Chronic Neck Pain (CNP) is a common musculoskeletal disorder that affects a significant proportion of the general population. It is characterized by persistent pain and stiffness in the neck and upper shoulder region, often resulting in reduced range of motion, muscle weakness, and decreased quality of life. Standard cervical physiotherapy has been widely used as a primary treatment for CNP, but the literature on its effectiveness in reducing pain and improving function remains inconclusive. Recently, there has been growing interest in the role of diaphragm manual therapy (DMT) as an adjunct treatment for CNP. This article reports the results of a randomized controlled trial aimed at investigating the effects of DMT in combination with standard cervical physiotherapy on pain, cervical active range of motion, pain pressure threshold, disability, and quality of life in patients with CNP.

The trial was conducted by Bozzolan et al. (2021) in a private practice clinic and enrolled 40 patients with CNP who were randomly assigned to receive either three 30-minute sessions of standard cervical physiotherapy and DMT or Sham Diaphragm Technique (SDT). Participants and assessors were blinded to the treatment assignment. The primary outcome was pain, and the secondary outcomes were cervical active range of motion, pain pressure threshold, disability, and quality of life measured at baseline, before and after each session, at 3 and 6 months. Adverse events related to the intervention were also monitored. A non-parametric multivariate approach (combined permutation test) was applied to assess the effect of the treatment on all the outcomes, and an intention-to-treat analysis was performed.

The results of the study showed that the addition of DMT to standard cervical physiotherapy led to a statistically significant improvement in the overall outcomes compared to the SDT group. The combined permutation test showed a significant higher improvement in the DMT group compared to the SDT group (p-value = 0.0002). However, the between-group comparisons on single outcomes showed a statistically significant improvement only for the pain pressure threshold on the upper trapezius (adjusted p-value = 0.029). No adverse events related to the intervention were registered.

These findings suggest that the addition of DMT to standard cervical physiotherapy may lead to a better global outcome in patients with CNP. However, the clinical relevance of this improvement is unclear, and the primary outcome of pain seems to have no significant role. Therefore, further studies are needed to confirm and clarify these results.

Reference: Simoni G, Bozzolan M, Bonnini S, Grassi A, Zucchini A, Mazzanti C, Oliva D, Caterino F, Gallo A, Da Roit M. Effectiveness of standard cervical physiotherapy plus diaphragm manual therapy on pain in patients with chronic neck pain: A randomized controlled trial. J Bodyw Mov Ther. 2021 Apr;26:481-491. doi: 10.1016/j.jbmt.2020.12.032. Epub 2021 Feb 16. PMID: 33992285.