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

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.

Study Overview

• Status: Completed
• Conditions: Cervical Spinal Stenosis
• Intervention / Treatment: Behavioral: Nerve Flossing; Behavioral: Deep Neck Flexor Strengthening

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 62
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan
      • Green International University

Participation Criteria

Eligibility Criteria

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

Description

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).

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Nerve Flossing Group; Participants in this arm will receive Nerve Flossing techniques targeting the cervical and upper limb neural tissues. The intervention involves controlled, low-amplitude movements of the neck and upper limb to improve neural mobility. Sessions will be conducted as per the study protocol.	Behavioral: Nerve Flossing; 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
Experimental: Deep Neck Flexor Strengthening Group; Participants in this arm will receive Deep Neck Flexor strengthening exercises using low-load, targeted movements to improve activation and strength of the deep cervical flexor muscles. The exercises focus on enhancing cervical stability and posture. Sessions will be conducted as per the study protocol.	Behavioral: Deep Neck Flexor Strengthening; 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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	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.	Baseline and 12 weeks post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Neck Disability Index Score	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.	Baseline and 12 weeks post-intervention
Change in Cervical Range of Motion	Change in cervical flexion, extension, and rotation range of motion from baseline to 6 weeks and 12 weeks, measured by using inclinometer.	Baseline and 12 weeks post-intervention

Collaborators and Investigators

• Sponsor: Green International University

Study record dates

Study Major Dates

• Study Start (Actual): April 6, 2026
• Primary Completion (Actual): April 29, 2026
• Study Completion (Actual): May 6, 2026

Study Registration Dates

• First Submitted: May 17, 2026
• First Submitted That Met QC Criteria: May 17, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 22, 2026
• Last Update Submitted That Met QC Criteria: May 17, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Physical Therapy; Physiotherapy; Neck Pain; Range of Motion; Cervical Spinal Stenosis; Cervical Spine; Neck Disability; Neural Mobilization; Nerve Flossing; Deep Neck Flexor
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Neck Pain
• Other Study ID Numbers: GIU/REC/26-34

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Only IPD used in the results publication will be shared
• IPD Sharing Time Frame: It will be available after the completion of the study.
• IPD Sharing Access Criteria: Through the corresponding author.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

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