Manual Therapy to the Cervical Spine and Diaphragm Combined With Breathing Reeducation Exercises, in nsCNP Patients
Condition: Chronic Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Chronic neck pain (CNP) is reported to be one of the most common musculoskeletal pain
      syndromes. Studies showed that patients with chronic neck pain compensated with changes in
      Pain, Function, Musculoskeletal and Respiratory outcomes. The diaphragm is a primary
      respiratory muscle contributing to postural stability and spinal control. Many studies showed
      that manual therapy and exercise improve clinical and respiratory outcomes in CNP patients.
      Few studies highlight the importance of diaphragm manual therapy and Reeducation Breathing
      Exercises in musculoskeletal diseases and in CNP patients. However, the exact mechanism is
      still unclear. This study aims to examine the hypothesis that: "Diaphragm Manual Therapy and
      Breathing Reeducation Exercises combined with cervical manual therapy - improve clinical and
      respiratory outcomes more than cervical manual therapy intervention only or conventional
      physiotherapy
    

Detailed description: 
      Chronic neck pain (CNP) may affect the physical, social, and psychological aspects of the
      individual, contributing to the increase in costs in society and business. Neck pain is a
      major cause of morbidity and disability in everyday life and at the workplace, in many
      different countries and populations, but its basic pathology and pathophysiology are still
      unclear.

      CNP patients present respiratory dysfunction and pain presence is accompanied by a varying
      amount of decrements in several clinical outcomes affecting the neuromusculoskeletal system
      like disability, range of motion restriction, and decreased proprioception as well as
      neuromuscular control. However, the quality of life and psychology of patients with CNP are
      affected in parallel. The diaphragm is the most important respiratory muscle also
      contributing to postural stability and spinal control. Several studies have shown that
      diaphragm manual therapy and breathing retraining exercises can improve respiratory, as well
      as pain, function, and musculoskeletal outcomes in chronic low back pain. However, the
      effectiveness in patients with chronic neck pain has not been definitively determined in
      relation to other physical therapy interventions. The primary purpose of the present study is
      to determine further the effectiveness of Diaphragmatic Manual Therapy and Breathing
      Reeducation Exercises in CNP patients. The secondary purpose is to investigate the
      relationship between CNP, breathing dysfunction, pain, disability, and musculoskeletal
      clinical outcomes.

      The present study is expected to recruit 90 patients with CNP. Patients with CNP will be
      randomly assigned to (1) Diaphragmatic Manual Therapy plus Cervical Manual Therapy plus
      Breathing Reeducation Exercises (2) Cervical Manual Therapy plus sham Diaphragmatic Manual
      Therapy and (3) Conventional Physiotherapy. Each participant will receive a particular
      intervention program depending on their group allocation. All participants will receive two
      evaluation sessions before and after the intervention.
    

Intervention name(s): Cervical plus Diaphragmatic Manual Therapy plus Breathing Reeducation Exercises; Cervical Manual Therapy plus sham Diaphragmatic Manual Therapy; Conventional Physiotherapy Program
Intervention type(s): Other; Other; Other
Intervention description(s): Diaphragmatic Manual Therapy consists of techniques intended to indirectly stretch and mobilize the diaphragmatic muscle fibers. This will help to improve muscle contraction and decrease tension. The experimental maneuvers include the Doming Diaphragmatic Technique as described by Leon Chaitow, Lewit, and the Manual Diaphragmatic Release Technique as described by Leon Chaitow. Both maneuvers are performed in two sets of 10 repetitions, within a 1-minute interval.
Cervical Manual Therapy consists of vertebral mobilization techniques according to the Mulligan technique.
Breathing Reeducation Exercises consist of i) recognition of the abnormal breathing pattern, ii) relaxation techniques for all the primary and accessory respiratory muscles, iii) diaphragm breathing reeducation iv) pursed lips exercise v) reeducation of the normal breathing rate; Ultrasound sham as Diaphragmatic Manual techniques. Disconnected ultrasound will be applied in the same position as for the experimental group for 15 min as a placebo treatment.
Cervical Manual Therapy: will consist of vertebral mobilization techniques according to Mulligan -; Conventional Physiotherapy Program consists of TENS for 15min, Microwave pulsed Diathermy for 10min, soft tissue techniques for 15min
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: neck pain,diaphragm manual, manual therapy