally, it has been demonstrated that Pilates greatly enhances spinal range of motion and decreases the Cobb angle.<\/p>\n Behavioral factors may contribute to the development of FHP. People may continue to strain themselves for extended periods of time because they are unaware of their poor posture13<\/a>, hence, the results of this study agreed with Elhafez et al.41<\/a>, who compared the effects of Pilates and cervical stabilization exercises on the cervical muscles\u2019 CVA, pain, function, and myoelectrical activity in FHP. The findings indicated that Pilates exercises improve CVA, strengthen the deep neck musculature, and lead to whole-body muscle rehabilitation, which in turn alleviates neck pain.<\/p>\n The magnitude of the between-group differences observed in the present study suggests that the benefits of Pilates training may be clinically meaningful in addition to being statistically significant. Regarding postural alignment, the Pilates group exhibited a 2\u00b0 greater improvement in CVA (95% CI 1.48\u20132.53) than the control group. Notably, this change exceeded the established minimal clinically important difference (MCID) of 1.40\u00b0 for CVA correction42<\/a>, supporting the clinical relevance of the postural adaptations achieved through the intervention. In addition, participants in the Pilates group demonstrated a 1.62-cm greater reduction in pain intensity on the VAS (95% CI 1.12\u20132.12) compared with controls. This improvement exceeded the reported MCID of 1.37\u00a0cm, indicating that the reduction in pain was likely perceptible and meaningful from the patient\u2019s perspective43<\/a>. Similarly, the between-group difference in NDI scores reached 5.98 points (95% CI 4.38\u20137.57), surpassing the reported minimal clinically important change threshold of approximately 3\u20133.5 points for patients with neck pain43<\/a>,44<\/a>, this finding suggests that the observed improvement in neck-related disability was sufficiently large to be considered clinically meaningful. Collectively, these findings suggest that Pilates training may produce clinically relevant improvements in posture, pain, and functional disability among breastfeeding women with FHP. However, it should be acknowledged that these published MCID values were derived from neck pain populations rather than breastfeeding women with forward head posture and therefore provide supportive clinical context rather than population-specific thresholds.<\/p>\n Nevertheless, these findings should be interpreted with appropriate caution. Although the intervention group demonstrated superior outcomes, the study was designed to evaluate the effectiveness of adding a supervised Pilates program to standard breastfeeding positioning education rather than to isolate the specific physiological effects of Pilates. Because the control group did not receive an attention-matched supervised intervention, part of the observed between-group differences may have been influenced by non-specific factors such as increased therapist interaction, supervised contact, or general physical activity. Therefore, future randomized controlled trials incorporating attention-matched active comparator interventions are warranted to better distinguish the intervention-specific effects of Pilates.<\/p>\n Pilates training is specifically planned to enhance overall body flexibility and well-being, emphasizing core strength, posture, and synchronized breathing. It\u2019s adaptable for individual needs and can effectively address specific postural issues. Research suggests that Pilates can have a significant positive impact on cervical spine health, with studies demonstrating significant improvements in CVA, cervical ROM, and postural alignment in individuals with FHP16<\/a>.<\/p>\n Workplace support and mothers\u2019 self-efficacy are significant factors in determining breastfeeding practice among working women, according to the results of previous research45<\/a>, which used the breastfeeding Self Efficacy Scale Short Form (BSES-SF), as these factors were found to be positively correlated.<\/p>\n Ahmed et al.46<\/a> found a correlation between breastfeeding and infant growth measured by weight and length, and Moradi et al.47<\/a> discovered that exclusive breastfeeding with breast milk has a significant impact on the child\u2019s growth indicators. These previous studies provide a clinical context for including infant anthropometric outcomes in breastfeeding populations. However, the present findings should be interpreted as exploratory observational outcomes and should not be interpreted as evidence of a direct physiological effect of maternal Pilates exercise on infant growth. Infant growth is a complex process influenced by a wide range of biological, nutritional, and environmental determinants. Consequently, the observed increases in infant weight and length should be interpreted with caution, and no direct causal relationship between the Pilates intervention and infant growth can be inferred.<\/p>\n According to the CVA, Mun and Roh48<\/a> examined how the Pilates program affected the FHP\u2019s cervicothoracic sagittal alignment, muscle strength, and endurance. The findings indicated that the Pilates training enhanced the strength and muscular endurance in the shoulder, as well as cervicothoracic sagittal alignment.<\/p>\n Furthermore, ergonomic breastfeeding instruction decreased the frequency of musculoskeletal diseases in women, as shown by Afshariani et al.49<\/a>. A study by Rani et al.26<\/a> evaluated common breastfeeding positions, recommended related to musculoskeletal problems and found that the most common position was the cross cradle hold associated with mechanical neck pain, while other positions also showed some musculoskeletal problems related to breastfeeding positioning, this is in line with the VAS results, which showed that the intervention group reported lower scores for pain.<\/p>\n Regarding FSS, a study by Saritacs and Picsirici50<\/a> investigated the effect of Pilates exercises on fatigue and physical self-perception in sedentary women, as for ten weeks, 50-minute Pilates sessions were held three days a week. The findings demonstrated that the Pilates exercise regimen can help sedentary women feel less exhausted and more confident about their bodies.<\/p>\n Although the current study showed notable improvements in FHP after the Pilates intervention, previous studies have reported inconsistent outcomes. For instance, H\u00fcrer et al.16<\/a> and Sharma and Roopa40<\/a> reported that Pilates programs were not superior to home exercises or cervical stabilization in improving pain and disability outcomes. These discrepancies could be explained by variations in the length of the intervention, the intensity of the exercise, the characteristics of the participants, the sample size, the degree of adherence, and the methods used to measure the results.<\/p>\n Numerous interrelated effects of the intervention are probably responsible for the observed improvements in CVA, cervical ROM, pain intensity, and QOL outcomes. Improved postural alignment may result from decreased overactivity of the cervical extensor and upper trapezius muscles and increased activation of the deep cervical flexor muscles. Improved neuromuscular control and joint mobility after repeated mobility-based and corrective exercises may account for increases in cervical ROM. Exercise-induced hypoalgesia, better muscle balance, and less mechanical stress on cervical tissues may all be linked to a decrease in pain intensity (VAS). Furthermore, decreased pain, higher confidence in carrying out daily tasks, improved functional capacity, and improved postural control are probably secondary to gains in QOL.<\/p>\n The observed improvements in posture, pain, and functional outcomes may be attributed to neuromuscular and biomechanical adaptations; however, these interpretations remain speculative as no direct electrophysiological or biomechanical measures were obtained in the present study. Therefore, the potential mechanisms discussed above should be interpreted with caution and viewed as plausible explanations rather than confirmed findings. Future studies incorporating objective neuromuscular and functional assessments are warranted to clarify underlying mechanisms.<\/p>\n Since FHP in females is thought to be linked to the onset and persistence of spine pain as well as several biomechanically driven disorders, studies have identified a substantial correlation between neck pain and this incorrect posture. The current study provides recent proof regarding the beneficial impact of Pilates activities on breastfeeding mothers\u2019 FHP. Further research is necessary to assess the long-term impact of Pilates exercises on FHP in breastfeeding women because of its limitations, which include its brief length, the inability to assess FHP status before initiation of the breastfeeding experience, and the inability to examine the exercises\u2019 long-term effects.<\/p>\n Several limitations should be taken into consideration, even if APECS posture assessment application provides a useful and accessible way to examine the CVA. Measurement variability may be introduced by participant position, camera distance, image quality, and lighting conditions, all of which affect app-based postural analysis. Although standardized imaging procedures were implemented to minimize these sources of variability, some degree of measurement error cannot be completely excluded. In addition, the APECS posture assessment application has been validated in general adult populations rather than specifically in postpartum or breastfeeding women. Postpartum-related changes, including alterations in body composition, breast enlargement associated with lactation, changes in thoracic posture, and reduced visibility of anatomical landmarks, may influence the accuracy of photogrammetric assessment. Therefore, the reliability reported in general adult populations may not be fully generalizable to breastfeeding women. Future studies should establish the validity, reliability, and other clinimetric properties of APECS specifically in postpartum and breastfeeding populations.<\/p>\n Another limitation is that examiner-specific intra-rater reliability for cervical ROM measurements was not formally established before data collection. Although all measurements were performed by the same trained assessor using a standardized protocol under identical testing conditions to minimize measurement variability, some degree of measurement error cannot be completely excluded. Future studies should establish and report examiner-specific intra- and inter-rater reliability to further strengthen measurement precision.<\/p>\n A limitation of the present study is the lack of detailed musculoskeletal assessments, including objective measures of muscle strength, muscle length, deep cervical flexor endurance, scapular muscle function, and core stability. Consequently, the specific physiological mechanisms contributing to the observed clinical and postural improvements could not be directly examined. Future research should incorporate comprehensive musculoskeletal evaluations to support more individualized exercise prescription and to provide a clearer understanding of the factors underlying treatment-related changes.<\/p>\n Another limitation of this study is that the control group received only breastfeeding positioning adjustment, which may not adequately control for therapist attention or placebo effects, potentially introducing performance bias. Therefore, the observed between-group differences should be interpreted with caution, as they may partly reflect non-specific effects of supervised intervention rather than the isolated effects of Pilates. Future studies should include attention-matched or sham-controlled interventions to better isolate the specific effects of the treatment. This study\u2019s short follow-up duration and lack of long-term outcome evaluation are limitations that make it difficult to determine the long-term sustainability of the observed outcomes.<\/p>\n In addition, breastfeeding practices may naturally evolve between 6 and 12 months postpartum. Although daily breastfeeding duration was comparable between groups at baseline, changes in breastfeeding frequency and duration during the study period were not monitored and may have contributed to variability in postural loading. Future studies should consider stratification according to infant age and longitudinal monitoring of breastfeeding practices throughout follow-up.<\/p>\n An additional limitation of the present study is that sleep quality and depressive symptoms were not assessed using validated instruments. Both factors may influence pain perception, fatigue levels, breastfeeding self-efficacy, and QOL, and therefore their potential contribution to the observed outcomes cannot be disregarded. Future research should include standardized assessments of sleep and psychological well-being to enable a more comprehensive evaluation of their potential confounding effects.<\/p>\n Although the SF-36 is a multidimensional instrument with eight distinct subscales, the present analysis reported a composite score to summarize overall QOL. This approach may mask domain-specific effects and limit the clinical interpretability of the findings. Future studies should therefore present the SF-36 subscales separately to better capture intervention-related changes across physical and psychological domains.<\/p>\n A further limitation concerns the interpretation of infant growth outcomes. Although infants in the Pilates group demonstrated greater improvements in weight and length, infant growth is influenced by multiple factors that were not controlled in the present study, including genetic, nutritional, and environmental influences. Therefore, these findings should be considered exploratory and interpreted with caution, as the study was not designed to establish a causal relationship between maternal Pilates exercise and infant growth. Future studies should account for these potential confounding factors when evaluating infant growth outcomes.<\/p>\n Moreover, participant and therapist blinding was not feasible because of the nature of the exercise intervention. Although assessor blinding, allocation concealment, standardized treatment protocols, and independent statistical analysis were implemented to reduce potential bias, some degree of performance bias cannot be completely excluded.<\/p>\n Furthermore, there is an ethical limitation preventing the enrollment of a third group receiving Pilates exercise but not breastfeeding positioning adjustment.<\/p>\n","protected":false},"excerpt":{"rendered":"The purpose of the current study was to examine how Pilates exercises affect breastfeeding women\u2019s FHP using CVA,…\n","protected":false},"author":2,"featured_media":124785,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[24,25,62755,62759,62760,62757,62756,1668,1743,4965,1744,62758,160],"class_list":["post-124784","post","type-post","status-publish","format-standard","has-post-thumbnail","category-ai","tag-ai","tag-artificial-intelligence","tag-breastfeeding","tag-breastfeeding-positioning","tag-cervical-pain","tag-craniovertebral-angle","tag-forward-head-posture","tag-health-care","tag-humanities-and-social-sciences","tag-medical-research","tag-multidisciplinary","tag-pilates","tag-science"],"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/posts\/124784","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/comments?post=124784"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/posts\/124784\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/media\/124785"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/media?parent=124784"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/categories?post=124784"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ai\/wp-json\/wp\/v2\/tags?post=124784"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}