Effects of Feldenkrais Approach in Cases With Forward Head Posture

NCT06968052 | Recruiting

• 1 other identifier: IUC-FTR-Tt25
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 2

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.

Conditions

Forward Head Posture

Keywords

Rehabilitation; Posture; Proprioception; Exercise; Muscle Strength; Spine

Outcome Measures

Primary Outcomes (4)

• Cervical Joint Position Sense

  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.

  8 weeks

• Cervical Muscle Strength

  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.

  8 weeks

• Cervical Range of Motion

  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.

  8 weeks

• Postural Assessment

  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.

  8 weeks

Secondary Outcomes (3)

• Neck Disability Index (NDI)

  8 weeks

• Numeric Pain Rating Scale (NPRS)

  8 weeks

• Global Rating of Change (GROC) Scale

  8 weeks

Study Arms (2)

Group A

EXPERIMENTAL

Participants in Group A will receive a combined program of corrective exercises and the Feldenkrais method. The program includes posture-focused Feldenkrais movements and stretching/strengthening exercises for postural muscles (e.g., pectorals, cervical extensors, deep neck flexors, and scapular retractors). The intervention will be delivered twice weekly over 8 weeks, totaling 16supervised 45-minute sessions by a physiotherapist.

Other: Strength and Feldenkrais Exercise

Group B

ACTIVE COMPARATOR

Participants in Group B will receive a program combining corrective and breathing exercises. Corrective exercises will be performed at the same sets and repetitions as Group A, adjusted to individual tolerance. Breathing exercises include diaphragmatic breathing and thoracic expansion, performed in 2-3 sets of 7 repetitions. The intervention will be delivered twice weekly over 8 weeks, totaling 16supervised 45-minute sessions by a physiotherapist.

Other: Strength Exercise

Interventions

Strength and Feldenkrais Exercise OTHER

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.

Group A

Strength Exercise OTHER

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.

Group B

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• Istanbul University - Cerrahpasa: lead

Study Sites (2)

Istanbul University-Cerrahpaşa

Istanbul, Buyukcekmece, 34500, Turkey (Türkiye)

RECRUITING

Istanbul University-Cerrahpaşa

Istanbul, Turkey (Türkiye)

NOT YET RECRUITING

MeSH Terms

Conditions

Motor Activity

Condition Hierarchy (Ancestors)

Behavior

Study Officials

• Ayşe Zengin Alpözgen, Assoc. Prof.

  Istanbul University - Cerrahpasa

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: 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.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: May 5, 2025
• First Posted: May 13, 2025
• Study Start: May 25, 2025
• Primary Completion (Estimated): May 5, 2026
• Study Completion (Estimated): June 29, 2026
• Last Updated: November 20, 2025

Record last verified: 2025-04

Data Sharing

• IPD Sharing: Will not share

Locations

TU (2)