# The Effectiveness of Manual Therapy in the Cervical Spine and Diaphragm, in Combination with Breathing Re-Education Exercises, on the Range of Motion and Forward Head Posture in Patients with Non-Specific Chronic Neck Pain: A Randomized Controlled Trial

## TL;DR

This study tested if combining manual therapy on the neck and diaphragm with breathing exercises helps improve neck movement and posture in people with chronic neck pain.

## Contribution

The study introduces a novel approach combining diaphragm therapy and breathing re-education for chronic neck pain treatment.

## Key findings

- The experimental group showed significant improvement in cervical spine range of motion compared to the control group.
- Improvements in craniovertebral angle were similar across all groups.
- Benefits from the experimental group were maintained three months after treatment.

## Abstract

Background/Objectives: A randomized controlled trial (RCT) was designed to test the emerging role of respiratory mechanics as part of physiotherapy in patients with non-specific chronic neck pain (NSCNP). Methods: Ninety patients with NSCNP and symptom duration >3 months were randomly allocated to three intervention groups of equal size, receiving either cervical spine (according to the Mulligan Concept) and diaphragm manual therapy plus breathing reeducation exercises (experimental group—EG1), cervical spine manual therapy plus sham diaphragmatic manual techniques (EG2), or conventional physiotherapy (control group—CG). The treatment period lasted one month (10 sessions) for all groups. The effect on the cervical spine range of motion (CS-ROM) and on the craniovertebral angle (CVA) was examined. Outcomes were collected before treatment (0/12), after treatment (1/12), and three months after the end of treatment (4/12). The main analysis comprised a two-way mixed ANOVA with a repeated measures factor (time) and a between-groups factor (group). Post hoc tests assessed the source of significant interactions detected. The significance level was set at p = 0.05. Results: No significant between-group baseline differences were identified. Increases in CS-ROM and in CVA were registered mainly post-treatment, with improvements maintained at follow-up for CS-ROM. EG1 significantly improved over CG in all movement directions except for flexion and over EG2 for extension only, at 1/12 and 4/12. All groups improved by the same amount for CVA. Conclusions: EG1, which included diaphragm manual therapy and breathing re-education exercises, registered the largest overall improvement over CG (except for flexion and CVA), and for extension over EG2. The interaction between respiratory mechanics and neck mobility may provide new therapeutic and assessment insights of patients with NSCNP.