Forward Head Posture
Conditions
Keywords
Rehabilitation, Posture, Proprioception, Exercise, Muscle Strength, Spine
Brief summary
It is thought that adding approaches that increase posture awareness to corrective exercise programs will contribute to the treatment. The aim of the study is to evaluate the effect of adding the Feldenkrais method to the corrective exercise program applied to individuals with forward head posture on cervical joint position sense, muscle strength, joint range of motion and posture parameters.
Detailed description
The combination of the Feldenkrais method with corrective exercises stands out as an innovative approach to the problem of forward head posture. This approach aims to not only eliminate physical alignment errors but also increase individuals' internal awareness of posture and movement patterns by integrating traditional postural correction techniques with Feldenkrais' movement efficiency and awareness-oriented principles. In this way, it may be possible for the postural improvements obtained to be more sustainable. It is reported that the Feldenkrais method supports neuromuscular control by increasing body awareness and contributes to movement quality. In light of this information, it is predicted that the addition of the Feldenkrais method to the corrective exercise program applied to individuals with forward head posture will provide additional improvement in cervical joint position sense, muscle strength, range of motion and posture parameters.
Interventions
OTHERStrength Exercise
This is a non-drug, non-device corrective exercise program tailored for adults with forward head posture. It includes postural muscle strengthening and stretching, such as deep neck flexor activation, scapular retraction, and pectoral stretching. Additionally, participants perform diaphragmatic and thoracic breathing exercises.
OTHERStrength and Feldenkrais Exercise
This is a behavioral, non-drug and non-device-based intervention combining somatic awareness through Feldenkrais principles with neuromuscular re-education. Movements emphasize minimal effort, reduced muscle tension, and improved self-perception of posture. The approach supports individualized progression and complements conventional physiotherapy without the use of pharmacological agents or medical equipment.
Sponsors
Istanbul University - Cerrahpasa
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
This study will employ assessor and statistician blinding. The physiotherapists performing baseline and post-intervention assessments will be blinded to group allocation to minimize bias. Additionally, statistical analyses will be conducted by a researcher blinded to group assignments. Participants and therapists delivering the intervention will not be blinded due to the nature of the exercise-based intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Being between 18-65 years of age * CVA (cervicovertebral angle) ≤50° (16,17) * Spending at least 4 hours of daily desk time 5 days a week
Exclusion criteria
* Having temporomandibular dysfunction * Having any spinal deformity * Having cervical trauma or pain treatment within the last 6 months * Having previously participated in a corrective exercise program * History of neurological disorder * History of spinal or thoracic surgery * Having hearing impairment * Use of analgesics/muscle relaxants
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cervical Joint Position Sense | 8 weeks | Cervical joint position sense was assessed using a laser pointer-based method to evaluate proprioceptive accuracy. A laser device was securely mounted on the participant's head, and a neutral head position was established as a reference. Participants were instructed to move their heads in specific directions (flexion, extension, lateral flexion, or rotation) and, with eyes closed, return to the starting position. The laser beam projected onto a target screen allowed measurement of repositioning error-the distance between the original and returned laser point. Each direction was tested once, followed by three recorded trials, with the average used for analysis. |
| Cervical Muscle Strength | 8 weeks | Cervical muscle strength was assessed isometrically using the Lafayette Manual Muscle Tester. Participants were seated upright in a backless, armless chair with feet flat on the floor. Initial calibration involved maximal voluntary isometric contraction with hands pressed together in front of the body. Measurements were then taken with the neck in a neutral position, applying resistance to the forehead (flexion), occiput (extension), lateral head (lateral flexion), and chin (rotation). Three trials were recorded per direction, with averages used for analysis. A 3-minute rest was provided between attempts. Participants could stop at any time if discomfort occurred. |
| Cervical Range of Motion | 8 weeks | Cervical range of motion (ROM) was measured using the Baseline Digital Absolute+Axis Goniometer, a reliable and clinically validated tool for assessing cervical spine movements. Active cervical motions-including flexion, extension, right/left lateral flexion, and right/left rotation-were measured following standardized procedures defined by Norkin et al. Participants performed each movement actively while seated in an upright position. The goniometer provided objective angular measurements. This tool has demonstrated good to excellent intrarater reliability (ICC: 0.70-0.93) in previous research, confirming its suitability for both clinical and research purposes. |
| Postural Assessment | 8 weeks | Postural parameters were assessed using the PostureScreen Mobile (PSM) application, a validated digital tool for quantifying postural deviations. Static posture images were taken from anterior, posterior, and lateral views while participants stood in a relaxed upright position. Key anatomical reference points were marked within the app, which then calculated deviations from ideal posture in degrees or centimeters. This method allows for objective and reliable analysis of head, shoulder, and spinal alignment, providing quantifiable data to track changes over time and inform targeted corrective interventions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Pain Rating Scale (NPRS) | 8 weeks | The Numeric Pain Rating Scale (NPRS) is a widely used tool to assess the intensity of pain. Participants are asked to rate their neck pain on a scale from 0 to 10, where 0 indicates no pain and 10 represents the worst pain imaginable. NPRS has demonstrated moderate to high test-retest reliability (ICC = 0.67-0.96) and strong convergent validity (r = 0.79-0.95) when compared with the Visual Analog Scale (VAS). It provides a simple, valid, and reliable measure for both clinical and research purposes in individuals with neck pain. |
| Global Rating of Change (GROC) Scale | 8 weeks | The Global Rating of Change (GROC) Scale is a subjective tool used to evaluate participants' perceived change and satisfaction with treatment outcomes. At the end of the intervention period, participants rate their overall change on a 7-point scale ranging from -3 (much worse) to +3 (much better). This measure reflects perceived clinical effectiveness by capturing the individual's overall sense of improvement or deterioration, offering insight into the meaningfulness of treatment from the patient's perspective. The GROC is commonly used in rehabilitation research to complement objective outcome measures. |
| Neck Disability Index (NDI) | 8 weeks | The Neck Disability Index (NDI) is a self-reported questionnaire designed to evaluate how neck pain affects daily activities. It includes 10 items grouped under pain-related aspects (e.g., pain intensity, headaches, sleep, concentration), selective daily activities (e.g., driving, lifting, work, recreation), and essential daily activities (e.g., personal care, reading). Each item is scored from 0 to 5, and total scores are converted to a percentage out of 100. Higher scores indicate greater disability. The Turkish version of the NDI has demonstrated excellent test-retest reliability (ICC = 0.979) and strong construct validity in Turkish-speaking populations. |
Countries
Turkey (Türkiye)
Outcome results
None listed