The Effects of Stabilization Exercises and Taping on Cervical Muscle Strength, Endurance, and Function in Women With Forward Head Posture.

The Neck Disability Index is used to evaluate symptoms and functional limitations in patients with neck pain. It consists of 10 sections, with the first four assessing symptoms and six assessing functional activities. Each section is scored from 0 (no disability) to 5 (total disability), resulting in a total score ranging from 0 to 50. Higher total scores indicate greater disability.

Forward head posture was assessed using the craniovertebral angle. Participants stood in a relaxed upright position while a digital camera was positioned 2 m to their right at shoulder height on a tripod. The craniovertebral angle was measured from the photograph as the angle between the line connecting the ear tragus to the spinous process of C7 and a horizontal line through C7. A craniovertebral angle ≤ 50° was considered indicative of forward head posture, whereas values > 50° were accepted as normal.

The strength and endurance of the deep cervical flexor muscles were assessed using the craniocervical flexion test. An uninflated pressure sensor (biofeedback stabilizer) was positioned behind the neck, resting against the occiput between the earlobe and the projection of the mandible. During the craniocervical flexion movement, performed gently and slowly as a head-nodding action (as if saying "yes"), isometric contractions were maintained while the pressure was increased from 20 mmHg to 30 mmHg in 2-mmHg increments. The calculated activation index was considered a measure of deep cervical flexor muscle strength, with a maximum activation index of 10 mmHg. The cumulative performance index was used to assess deep cervical flexor muscle endurance .

The cervical extensor endurance test is an objective assessment used in individuals with forward head posture. Participants lay prone with the head hanging off the table edge, while the upper thoracic spine was supported at the T6 level. An inclinometer was secured to the head, and a 2-kg weight was attached via a strap. Participants were instructed to maintain the head in a chin-tuck position with the cervical spine held horizontally. The test was terminated if the head position deviated by more than 5°, the maximum duration of 5 minutes was reached, or the participant could not continue due to pain or fatigue. The time for which the horizontal position was maintained was recorded in seconds. The test was performed twice, with a 3-minute rest between trials.