Bruegger's Relief Exercise in Chronic Mechanical Neck Pain

Neck pain is the second most prevalent musculoskeletal disorder worldwide. Neck pain persisting for more than three months is classified as chronic neck pain (CNP). Individuals with chronic mechanical neck pain (CMNP) exhibit distinct neuromuscular and epidemiological characteristics This imbalance contributes to impaired cervical stability and altered movement control.According to the Global Burden of Disease 2019 report, the global age-standardized prevalence of neck pain was approximately 2,696.5 per 100,000 population (≈2.7%), with an incidence rate of 579.1 per 100,000 population (≈0.58%). In Pakistan, musculoskeletal pain among young adults has been reported to range between 55-60%, with neck pain representing a major complaint Forward head posture (FHP) is a common postural deviation associated with chronic mechanical neck pain. It is highly prevalent, affecting approximately 62% of young adults in Pakistan and nearly 64% globally. FHP is characterized by anterior translation of the head, lower cervical flexion, and often increased upper cervical extension. The craniovertebral angle (CVA), defined as the angle formed between a horizontal line through the C7 spinous process and a line connecting the tragus of the ear to C7, is commonly used to quantify forward head posture. A reduced CVA indicates greater forward head translation and has been associated with increased pain intensity and reduced endurance of the deep cervical flexor muscles. Postural deviation and neuromuscular imbalance contribute to mechanical stress on cervical structures, functional limitations, and persistent symptoms in individuals with CMNP.

Given the high prevalence of forward head posture and its association with chronic mechanical neck pain, interventions targeting postural correction and neuromuscular re-education may be clinically beneficial.

This randomized controlled trial aims to evaluate the effect of Bruegger's Relief Exercise combined with conventional physical therapy on pain intensity, functional disability, cervical range of motion, and craniovertebral angle in individuals with chronic mechanical neck pain.

Inclusion criteria

• • Participants falling in this category would be recruited into the study.

• Age 20-50 years
• Diagnosis of chronic mechanical neck pain (>3 months)
• Pain intensity ≥ 3/10 on NPRS
• Neck Disability Index score ≥ 10/50
• Willing to participate and provide informed consent

Exclusion criteria

• • Participants falling in this category would be excluded from the study.

• History of cervical spine fracture or surgery
• Systemic musculoskeletal or neurological disease
• Recent whiplash injury (within 6 months)
• Botulinum toxin injection within previous 6 months
• Severe structural deformity (e.g., torticollis, severe scoliosis)
• Red flag signs (fever, unexplained weight loss, progressive neurological deficit)
• Positive cervical instability tests (Sharp-Purser or Alar ligament test)
• Clinical signs of cervical radiculopathy (positive Spurling's/ULTT/distraction test)