pISSN 2288-6982
eISSN 2288-7105



Review Article

Phys. Ther. Korea 2021; 28(1): 18-26

Published online February 20, 2021

© Korean Research Society of Physical Therapy

Effects of Biofeedback Based Deep Neck Flexion Exercise on Neck Pain: Meta-analysis

Joo-Hee Park1 , PT, PhD, Hye-Seon Jeon1,2 , PT, PhD, Ji-hyun Kim3 , BPT, PT, Ye Jin Kim3 , BPT, PT, Gyeong Ah Moon3 , BPT, PT, One-bin Lim1 , PT, PhD

1Department of Physical Therapy, College of Health Science, Yonsei University, 2Department of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University, 3Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Korea

Correspondence to: Hye-Seon Jeon

Received: December 29, 2020; Revised: January 13, 2021; Accepted: January 14, 2021


Previous studies have reported that deep neck flexor (DNF) exercise can improve neck problems, including neck pain, forward head posture, and headache, by targeting the deep and superficial muscles of the neck. Despite the prevailing opinion across studies, the benefits of DNF can vary according to the type of neck problems and the outcome measures adopted, ranging from positive outcomes to non-significant benefits. A meta-analysis was conducted in this study to assess conclusive evidence of the impact of DNF exercise on individuals with neck problems. We used PUBMED, MEDLINE, NDSL, EMBASE, and Web of Science to search for primary studies and the key terms used in these searches were “forward head posture (FHP),” “biofeedback,” “pressure biofeedback unit,” “stabilizer,” “headache,” and “neck pain.” Twenty-four eligible studies were included in this meta-analysis and were coded according to the type of neck problems and outcome measures described, such as pain, endurance, involvement of neck muscle, craniovertebral angle (CVA), neck disability index (NDI), cervical range of motion (CROM), radiographs of the neck, posture, strength, endurance, and headache disability index. The overall effect size of the DNF exercise was 0.489. The effect sizes of the neck problems were 0.556 (neck pain), –1.278 (FHP), 0.176 (headache), and 1.850 (mix). The effect sizes of outcome measures were 1.045 (pain), 0.966 (endurance), 0.894 (deep neck flexor), 0.608 (superficial neck flexor), 0.487 (CVA), 0.409 (NDI), and 0.252 (CROM). According to the results of this study, DNF exercise can effectively reduce neck pain. Thus, DNF exercise is highly recommend as an effective exercise method for individuals suffering from neck pain.

Keywords: Biofeedback, Deep neck flexor exercise, Meta-analysis, Neck pain