Respiratory Exercises Versus Deep Neck Flexor Training in Chronic Mechanical Neck Pain

Effect of Respiratory Muscle Exercises Versus Deep Neck Flexor Training on Pain, Function and Neck Muscle Endurance in Patients With Chronic Mechanical Neck Pain

This study will be conducted to compare the effect of adding respiratory exercises versus deep neck flexor training to conventional program on pain, cervical ROM, cervical muscle endurance, function, and chest expansion in patients with chronic mechanical neck pain. Sixty-six (66) of both genders ranging in age from 18 to 35 years old, with a history of mechanical neck pain longer than 3 months (chronic neck pain) will be invited to participate in this study. Participants will be randomly assigned into one of the three experimental groups as follow:

Group A will receive respiratory exercises in form of diaphragmatic breathing & respiratory muscle stretch gymnastics plus conventional program.

Group B will receive deep neck flexor training in the form of low-load craniocervical flexion using feedback from an air-filled pressure sensor placed behind the neck plus conventional program.

Group C (control group) will receive conventional program in form of TENS, infrared, isometric neck strengthening exercises and stretching exercises.

Study Overview

• Status: Recruiting
• Conditions: Chronic Neck Pain
• Intervention / Treatment: Other: Respiratoty exercises; Other: Deep neck flexor training; Other: conventional program

Detailed Description

Introduction:

Neck pain (NP) impacts the cervical motor system, posture, and movement. Motor output of cervical muscles is impaired. Muscles have decreased strength, endurance, and force steadiness and cervical muscle behavior is altered eg., decreased activity of deep postural muscles, reduced directional specificity, delayed onset of muscle responses and muscle fatigability. Patients with neck pain usually present with weak deep neck flexors and extensors, increased fatigability of superficial neck flexors, alterations in posture, limited range of motion, decreased proprioception and other psycho-social affections such as anxiety, depression, kinesiophobia, and catastrophizing. These factors are responsible for the predisposition of respiratory dysfunction in these patients.

Statement of the problem:

This study will be conducted to answer the following question: Does adding respiratory exercises or deep neck flexor training to conventional program have any effect on pain, ROM, cervical muscle endurance, function, and chest expansion?

Significance of the study:

The Global Burden of Disease Study stated that neck pain is globally the fourth largest physical complaint in years lived with a disability. The clinical practice guidelines recommended for patients with CNP interventions are: education, cervical mobilization and manipulation, thoracic manipulation, and mixed exercises for cervical and scapulothoracic regions, or an association of different interventions. Despite the high prevalence and significant impact of chronic neck pain, the optimal exercise-based intervention remains unclear. While previous research has investigated the benefits of conventional physical therapy, there is no study to date comparing the effect of respiratory exercises versus deep neck flexor training while adding to conventional program in the management of chronic neck pain patients. Therefore the current study will be conducted to compare the effectiveness of adding respiratory exercises versus deep neck flexor training to conventional program in patients with chronic neck pain.

Delimitations:

This study will be delimited to:

1. Sixty-six patients of both genders, ranging in age from 18 to 35 years old, with a history of neck pain longer than 3 months (chronic neck pain).
2. There will be three groups of twenty-two patients for each group; Group (A) will receive respiratory exercises in the form of diaphragmatic breathing & respiratory muscle stretch gymnastics plus conventional program in form of TENS, infrared, isometric strengthening and stretching exercises, Group (B) who will receive deep neck flexor training in form of low load craniocervical flexion using feedback from an air-filled pressure sensor placed behind the neck plus conventional program in form of TENS, infrared, isometric strengthening and stretching exercises & Group (C) who will receive combination of respiratory exercises and deep neck flexor training plus conventional program in form of TENS, infrared, isometric strengthening and stretching exercises for two times per week for 8 weeks.
3. Neck pain will be measured by a visual analogue scale (VAS).
4. The ACROM will be measured using a cervical range of motion device.
5. Deep neck flexor endurance of cervical flexion will be assessed with the cranio-cervical flexion test using feedback from an air-filled pressure sensor.
6. Neck function will be assessed with Arabic version of Neck Disability Index (NDI).
7. Chest expansion will be assessed with measuring tape.

• Study Type: Interventional
• Enrollment (Estimated): 66
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: ola ismail ibrahim, M.Sc.; Phone Number: +201008283364; Email: olaismailibrahim@gmail.com
• Study Contact Backup: Name: karima abdelaty hassan, Ass. Prof.; Phone Number: +201114032967; Email: karima.abdelaty@pt.cu.edu.eg

Study Locations

• Egypt
  • Zagazig, Egypt
    • Recruiting
    • Taheel center for physiotherapy
    • Contact: ola ismail ibrahim, M.Sc.; Phone Number: +201008283364; Email: olaismailibrahim@gmail.com
    • Contact: karima abdelaty hassan, Ass.Prof.; Phone Number: +201114032967; Email: karima.abelaty@pt.cu.edu.eg
    • Principal Investigator: ola ismail ibrahim, M.Sc.

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Patients have mechanical neck pain lasting longer than three months.
2. The ages of patients range from 18 to 35 years.
3. Patients are lifetime non-smoker and non-alcoholic.

Exclusion Criteria:

1. History of trauma or cervical spine fractures.
2. Previous spinal surgery.
3. Any inflammatory pathology.
4. Any cervical disc pathology and neurological signs.
5. Malignancy.
6. Cervical radiculopathy.
7. Rheumatoid arthritis.
8. Pregnant female.
9. Currently using muscle relaxation medication.
10. History of respiratory and cardiovascular illness

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Respiratory exercises group; 22 male and female patients with chronic mechanical neck pain who will receive respiratory exercises in form of diaphragmatic breathing & respiratory muscle stretch gymnastics plus conventional program.	Other: Respiratoty exercises; respiratory exercises in form of diaphragmatic breathing & respiratory muscle stretch gymnastics plus conventional program
Experimental: Deep neck flexor training group; 22 male and female patients with chronic mechanical neck pain who will receive deep neck flexor training in the form of low-load craniocervical flexion using feedback from an air-filled pressure sensor placed behind the neck plus conventional program	Other: Deep neck flexor training; deep neck flexor training in the form of low-load craniocervical flexion using feedback from an air-filled pressure sensor placed behind the neck plus conventional program
Experimental: control group; 22 male and female patients with chronic mechanical neck pain who will receive conventional program in form of TENS, infrared, isometric neck strengthening exercises and stretching exercises	Other: conventional program; conventional program in form of TENS, infrared, isometric neck strengthening exercises and stretching exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck pain	pain will be assessed by visual analogue scale	From enrollment to the end of treatment at 8 weeks
Cervical ROM	cervical ROM will be assessed by CROM device	From enrollment to the end of treatment at 8 weeks
Neck muscle endurance	Neck muscle endurance will be assessed by crainiocervical flexion test using feedback from pressure sensor	From enrollment to the end of treatment at 8 weeks
Chest expansion	chest expansion will be assessed by taping measurement	From enrollment to the end of treatment at 8 weeks
Neck function	Neck function will be assessed by neck disability index, Arabic version	From enrollment to the end of treatment at 8 weeks

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Director: karima abdelaty hassan, Ass. Prof., Cairo university; Study Director: dina sayed abdullah, lecturer, Cairo university

Study record dates

Study Major Dates

• Study Start (Actual): March 10, 2026
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: April 3, 2026
• First Submitted That Met QC Criteria: April 12, 2026
• First Posted (Actual): April 15, 2026

Study Record Updates

• Last Update Posted (Actual): April 22, 2026
• Last Update Submitted That Met QC Criteria: April 20, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: chronic neck pain; respiratory exercises; deep neck flexor training
• Other Study ID Numbers: Chronic mechanical neck pain

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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