The Effectiveness of Spinal, Diaphragmatic, and Specific Stabilization Exercise Manual Therapy and Respiratory-Related Interventions in Patients with Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis

Abstract

Patients with nonspecific chronic neck pain (NSCNP) exhibit respiratory dysfunction. This systematic review aimed to analyze randomized controlled trials (RCTs) investigating the effect of spinal and/or diaphragmatic and/or specific stabilization exercise manual therapy and/or respiratory exercises on musculoskeletal and respiratory diagnostic outcomes in patients with NSCNP. A systematic search and selection of RCTs was performed in three scientific databases (Pubmed, Scopus, and Physiotherapy Evidence Database (PEDro)) and one search engine (Google Scholar) from inception to April 2022. Relevant studies published in the English language were extracted, evaluated, and independently rated for methodological quality (PEDro scale). The quality of the evidence was assessed with the GRADE approach. Out of 1089 studies collected in total, 1073 were excluded (i.e., did not meet the inclusion criteria or were duplicates). Sixteen RCTs were finally included, rated on 5.62/10 (PEDro score) on average for methodological quality. Overall, there was sparse evidence that spinal and/or diaphragmatic manual therapy and/or trunk stabilization exercises and/or respiratory exercises significantly improved pain, disability, and respiratory outcomes in patients with NSCNP immediately post-treatment. However, the clinical heterogeneity between studies was significant, and the level of certainty of the evidence was low to very low. More, high-quality RCTs are required, contributing to the holistic diagnostic monitoring and management of patients with NSCNP.

The Effectiveness of Manual Therapy in the Cervical Spine and Diaphragm, in Combination with Breathing Reeducation Exercises, in Patients with Non-Specific Chronic Neck Pain: Protocol for Development of Outcome Measures and a Randomized Controlled Trial

“…The study aspires to provide a more holistic approach in patients with a condition which has, up until now, been considered to involve mainly the neuromusculoskeletal system [ 18 , 19 ]. The specific components of this approach have not yet been determined.…”

“…The specific components of this approach have not yet been determined. It is possible that the release of the diaphragm, in combination with breathing reeducation, will not only decrease pain and other musculoskeletal-related outcomes, but also may improve the body’s ability to achieve homeostasis, in general [ 19 ].…”

“…Only one previous systematic review, which mainly addressed the association between MT, respiratory parameters, and NSCNP, could be identified in the literature [ 18 ]. However, our subsequent systematic review demonstrated the lack of existing clinical trials in examining the effectiveness of mobilization techniques of the cervical spine and diaphragm in combination with breathing reeducation exercises for NSCNP relief [ 19 ]. Moreover, it highlighted the absence of clinical trials in analyzing the effectiveness of diaphragmatic manual techniques or cervical mobilization techniques as a single intervention regaridng respiratory outcomes in patients with NSCNP [ 19 ].…”

“…However, our subsequent systematic review demonstrated the lack of existing clinical trials in examining the effectiveness of mobilization techniques of the cervical spine and diaphragm in combination with breathing reeducation exercises for NSCNP relief [ 19 ]. Moreover, it highlighted the absence of clinical trials in analyzing the effectiveness of diaphragmatic manual techniques or cervical mobilization techniques as a single intervention regaridng respiratory outcomes in patients with NSCNP [ 19 ].

Figure 1 The three aspects of chronic neck pain dysfunction, with corresponding references.

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