Targeted Cervical Versus Integrated Trunk and Diaphragmatic Muscle Retraining for Chronic Mechanical Neck Pain (INT-CMNP)

Comparison of Targeted Cervical Versus Integrated Trunk and Diaphragmatic Muscle Retraining on Pain and Disability in Chronic Neck Pain: A Randomized Clinical Trial

Persistent pain, functional disability, cervical motor control deficit, and abnormal posture are associated with chronic mechanical neck pain. This study aimed to evaluate the efficacy of an integrated physiotherapy program of cervical motor control training, lumbopelvic stabilization, diaphragmatic breathing exercises, and pressure biofeedback versus conventional cervical physiotherapy in patients with chronic mechanical neck pain through a randomized controlled trial.

40 eligible participants were randomly assigned to the experimental or control group. The two groups were all given supervised physiotherapy three times a week for 6 weeks plus a standardized home exercise program. The main aim was to investigate the efficacy of the interventions on pain intensity and neck related disability. Secondary outcomes were CROM, DCFE, head position, and patient perceived recovery. Outcome measures were conducted at both baseline and the end of the six-week intervention.

Study Overview

• Status: Completed
• Conditions: Neck Pain; Chronic Mechanical Neck Pain
• Intervention / Treatment: Behavioral: Integrated Physiotherapy; Behavioral: Conventional Physiotherapy

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Arab Emirates
  • Ajman Emirate
    • Ajman, Ajman Emirate, United Arab Emirates
      • Thumbay Physical Therapy & Rehabilitation Hospital

Participation Criteria

Eligibility Criteria

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

Description

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.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Integrated Physiotherapy; Participants were treated with a comprehensive physiotherapy intervention that included cervical motor control exercises with pressure biofeedback, lumbopelvic stabilization exercises, diaphragmatic breathing exercises, and additional physiotherapy interventions as clinically necessary. Three times per week for 6 weeks. In addition, a standardized home exercise program was performed during the intervention.	Behavioral: Integrated Physiotherapy; Participants were given an integrated physiotherapy program which comprised motor control training for the cervical spine with pressure biofeedback, lumbopelvic stabilization exercises, diaphragmatic breathing exercises, and a standardized home exercise program. Three treatment sessions per week for six weeks were conducted under supervision.
Active Comparator: Conventional Physiotherapy; All participants underwent conventional cervical physio, which included cervical range of motion exercises, cervical isometric strengthening, upper trapezius and levator scapulae and pectoral muscles stretching, scapulothoracic strengthening, proprioceptive training, postural correction exercises and intermittent cervical traction as clinically indicated. Treatment was given three times a week for 6 weeks. A standardized home exercise program was also performed by the participants during the intervention period.	Behavioral: Conventional Physiotherapy; Conventional cervical physiotherapy included cervical range-of-motion exercises, isometric strengthening, stretching, scapulothoracic strengthening, proprioceptive training, postural exercises, and a standardized home exercise program. Supervised treatment was provided three times per week for six weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck Disability	Neck-related disability will be assessed using the NDI. Higher scores indicate greater disability.	Baseline and 6 weeks
Pain Intensity	Pain intensity will be assessed using the NPRS. The NPRS is an 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain). Lower scores indicate reduced pain intensity.	Baseline and 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cervical Range of Motion	Cervical range of motion will be measured in flexion, extension, rotation, and lateral flexion using standard clinical assessment procedures.	Baseline and 6 weeks
Deep Cervical Flexor Endurance	Deep cervical flexor muscle endurance will be assessed using a standardized endurance test.	Baseline and 6 weeks
Head Posture	Forward head posture will be assessed by measuring the craniovertebral angle.	Baseline and 6 weeks
Global Rating of Change	Participant-perceived overall improvement will be assessed using the GROC scale.	6 weeks

Collaborators and Investigators

• Sponsor: Gulf Medical University

Study record dates

Study Major Dates

• Study Start (Actual): May 2, 2026
• Primary Completion (Actual): June 26, 2026
• Study Completion (Actual): June 30, 2026

Study Registration Dates

• First Submitted: July 1, 2026
• First Submitted That Met QC Criteria: July 1, 2026
• First Posted (Actual): July 8, 2026

Study Record Updates

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

More Information

Terms related to this study

• Keywords: Rehabilitation; Pain; Randomized Controlled Trial; Physiotherapy; Neck Disability; Chronic Mechanical Neck Pain; Cervical Range of Motion; Deep Cervical Flexor Training; Cervical Motor Control; Pressure Biofeedback
• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Neck Pain
• Other Study ID Numbers: COHSSTD32Jan2026; RB-COHS-STD-32-Jan-2026 (Other Identifier: Gulf Medical University, Ajman)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The decision regarding the sharing of de-identified individual participant data has not yet been finalized. Data sharing will be considered after study completion and publication, subject to institutional policies, ethical requirements, participant confidentiality, and applicable data-sharing agreements.

Drug and device information, study documents

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