Effects of Feldenkrais Approach in Cases With Forward Head Posture

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 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 (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 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.

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.

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.

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.