Novel Orthosis Reduces Neck Pain Associated with Forward Head Posture in Active Duty Service Members – A Randomized Waitlist-Controlled Trial- MHSRS 2026

m smith, n hogaboom, v morris, x yuan, m nordstrom

Abstract accepted for podium presentation at the 2026 Military Health System Research Symposium (MHSRS)

Introduction: Chronic neck pain impacts active-duty Service Members (ADSMs) across all occupational specialties. Reduction of cervical lordosis in forward head posture (FHP) can lead to myofascial restrictions, and increased neck pain. This study investigated the safety and efficacy of a novel, non-invasive therapy collar to improve FHP and neck pain among ADSMs.

Methods: This single-site, randomized, waitlist-controlled trial at WRNMMC was approved by the Institutional Review Board (WRNMMC-2021-0347). ADSMs (18-55 years) with chronic neck pain and FHP were enrolled and randomized into one of two groups: Immediate Treatment (IT) or 6-Week Waitlist-Control (WC). Participants were instructed to wear the collar for 20 minutes daily for 6 weeks. Outcome measures [e.g., Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI)] and radiographs were collected at baseline, 6-, and 12-weeks post-enrollment. Linear mixed-effects models were used to estimate between-group differences in change from baseline to 6 weeks for each outcome and to assess longitudinal changes within the IT group out to 12 weeks. Statistical significance was set at p < 0.05 for all tests.

Results: 35 participants (IT: n = 18; 72.2% F, 37.9 ± 6.8 years; WC: n = 17; 47.1% F, 39.0 ± 6.6 years) completed the 6-week intervention and were eligible for analysis at 6- and 12-weeks (n = 34). At 6 weeks, the age-adjusted between-group differences in NPRS and NDI change scores were -2.59 points (SE = 0.52, p < 0.0001) and -6.37% (SE = 2.73, p = 0.026), respectively, demonstrating statistically significant between-group differences favoring the IT group. The IT group additionally met the MCID for the NPRS (-2.00 ± 1.78) compared to WC group (+0.59 ± 1.23), but neither group met the MCID for the NDI (IT: -3.67 ± 7.89 %; WC: +2.71 ± 8.24 %). There were no significant differences noted in radiographic measures. At 12 weeks, the IT group demonstrated sustained improvement on the NPRS and NDI. 

Conclusion: Evaluating the effects of a wearable, take-home device for neck pain due to FHP is highly relevant to ADSMs considering their occupational requirements. Preliminary results suggest donning a therapy collar for 6 weeks can yield pain reduction and functional improvement compared to conventional treatment out to 12 weeks, despite no significant radiographic changes. This suggests the short-term pain reduction may be in part due to improvements in myofascial restrictions, although further research is needed.