Positional Relaxation Technique and Static Stretching in Nonspecific Neck Pain

Comparison of the Immediate Effects of Positional Relaxation Technique and Static Stretching in Young Individuals With Nonspecific Neck Pain

Neck pain is one of the most common and painful musculoskeletal disorders. Between 20% and 70% of adults experience neck pain during their lifetime. The lifetime prevalence ranges from 14.2% to 71%. In the vast majority of neck pain cases, no obvious pathology or anatomical abnormality can be identified, and this condition is defined as "nonspecific neck pain".

Although nonspecific neck pain generally has a benign course, it can progress to chronic pain in approximately one-third of individuals. Furthermore, 20-50% of patients still experience limitations in activities of daily living after one year and develop persistent symptoms. It has been suggested that nociplastic pain mechanisms may be involved in nonspecific neck pain, and understanding these mechanisms has become crucial for effective treatment planning.

Factors such as non-ergonomic working postures, stress, negative emotions, and carrying heavy loads play a role in the development of nonspecific neck pain. The widespread use of computers, tablets, and smartphones also increases the prevalence of nonspecific neck pain by causing strained postures. The multidimensional and complex nature of risk factors for neck pain indicates that this condition is not usually due to a single factor but rather arises as a result of multiple and persistent exposures.

Individuals with neck pain experience decreased cervical muscle strength, impaired intermuscular coordination, myofascial trigger points, decreased cervical range of motion, and increased tone, particularly in the upper trapezius, levator scapulae, and sternocleidomastoideus muscles. These physiological changes can negatively impact participation in school, work, and social life, leading to a decrease in quality of life.

Various physiotherapy approaches are used in the management of non-specific neck pain. One of these, the Positional Relaxation Technique, is based on the principle of strain-counterstrain and involves placing dysfunctional tissues in painless, comfortable positions to reduce muscle spasm or tension. This position, held for approximately 90 seconds, facilitates neuromuscular realignment by decreasing muscle spindle sensitivity and gamma motor neuron activity. This technique reduces muscle tension and fascial dysfunction, increases circulation, alleviates edema and pain, and supports muscle strength.

Static stretching exercises, on the other hand, involve holding the muscle in a lengthened position for a specific period of time and are a frequently preferred method in musculoskeletal rehabilitation. Static stretching has been shown to have positive effects such as increasing flexibility and reducing pain. This technique has been evaluated in the literature, both alone and in combination with other exercises.

Breathing exercises, particularly diaphragmatic breathing, activate the parasympathetic nervous system, promote relaxation, reduce muscle tone, and enhance the therapeutic effect by regulating the physiological stress response. These exercises have been reported to improve neuroimmune responses, reduce sympathetic tone, reduce oxidative stress, and modulate pain. Furthermore, respiratory training provides short-term pain reduction, increased cervical range of motion, and improved neck muscle activation.

However, studies comparing the immediate effects of positional relaxation and static stretching exercises, particularly when applied in combination with breathing exercises under the same protocol, in young individuals with nonspecific neck pain are quite limited. Most existing studies have examined these techniques separately or focused on long-term outcomes.

The purpose of this study was to compare the immediate effects of positional relaxation and static stretching exercises on muscle viscoelastic properties, pain intensity, and cervical range of motion in young individuals with nonspecific neck pain.

Study Overview

• Status: Completed
• Conditions: Nonspecific Neck Pain
• Intervention / Treatment: Other: Positional Relaxation Technique and Breathing Exercises; Other: Static Stretching and Breathing Exercises

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye), 34010
    • Istinye University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Diagnosis of nonspecific neck pain.
2. Being between 18 and 30 years of age.
3. Pain intensity of at least 3/10 on the Visual Analog Scale at baseline.
4. Limited cervical movement in any direction.
5. Ability to follow verbal instructions and perform basic exercises independently.
6. Not having participated in another neck pain treatment program in the last 4 weeks.
7. Voluntarily agreeing to participate and signing the informed consent form.

Exclusion Criteria:

1. History of neck trauma, surgery, or fracture.
2. Diagnosis of any neurological disease (e.g., multiple sclerosis, stroke).
3. Concomitant structural causes of neck pain (e.g., herniated disc, cervical radiculopathy).
4. Use of muscle relaxants or painkillers within 48 hours before the evaluation.
5. Presence of a known psychiatric disorder that would prevent participation.
6. Presence of a vestibular or balance disorder affecting head or neck movement.
7. Inability to perform required exercises due to severe pain or other physical limitations.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Positional Relaxation Technique and Breathing Exercises; Based on Strain-Counterstrain principles, the Positional Relaxation Technique will be applied to cervical muscles commonly affected by non-specific neck pain, such as the upper trapezius, levator scapulae, and sternocleidomastoid. The participant will be placed in a supine position, where the targeted muscle will be shortened and placed in a pain-free position. After determining the ideal position for each muscle that minimizes pain, this position will be maintained for 30 seconds and three repetitions will be performed. During this time, the participant will engage in slow diaphragmatic breathing during these repetitions. The same procedure will be repeated for the other muscles. A 15-second rest will be given between each new muscle. No active movement will be expected from the participant during the exercise. The entire exercise is expected to last approximately 5 minutes	Other: Positional Relaxation Technique and Breathing Exercises; Based on Strain-Counterstrain principles, the Positional Relaxation Technique will be applied to cervical muscles commonly affected by non-specific neck pain, such as the upper trapezius, levator scapulae, and sternocleidomastoid. The participant will be placed in a supine position, where the targeted muscle will be shortened and placed in a pain-free position. After determining the ideal position for each muscle that minimizes pain, this position will be maintained for 30 seconds and three repetitions will be performed. During this time, the participant will engage in slow diaphragmatic breathing during these repetitions. The same procedure will be repeated for the other muscles. A 15-second rest will be given between each new muscle. No active movement will be expected from the participant during the exercise. The entire exercise is expected to last approximately 5 minutes.
Experimental: Static Stretching and Breathing Exercises; In this group, a passive static stretching protocol will be applied to the same cervical muscles (upper trapezius and sternocleidomastoid and levator scapulae) on the painful side. The stretching position will be held for 30 seconds for each muscle, repeated three times. A 15-second rest will be given between each new muscle. The participant will be guided to diaphragmatic breathing during the stretching. The exercises will be performed under the supervision of a physiotherapist to ensure participant comfort and proper technique. The entire session is planned to last approximately 5 minutes.	Other: Static Stretching and Breathing Exercises; In this group, a passive static stretching protocol will be applied to the same cervical muscles (upper trapezius and sternocleidomastoid and levator scapulae) on the painful side. The stretching position will be held for 30 seconds for each muscle, repeated three times. A 15-second rest will be given between each new muscle. The participant will be guided to diaphragmatic breathing during the stretching. The exercises will be performed under the supervision of a physiotherapist to ensure participant comfort and proper technique. The entire session is planned to last approximately 5 minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscle Tone	The Myoton Digital Palpation Device will be used to measure muscle tone, This device has proven reliable in measuring neck muscle tone. The device applies a mechanical impulse via a probe placed at a right angle to the muscle. The muscle tissue response parameters are automatically recorded by the device and used to calculate the muscle's biomechanical properties.For each participant, measurements will be made on the upper trapezius, levator scapulae, and sternocleidomastoid muscles on the side where the pain is most intense. The probe will first apply a preload of 0.18 N, followed by a brief mechanical impulse of 0.40 N, resulting in a total force of 0.58 N. Each muscle will be measured three times, and the average value will be recorded. Standard positioning and skin contact will be ensured during the measurement.	4 weeks
Muscle Stiffness	The Myoton Digital Palpation Device will be used to measure muscle stiffness. This device has proven reliable in measuring neck muscle tone. The device applies a mechanical impulse via a probe placed at a right angle to the muscle. The muscle tissue response parameters are automatically recorded by the device and used to calculate the muscle's biomechanical properties. For each participant, measurements will be made on the upper trapezius, levator scapulae, and sternocleidomastoid muscles on the side where the pain is most intense. The probe will first apply a preload of 0.18 N, followed by a brief mechanical impulse of 0.40 N, resulting in a total force of 0.58 N. Each muscle will be measured three times, and the average value will be recorded. Standard positioning and skin contact will be ensured during the measurement.	4 weeks
Muscle Elasticity	The Myoton Digital Palpation Device will be used to measure muscle elasticity. This device has proven reliable in measuring neck muscle tone. The device applies a mechanical impulse via a probe placed at a right angle to the muscle. The muscle tissue response parameters are automatically recorded by the device and used to calculate the muscle's biomechanical properties. For each participant, measurements will be made on the upper trapezius, levator scapulae, and sternocleidomastoid muscles on the side where the pain is most intense. The probe will first apply a preload of 0.18 N, followed by a brief mechanical impulse of 0.40 N, resulting in a total force of 0.58 N. Each muscle will be measured three times, and the average value will be recorded. Standard positioning and skin contact will be ensured during the measurement.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pressure Pain Threshold	A digital pressure algometer will be used to assess the pressure pain threshold on the upper trapezius, levator scapulae, and sternocleidomastoid (SCM) muscle. The probe will be pressed with increasing force at a right angle until the participant indicates the onset of pain. The average of three trials will be recorded.	4 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Numeric Rating Scale	This is a simple, sensitive, and reproducible tool frequently used to assess pain intensity. Its ease of use has made it the most frequently used self-assessment scale in studies. Participants were asked to rate their pain intensity on a scale of 0 to 10, with 0 representing "no pain" and 10 representing "unbearable pain".	4 weeks
Neck Disability Index	Neck-related functional disability will be assessed using the Neck Disability Index questionnaire. This questionnaire is designed to assess the impact of neck pain on the ability to manage daily life. The maximum score for each section is 5: if the first statement is marked, the section score = 0, and if the last statement is marked, the score = 5. The total score will be converted to a percentage to reflect the level of disability.	4 weeks
Cervical Joint Range of Motion	Cervical mobility will be measured using a digital goniometer. The movements to be measured will include flexion, extension, right and left lateral flexion, and rotation. The participant will be seated upright, and each movement will be performed actively. Three attempts will be made for each direction, and the best result will be recorded.	4 weeks
Satisfaction with Treatment - Global Rating of Change Scale	All study participants' satisfaction with their treatment at the end of the study will be assessed using the Global Rating of Change Scale. is a scale in which patients quantify the degree of improvement or deterioration in their health over time from their own perspective. There are different rating types on the Global Rating of Change Scale. In our study, the 7-stage form, ranging from -3 to +3 (-3: much worse, 0: the same, +3: completely recovered), will be preferred.	4 weeks

Collaborators and Investigators

• Sponsor: Istinye University

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2025
• Primary Completion (Actual): April 1, 2026
• Study Completion (Actual): May 1, 2026

Study Registration Dates

• First Submitted: November 28, 2025
• First Submitted That Met QC Criteria: February 23, 2026
• First Posted (Actual): February 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 8, 2026
• Last Update Submitted That Met QC Criteria: May 7, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Static Stretching; Pain Threshold; Neck disability index; Myoton; Positional Relaxation Technique; Nonspecific Neck Pain
• Additional Relevant MeSH Terms: Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Therapeutics; Mind-Body Therapies; Complementary Therapies; Exercise Movement Techniques; Physical Therapy Modalities; Patient Care; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Exercise; Breathing Exercises; Muscle Stretching Exercises
• Other Study ID Numbers: 175

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No