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NCT Number: NCT07604935

Comparative Effects of Nerve Flossing and Deep Neck Flexor Muscle Strengthening on Pain, Range of Motion and Functional Disability on Cervical Spinal Stenosis

The goal of this randomized clinical trial is to compare the effectiveness of Nerve Flossing and Deep Neck Flexor strengthening exercises in individuals with cervical spinal stenosis. The study aims to determine which treatment is more effective in reducing neck pain, improving cervical range of motion, and enhancing the ability to perform daily activities. Participants will be randomly assigned to receive either Nerve Flossing or Deep Neck Flexor exercises for specified duration. Both groups will attend physiotherapy sessions 3 times per week as assigned. Outcomes such as pain intensity, neck disability, and range of motion will be measured before and after the intervention using standard assessment tools. This study will help identify a more effective physiotherapy approach for managing symptoms of cervical spinal stenosis.

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Key information

Conditions

Cervical Spinal Stenosis Neck Pain Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms

Age range

20 year–50 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Green International University

Lahore, Punjab Province, Pakistan

About this study

Cervical spinal stenosis is a condition characterized by narrowing of the spinal canal in the cervical region, leading to compression of neural structures. This often results in neck pain, reduced cervical range of motion, and functional disability that affects daily activities and quality of life. Conservative management through physiotherapy is the preferred initial approach before considering surgical intervention. Among conservative techniques, Nerve Flossing and Deep Neck Flexor strengthening are commonly used but their comparative effectiveness remains unclear. Nerve Flossing involves controlled, low-amplitude movements of the neck and upper limb to mobilize neural tissues and reduce nerve-related pain and sensitivity. Deep Neck Flexor strengthening uses specific low-load exercises to improve the activation and endurance of the deep cervical flexors that support head and neck posture. This study is conducted to address the gap in evidence by directly comparing these two interventions in patients with cervical spinal stenosis. The findings will help physiotherapists and clinicians select the most effective treatment approach for reducing pain and improving function in this population.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Adults aged 20-50 years, both male and female.
  • Clinical and radiological (MRI) diagnosis of cervical spinal stenosis.
  • Cervical pain with or without radiating to the upper limb.
  • At least one neurological sign, such as sensory disturbance, muscle weakness or diminished reflexes.
  • Symptoms present for more than 4 weeks but less than 6 months.
  • Ability to understand and follow exercise instructions.
  • VAS pain score ≥ 3/10 at baseline.

Exclusion criteria

  • History of cervical spine surgery
  • Recent trauma, fracture, or cervical instability.
  • History of disc herniation involving surgery.
  • Other neurological or musculoskeletal conditions, including peripheral neuropathy, thoracic outlet syndrome, and rheumatoid arthritis.
  • Pregnancy.
  • Recent medication use that may impact nerve function (e.g., systemic steroids).

Treatment and study plan

Nerve Flossing

Behavioral

This intervention involves controlled, low-amplitude movements of the neck and upper limb to mobilize the cervical and upper limb neural tissues. The technique aims to reduce mechanical sensitivity of the nerves, improve neural mobility, and alleviate nerve-related pain in patients with cervical spinal stenosis. The specific dosage, frequency, and duration will be applied as per the study protocol.

Other names: Group A

Deep Neck Flexor Strengthening

Behavioral

Low-load, targeted exercises to improve activation and endurance of the deep cervical flexor muscles. Focuses on enhancing cervical stability and posture. Frequency, duration, and repetitions will follow the study protocol.

Other names: Group B

Primary outcomes

  1. Pain Intensity

    Time frame: Baseline and 12 weeks post-intervention

    Pain intensity will be measured using the Visual Analogue Scale (VAS), where participants mark their pain level on 100mm line ranging from "no pain" (0) to "worst imaginable pain (100). Higher scores indicate greater pain intensity.

Secondary outcomes

  1. Change in Neck Disability Index Score

    Time frame: Baseline and 12 weeks post-intervention

    Change in neck-related disability from baseline to 6 weeks and post-intervention, measured using the Neck Disability Index (NDI) on a scale of 0-50. Higher scores indicate greater disability.

  2. Change in Cervical Range of Motion

    Time frame: Baseline and 12 weeks post-intervention

    Change in cervical flexion, extension, and rotation range of motion from baseline to 6 weeks and 12 weeks, measured by using inclinometer.

Sponsors and collaborators

Lead sponsor

Green International University

Other

Registry information

Acronym: NF-DNF

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
May 22, 2026
Registry last updated
May 22, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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