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.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(20):49 Healthcare (Basel) . 2025 Jul 21;13(14):1765.What this means for my practice?
For adults with chronic, non-specific neck pain, coupling diaphragm manual therapy and breathing re-education with Mulligan-based cervical manual therapy yields superior and durable gains in cervical ROM over one month (maintained at three months), but not superior improvements in forward head posture compared with controls. Clinically, consider integrating respiratory-focused manual and breathing strategies to break mobility plateaus while using additional/targeted interventions for posture. Limitations include short follow-up, lack of patient-reported outcomes (pain/disability), and mean-imputation for minimal missing data.
Resumo do estudo
Ninety patients with non-specific chronic neck pain were randomized to receive cervical spine (Mulligan Concept) and diaphragm manual therapy plus breathing re-education (EG1; n=30), cervical spine manual therapy plus sham diaphragmatic therapy (EG2; n=30), or conventional physiotherapy (CG; n=30). The primary outcome of interest was active cervical spine range of motion (flexion/extension, bilateral side-flexion, bilateral rotation). Secondary outcome was forward head posture (craniovertebral angle). Outcomes were assessed pre-treatment, immediately post-treatment (after 10 sessions/1 month), and at 3 months. Overall, the results of the study revealed larger ROM gains with EG1 versus CG in five of six directions (except flexion) and versus EG2 for extension, with improvements generally maintained at 3 months; craniovertebral angle improved similarly across groups. These findings suggest that integrating diaphragm-focused manual therapy and breathing re-education augments cervical mobility beyond conventional care, though posture change (CVA) may require additional strategies.
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