Targeted Cervical Versus Integrated Trunk and Diaphragmatic Muscle Retraining for Chronic Mechanical Neck Pain

Chronic mechanical neck pain is one of the most prevalent musculoskeletal conditions and is related to ongoing pain, diminished cervical movement, poor neck muscle control, poor posture, and diminished functional ability. Conventional physiotherapy emphasizes the mobility, strengthening, stretching and postural correction of the cervical region. Recent research indicates that cervical motor control, trunk stabilization and respiratory training may be beneficial when integrated into a rehabilitation program, as multiple aspects of spinal stability and motor control can be targeted.

The study was designed as a single center, parallel-group, assessor-blinded randomized controlled trial, to compare the effectiveness of integrated physiotherapy program to conventional cervical physiotherapy in subjects with chronic mechanical neck pain.

Participants were recruited from the outpatient physiotherapy department of Thumbay Physical Therapy and Rehabilitation Hospital, Ajman, UAE, where they met the inclusion criteria for having mechanical neck pain with a duration of at least three months. After obtaining informed consent, participants were allocated by a computer-generated random sequence in a 1:1 ratio to either the experimental or control group, with allocation concealed.

The experimental group received an integrated rehabilitation program that included cervical motor control training with pressure biofeedback, lumbopelvic stabilization exercises, diaphragmatic breathing exercises and traditional physiotherapy interventions as clinically needed. The control group received conventional cervical physiotherapy which included cervical range of motion exercises, isometric strengthening, stretching, scapulothoracic strengthening, proprioceptive training, postural exercises, and other standard physiotherapy treatment. Both groups underwent supervised treatment three times a week for six weeks and an identical home exercise program during the intervention.

The primary outcome measures included intensity of pain (Numeric Pain Rating Scale [NPRS]) and neck-related disability (Neck Disability Index [NDI]). Secondary outcome measures were the cervical range of motion, deep cervical flexor endurance, craniovertebral angle for head posture and the Global Rating of Change (GROC). Assessment of outcomes was conducted at baseline and at the end of the six-week interventions by an assessor who was not aware of the allocation of the interventions.

This study aimed to evaluate the effectiveness of an integrated physiotherapy approach including cervical motor control training, lumbopelvic stabilization, diaphragmatic breathing exercises, and pressure biofeedback in comparison to a conventional cervical physiotherapy approach for reduction of pain, disability, and cervical function and postural control in patients with chronic mechanical neck pain.

Inclusion criteria

• Age in the range 18-60 years.
• CNMP (lasting more than 3 months).
• NPRS score ≥ 3.
• Head Impact Test (HIT-6) score < 50.
• Absence of clinical signs of cervical radiculopathy.
• Capacity to comprehend study procedures, follow directions for exercising and sign informed consent in writing.
• Diaphragmatic function impairment by the DNS diaphragm test with asymmetric or inadequate rib expansion laterally, high elevation of upper chest or shoulder girdle and diminished truncal stabilization during inhalation.

Exclusion criteria

• Participants were excluded if they had cervical radiculopathy, cervical myelopathy, previous cervical spine surgery, spinal fracture, inflammatory arthritis, malignancy, neurological disorders, pregnancy, or any other serious spinal pathology that would make it difficult for the participant to participate in the rehabilitation programme. People with cognitive deficits or any medical condition which hampered their safe involvement in the exercise programme were also excluded.