Clinical Research Directory

Multimodal Manual Therapy vs. Maitland Mobilization for Chronic Non-Specific Neck Pain

Chronic non-specific neck pain (CNNP) is a common musculoskeletal disorder associated with persistent pain, functional disability, and reduced quality of life. Manual therapy techniques such as Maitland mobilization and multimodal manual therapy are frequently used in physiotherapy; however, evidence directly comparing their effectiveness remains limited. This study aims to compare the effects of Multimodal Manual Therapy and Maitland Mobilization on pain intensity, functional disability, and quality of life in patients with chronic non-specific neck pain. A randomized clinical trial will be conducted at Life Care Hospital, Bahawalnagar, involving 54 participants aged 18-35 years who meet the inclusion criteria. Participants will be randomly allocated into two equal groups. Group A will receive Maitland mobilization, while Group B will receive Multimodal Manual Therapy, including high thoracic manipulation (T4), cervical mobilization, and suboccipital muscle inhibition. Both groups will receive treatment three times per week for four weeks. Outcome measures will include the Numeric Pain Rating Scale (NPRS) for pain, the Neck Disability Index (NDI) for functional disability, and the Short Form-12 (SF-12) questionnaire for quality of life. Assessments will be performed at baseline, the second week, and the fourth week. Data will be analyzed using SPSS version 24, with appropriate parametric or non-parametric statistical tests based on data distribution. The findings of this study are expected to identify the more effective intervention for improving pain, disability, and quality of life in individuals with chronic non-specific neck pain. The results may assist physiotherapists in selecting evidence-based treatment strategies and contribute to improving clinical management of this condition

Effect of Added Load on Map-Based Proprioceptive Training in Chronic Neck Pain

The purpose of this study is to find out whether adding an external load to a map-based cervical proprioceptive training program provides additional benefit for people with chronic neck pain. Adults aged 18-65 years with chronic neck pain were randomly allocated to two groups: one group performed map-based proprioceptive training without load (weightless group) and the other group performed the same training with a 2 kg load secured to the head with a band (weighted group). The main question is whether the added load improves cervical joint position sense (repositioning error). Shoulder joint position sense, scapular position (Lateral Scapular Slide Test), neck awareness (Fremantle Neck Awareness Questionnaire), neck disability (Neck Disability Index) and fear of movement (Tampa Scale of Kinesiophobia) were also assessed before and after the 8-week training period.

Effects of the Timing of Vagus Nerve Stimulation Combined With Exercise in Chronic Neck Pain

This randomized, sham-controlled, parallel-group clinical trial aims to investigate whether the timing of transcutaneous auricular vagus nerve stimulation (taVNS) relative to therapeutic exercise influences pain intensity, disability, autonomic function, and motor performance in individuals with chronic neck pain. A total of 81 participants will be randomly assigned to one of three groups: active taVNS before exercise and sound-sham stimulation after exercise (PRE), sound-sham stimulation before exercise and active taVNS after exercise (POST), or sound-sham stimulation both before and after exercise (CONTROL). All participants will complete a standardized supervised exercise program three times per week for six weeks. The study will use a double-dummy approach to standardize intervention procedures across groups and support blinding. The primary outcome will be neck pain intensity assessed using the Numeric Pain Rating Scale (NPRS). Secondary outcomes will include neck-related disability, heart rate variability, pressure pain threshold, exercise-induced hypoalgesia, and deep cervical flexor motor performance assessed using the craniocervical flexion test.

The Clinical Efficacy and Multimodal Imaging Mechanism of the Knot-tying Technique in the Treatment of Chronic Neck Pain

This study is a multicenter 1:1 randomized controlled trial, enrolling patients with chronic neck pain from the Rehabilitation Medicine Department of Huizhou Third People's Hospital. A total of 60 participants are planned to be recruited, divided 1:1 into a trial group receiving the knot-release acupuncture method and a sham acupuncture control group. The study aims to evaluate the immediate clinical efficacy and safety of the knot-release acupuncture method for treating chronic neck pain and to explore its peripheral-to-central mechanisms using multimodal detection technologies. The research content includes: 1. Dynamically monitoring core evaluation indicators in enrolled patients, including VAS scores, real-time shear wave elastography (SWE), cervical range of motion (ROM), Neck Disability Index (NDI-TH), and functional near-infrared spectroscopy (fNIRS), to assess the immediate clinical efficacy and safety of the knot-release acupuncture method for chronic neck pain. 2. Observing and recording any adverse events throughout the intervention period, systematically and scientifically evaluating the clinical safety of the knot-release acupuncture method for chronic neck pain, and providing a safety basis for its standardized clinical application.

Effects of Instrument-Assisted Soft Tissue Mobilization Versus Post Facilitation Stretch Technique in Chronic Neck Pain

Chronic neck pain is a prevalent musculoskeletal condition that commonly results in persistent pain, reduced cervical range of motion (ROM), functional disability, and decreased quality of life. Instrument-Assisted Soft Tissue Mobilization (IASTM) and Post Facilitation Stretch (PFS) are two manual therapy techniques frequently used in physiotherapy practice; however, limited evidence is available comparing their effectiveness in individuals with chronic neck pain. This randomized controlled trial aims to compare the effects of IASTM and PFS on pain intensity, cervical ROM, and neck-related disability. A total of 38 participants aged 18-50 years with non-specific chronic neck pain of at least 12 weeks' duration will be recruited using non-probability purposive sampling and randomly allocated into two equal groups. Group A will receive IASTM, while Group B will receive PFS. Both groups will also receive conventional physiotherapy consisting of hot pack application and transcutaneous electrical nerve stimulation (TENS). Treatment will be provided three times per week for two consecutive weeks, totaling six treatment sessions. Outcome measures will include the Numeric Pain Rating Scale (NPRS) to assess pain intensity, the Cervical Range of Motion (CROM) instrument to measure cervical mobility, and the Neck Disability Index (NDI) to evaluate functional disability. Assessments will be conducted at baseline, after the third treatment session, and at the completion of the intervention period. The study findings are expected to provide evidence regarding the comparative effectiveness of IASTM and PFS in the management of chronic neck pain and assist physiotherapists in selecting the most effective manual therapy approach to improve pain, cervical mobility, and functional outcomes in individuals with chronic neck pain.

Focused Versus Multi-Target Trigger Point Injection for Chronic Myofascial Neck Pain

Myofascial neck pain may involve several active trigger points in the neck and shoulder muscles. In clinical practice, it is not clear whether treating only the main trigger point that best reproduces the patient's pain is sufficient, or whether treating several active trigger points provides additional benefit. This randomized controlled trial will compare two trigger point injection strategies in adults with chronic myofascial neck or cervicoscapular pain and active trigger points in at least two different muscles. Participants will receive either a focused injection to the dominant active trigger point or multi-target injections to the active trigger points identified within the study protocol. All injections will be performed under ultrasound guidance using the same local anesthetic and injection technique. The main outcome will be average pain intensity at 4 weeks. The study will also evaluate early pain response, neck-related disability, global improvement, procedure duration, pain after the procedure, and adverse events. The study aims to determine whether treating several active trigger points provides enough additional clinical benefit to justify the greater number of injections and increased procedure burden.

Virtual Pain Education for Spinal Cord Stimulation Patients

Chronic pain is a leading cause of disability in the United States. When standard treatments fail, many patients develop treatment resistant pain and undergo Spinal Cord Stimulation (SCS) therapy. SCS uses an implanted device to send mild electrical currents to the spine to block pain signals before they reach the brain. However, long-term success is often limited by how a patient's nervous system and brain process chronic pain, as well as psychological factors like anxiety and excessive worrying about pain, also known as catastrophizing. To improve outcomes, this study combines SCS therapy with Pain Neuroscience Education (PNE). PNE is an educational approach that teaches patients how the brain and nervous system handle pain signals, reframing pain as a process that can be changed rather than just ongoing tissue damage. The goal of this pilot trial is to test the feasibility of using virtual, remote PNE sessions to help patients reduce pain catastrophizing and anxiety, while building overall psychological resilience. Additionally, the study explores an innovative, objective way to monitor pain levels by analyzing short voice recordings. Researchers want to see if specific vocal features change when a person's pain is well-controlled versus when it is uncontrolled. Participants enrolled in this study will receive either 1) standard spinal cord stimulation or 2) spinal cord stimulation plus the intervention--a virtual, multi-session PNE delivered remotely over a secure telehealth platform. Throughout the study, participants will complete standard clinical surveys to measure their physical function, anxiety, pain catastrophizing, and emotional resilience using standardized tools. Participants will also provide short voice recordings, such as holding a sustained "/ah/" vowel sound, during their virtual assessments. This allows researchers to safely evaluate the direct relationship between subtle voice patterns and reported clinical pain levels.

Trapezius Oxygenation and Cervical Function in Chronic Neck Pain

The aim of this study is to investigate the relationship between trapezius muscle oxygenation and cervical range of motion, muscle strength, and disability in individuals with chronic neck pain.

Effects of Schroth-Based Exercise on Kyphosis Angle, Muscle Strength, Balance, Pain, and Quality of Life in Hyperkyphosis With Chronic Neck Pain

The normal thoracic kyphosis angle of the spine is 20-40°, however, an angle of more than 40° is referred to as postural kyphosis, increased kyphosis or hyperkyphosis. Although postural kyphosis negatively affects individuals' general health status, physical performance, and quality of life, there is still no standardized protocol for correcting the thoracic kyphosis angle. Conservative treatment approaches such as postural training and exercises, manual therapy, postural corrective kinesiotaping, and orthotic use have been recommended for managing increased thoracic kyphosis. While numerous studies have demonstrated the effectiveness of three-dimensional exercise programs in the treatment of scoliosis, research examining their impact on kyphosis remains considerably limited.Nevertheless, the potential of these exercises to promote neuromuscular reorganization suggests that they may be similarly effective in individuals with thoracic kyphosis. This randomized controlled trial aims to evaluate the effects of a Schroth-based three-dimensional exercise program on kyphosis angle, trunk muscle strength, balance, pain, and quality of life in individuals with postural hyperkyphosis and chronic neck pain.

Clinical and Brain Activity Assessment Before and After Physiotherapy in People With Chronic Non-specific Neck Pain

The goal of this clinical trial is to investigate whether electroencephalographic features are associated with the multidimensional clinical characteristics of adults with chronic non-specific neck pain and whether clinical and brain function measures change following physiotherapy. Participants with chronic non-specific neck pain will receive six weekly treatment sessions consisting of a manual physiotherapy and neck-specific exercise programme, including a home exercise programme. Clinical, psychophysical, and 64-channel electroencephalographic assessments will be performed at baseline and approximately one week after completion of the intervention. Clinical outcomes will also be reassessed 12 weeks after the last treatment session. Electroencephalographic recordings will be obtained while participants are seated comfortably and instructed to remain relaxed. EEG-derived measures will be examined in relation to pain intensity, neck-related disability, psychological and cognitive-affective factors, sleep quality, and psychophysical pain responses. Healthy participants without chronic neck pain will undergo a comparable baseline assessment to provide reference data for the interpretation of brain function in the clinical group.

Cervical Epidural Block in Chronic Neck Pain

Chronic neck pain can negatively affect daily activities, work ability, and quality of life. Cervical epidural block is commonly used to reduce pain and inflammation, while exercise and physical therapy aim to improve muscle strength, endurance, movement control, and physical function. However, there is limited evidence comparing cervical epidural block alone with its combined use with exercise or physical therapy. This study aims to compare the effects of three treatment approaches in patients with chronic neck pain associated with cervical disc pathology or degenerative changes. Participants will receive cervical epidural block alone, cervical epidural block combined with cervical stabilization exercises, or cervical epidural block combined with physical therapy. Pain intensity, neck-related disability, and quality of life will be evaluated before treatment and at 1, 3, and 6 months after treatment using the Numeric Rating Scale, Neck Disability Index, and 12-Item Short Form Health Survey. The study will determine whether adding exercise or physical therapy to cervical epidural block provides additional clinical and functional benefits.

Accessory Inspiratory Muscles in Chronic Neck Pain

This cross-sectional case-control study aims to investigate the ultrasonographic structural and functional characteristics of accessory inspiratory muscles in individuals with chronic non-specific neck pain and compare them with healthy controls. In addition, the relationships between accessory inspiratory muscle characteristics, diaphragm function, respiratory muscle strength, and pulmonary function parameters will be examined. The findings may improve understanding of the respiratory involvement associated with chronic neck pain and contribute to more comprehensive assessment strategies.

Electroacupuncture on Neck Muscle Stiffness in Chronic Neck Pain

This randomized, single-blind, placebo-controlled clinical trial aims to investigate the immediate physiological effects of a single session of electroacupuncture (EA) on neck muscle stiffness in individuals with chronic neck pain. While acupuncture is a widely used complementary therapy for musculoskeletal pain, high-quality, objective evidence demonstrating its immediate effects on muscle biomechanics remains limited. This study will utilize Shear Wave Elastography (SWE)-a non-invasive, objective ultrasound-based technology-to measure these changes. Adult participants aged 18 to 65 with non-specific chronic neck pain (lasting ≥ 3 months) will be randomly allocated into one of two groups: 1. True Electroacupuncture (EA) Group: Participants will receive a 20-minute session of active electroacupuncture with comfortable electrical stimulation at specific neck and tender points. 2. Sham Acupuncture (Placebo) Group: Participants will receive a 20-minute session of non-penetrating sham acupuncture with a deactivated electroacupuncture device to ensure participant blinding. The primary objective is to evaluate immediate changes in the stiffness of the upper trapezius muscle, measured objectively via SWE (as Young's Modulus in kPa) before and immediately after the intervention. Secondary objectives include assessing immediate post-treatment changes in subjective pain and stiffness (Visual Analogue Scale), Pressure Pain Threshold (PPT), and active Cervical Range of Motion (CROM), alongside a 7-day post-intervention follow-up questionnaire on neck function.

Prospective Case Series Evaluating 6-Month and 12-Month Outcomes After Cryoneurolysis for Chronic Pain

To prospectively describe patient-centered and health utilization outcomes through 12 months after cryoneurolysis performed as routine clinical care for chronic pain at Yale.

Physical Profile of Cervicogenic Headache: Comparison With Neck Pain and Healthy Controls

The goal of this observational study is to compare physical findings across three adult groups. Cervicogenic headache (CGH) is a headache linked to a problem in the neck. Neck pain may affect posture, muscle function, grip strength, and sensitivity to pressure. Researchers do not know whether CGH has a distinct pattern of these findings. The main questions are: * Do posture, grip strength, muscle stiffness, elasticity, and pressure sensitivity differ among the groups? * Are any differences more closely associated with CGH than with neck pain? Researchers will compare adults ages 25 through 60. One group will include people with CGH lasting at least three months. Another group will include people with neck pain lasting at least six months. People in the neck pain group will have no headaches. Healthy participants will have no neck pain or headaches. Researchers will not provide treatment or change participants' usual care. Each participant will complete one study visit lasting about 15 minutes. Participants will: * Answer short questions about their health and pain * Stand while researchers measure their head and neck posture * Squeeze a device that measures grip strength * Complete brief tests of neck muscle stiffness and elasticity * Tell researchers when applied pressure first becomes painful Researchers will compare results across the three groups. The findings may guide future CGH assessment and treatment research.

Effectiveness of Mulligan Mobilization on Chronic Neck Pain and Range of Motion

This randomized controlled trial was conducted to evaluate the effectiveness of adding Mulligan Mobilization with Movement (MWM) to conventional physiotherapy in patients with chronic mechanical neck pain. Seventy-six participants aged 18-65 years were randomly assigned to receive either conventional physiotherapy alone or conventional physiotherapy combined with MWM for four weeks. Pain intensity, cervical range of motion, and functional disability were assessed before and after the intervention. The study aimed to compare changes in pain intensity, cervical range of motion, and functional disability between the two treatment groups.

Diaphragmatic Myofascial Release Added to Neck Exercises for Chronic Neck Pain

Chronic neck pain can affect daily activities and may be associated with pain, disability, fear of movement, and fatigue. Exercise is commonly used to manage chronic neck pain, but some people continue to experience symptoms despite exercise treatment. This study will investigate whether adding diaphragmatic myofascial release, a hands-on manual therapy directed toward the diaphragm and surrounding tissues, to a neck exercise program provides greater benefits than neck exercises alone in adults with chronic neck pain. Sixty adults aged 25 to 60 years with chronic neck pain lasting more than three months will be randomly assigned to one of two groups. The control group will receive a supervised neck exercise program, while the intervention group will receive the same neck exercise program combined with diaphragmatic myofascial release and related diaphragmatic manual therapy. Both groups will receive treatment for six weeks, with three supervised sessions per week. Pain, neck-related disability, fear of movement, and fatigue will be assessed before treatment, immediately after the six-week intervention, and four weeks after completion of treatment. The study will examine whether adding diaphragmatic myofascial release to neck exercises leads to greater improvements in these outcomes compared with neck exercises alone.

Association Between Periodontal Disease and Chronic Neck Pain

This study investigates whether there is an association between periodontal disease (gum disease) and chronic neck pain and related functional disability. Participants aged 30-55 years will be grouped based on their periodontal health status (healthy, gingivitis, or periodontitis). Neck pain intensity will be assessed using the Visual Analog Scale (VAS), and functional disability will be measured using the Neck Disability Index (NDI). The study aims to determine whether periodontal disease severity is linked to the severity of neck pain and disability, which may help clarify a potential connection between oral health and musculoskeletal health.

Muscle Energy Technique Versus Myofascial Release in Chronic Non Specific Neck Pain

Chronic non-specific neck pain is a common musculoskeletal condition that can significantly affect daily activities, sleep quality, and overall quality of life. It is often associated with muscle tightness, poor posture, and reduced neck mobility without any specific underlying structural pathology such as fracture or nerve compression. This study aims to compare two commonly used physiotherapy treatment techniques: Muscle Energy Technique (MET) and Myofascial Release Therapy (MFR) in individuals with chronic non-specific neck pain. A total of 52 participants aged 18-45 years with neck pain lasting more than three months will be included in this randomized controlled trial. Participants will be randomly assigned to one of two groups: Group A: Conventional physiotherapy plus Muscle Energy Technique Group B: Conventional physiotherapy plus Myofascial Release Therapy Both groups will receive treatment twice weekly for four weeks . Conventional physiotherapy will include moist heat application and stretching exercises for neck muscles. In addition, one group will receive Muscle Energy Technique targeting the upper trapezius, levator scapulae, and scalene muscles, while the other group will receive Myofascial Release Therapy targeting the same muscle groups. Outcome measures will be assessed at baseline, at the second week, and at the fourth week. The study will evaluate: Pain intensity (Numeric Pain Rating Scale) Neck range of motion (Inclinometer) Sleep quality (Pittsburgh Sleep Quality Index) Neck-related disability (Neck Disability Index) The results of this study may help determine which technique is more effective in reducing pain, improving movement, enhancing sleep quality, and reducing disability in individuals with chronic non-specific neck pain. This may support clinicians in selecting the most appropriate treatment approach.

Effects of Different Myofascial Release Techniques on Function in Chronic Non-Specific Neck Pain

This single-center, three-arm randomized controlled trial compares the effects of different myofascial release techniques, combined with a structured exercise program, on functional outcomes in individuals with chronic non-specific neck pain (CNNP). Eligible participants (aged 18 to 45 years, neck pain for at least 3 months, pain intensity VAS at least 3, and myofascial trigger points in the upper-quarter muscles) are allocated by simple randomization into three groups: * Conventional Therapy Group: hot pack, conventional TENS, and a structured exercise program. * Manual Myofascial Release Group: conventional therapy plus therapist-applied manual myofascial release. * Self-Myofascial Release Group: conventional therapy plus supervised self-applied myofascial release using a duo-ball, balls, and a massage stick/cane. All interventions are delivered 3 days per week for 6 weeks. The primary outcome is pain intensity. Secondary outcomes include pressure pain threshold and tolerance, cervical range of motion, muscle stiffness, craniovertebral angle, cervical proprioception, muscle strength and endurance, disability, neck awareness, multidimensional biopsychosocial status, sleep quality, quality of life, and kinesiophobia. The aim is to determine whether manual or self-applied myofascial release, added to exercise, produces greater functional improvement in people with chronic non-specific neck pain.

The Correlation Between Central Conduction Time and Central Pain Syndrome in Chronic Neck Pain

To investigate the neurophysiological relationship between Central Conduction Time measured via Somatosensory evoked potentials and pain intensity in individuals suffering from chronic neck pain

Diaphragmatic Breathing and Electroacupuncture for Chronic Neck Pain

Chronic non specific neck pain is a prevalent musculoskeletal disorder with significant impact on pain, forward head posture, and neck disability. Diaphragmatic breathing has been shown to improve relaxation and reduce musculoskeletal pain, while electroacupuncture has potential benefits in modulating pain pathways. However, the combined effect of these interventions in chronic neck pain remains unexplored. This randomized clinical trial aims to evaluate the effectiveness of diaphragmatic breathing and electroacupuncture, in addition to physiotherapy care, compared to simple, focused breathing, electroacupuncture, and physiotherapy care. The primary outcomes are the numeric pain rating scale (NPRS) and neck disability index (NDI), while secondary outcome include craniovertebral angle (CVA).

Tech-Assisted Exercise Training in Chronic Neck Pain

In this study, women with chronic neck pain residing in Afyonkarahisar, Turkey, will participate in an exercise-based intervention. Both the control and experimental groups will engage in conventional exercise programs; however, the experimental group will also receive an additional technology-assisted exercise program. It is anticipated that these interventions will positively impact participants' daily living activities and functional abilities. The study aims to assess whether the inclusion of technology-supported exercises leads to superior outcomes compared to conventional exercises alone. The findings are expected to provide valuable evidence on the effectiveness of integrating technology-assisted exercise programs into physiotherapy and rehabilitation practices for women with chronic neck pain.

Acute Effects of Motor Imagery and Motor Control Exercises in Individuals With Chronic Neck Pain

The aim of this study is to compare the effects of single-session motor imagery and motor control exercises on pain, pressure pain threshold, cervical proprioception, and motor imagery in individuals with chronic neck pain.