Effects of Manual Therapy and Exercise Training of Diaphragm in Patients With Chronic Neck Pain
Condition: Chronic Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Chronic neck pain is a commonly reported problem and often associated with functional
      disability. Studies showed that patients with chronic neck pain compensated with changes in
      breathing pattern. Primary functions of the diaphragm includes as the main respiratory muscle
      and contributing to the postural stability and spinal control. Diaphragm is located between
      the thorax and abdomen and has extensive and complex fascial connections to surrounding
      organs, muscles, and skeletons. Few studies showed that applying diaphragmatic manual
      techniques and breathing exercise training help to improve functions in patients with low
      back pain. However, how does the interventions directly influence on patients with chronic
      neck pain is still unclear. In this study, we make a hypothesis that diaphragmatic stretch
      technique and breathing exercise training help to reduce pain and improve functions in
      patients with chronic neck pain.
    

Detailed description: 
      Chronic neck pain is a serious health problem with low quality of life, disability and
      economical burdens. Studies have found that nearly 83% of chronic neck pain patients had
      changes in breathing patterns. Compensated breathing pattern by using the neck-accessory
      respiratory muscles may result in excessive muscle strains and over-activations, which may
      also contribute to develop chronic neck pain. The diaphragm is the most important respiratory
      muscle which attached to the ribs and spine, and thus has an influence on spinal stability.
      Few studies have showed that diaphragm releasing and breathing training can reduce pain and
      improve flexibility of posterior chain muscles, spinal range of motions, and ribcage
      excursions in asymptomatic adults and patients with low back pain. However, the effects in
      patients with chronic neck pain has not bee determined. Therefore, there are two main purpose
      of this study. First, to determine the relationships among diaphragm mobility, neck pain and
      dysfunction, and respiratory in patients with chronic neck pain. Second, to investigate the
      effects of diaphragm releasing, breathing training, or combined intervention on pain and
      disability in patients with chronic neck pain. It is expected to recruit 150 patients with
      chronic neck pain and 30 healthy volunteers. Patients with chronic neck pain will be randomly
      assigned to (1) manual therapy group (2) manual control group (3) breathing training group
      (4) general exercise control group (5) manual therapy combined breathing training group. Each
      participant will receive a specific intervention program depending on their group allocation.
      All participants will receive two evaluation sessions before and after the intervention
      including ultrasonography, cervical and thoracic function, respiratory functions, and
      autonomic balance.
    

Intervention name(s): Diaphragmatic Stretch Technique; Breathing Exercise Training
Intervention type(s): Other; Other
Intervention description(s): Diaphragmatic stretch technique is an intervention intended to indirectly stretch the diaphragmatic muscle fibers. This will help to decease tension generated by trigger points, normalizing muscle ﬁber length, and improve muscle contraction.; During diaphragmatic or abdominal breathing training, inhalation will caused diaphragm contract downwards, inflating the lungs. This filling of the lungs pushes the abdominal organs down leading to expansion of the abdomen. Subjects are required to do few repetitions during the intervention.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Ultrasonography; Diaphragm; Breathing exercise; Breathing dysfunction