Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial

Abstract

Neck pain and forward head posture (FHP) are typical in prolonged smartphone users and need to be targeted for treatment. We aimed to compare the effect of a routine therapeutic program with and without respiratory exercises on smartphone users with FHP and non-specific chronic neck pain (NSCNP). Sixty patients (aged 24.7 ± 2.1 years) with FHP and NSCNP were randomly assigned to the routine therapeutic program (n = 20), combined respiratory exercises with a routine therapeutic program (n = 20), or control (n = 20) groups. At baseline, there was no difference among groups at all variables. Each programme was implemented three times a week for eight weeks. Primary Outcome was pain measured by visual analogue scale (VAS), and secondary ones were forward head angle, the activity of specific muscles, and respiratory patterns, measured by photogrammetry, electromyography and manual, respectively. All outcomes were measured at baseline and eight weeks post-treatment. We used the repeated measures analysis of variance to examine the interaction between time and group, paired t-test for intragroup comparison, one-way analysis of variance for intergroup comparison, and Tukey post hoc test at a significant level 95% was used. There were significant differences in the combined group compared with the routine therapeutic group (P = 0.03) for diaphragm muscle activation, respiratory balance (P = 0.01), and the number of breaths (P = 0.02). There were significant within-group changes from baseline to post-treatment in the combined group for all outcomes above, but no changes in the therapeutic exercise routine group. Despite respiratory pattern, none of the secondary outcomes proved to be superior in the combination group compared to the routine therapeutic program in smartphone users with FHP and NSCNP. Future studies with longer follow-up assessments could strengthen these results.Trial registration: Current Controlled Trials using the IRCT website with ID number of, IRCT20200212046469N1 “Prospectively registered” at 04/03/2020.

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

“…On average, the methodological quality score of all included studies rated with the PEDro scale ( Table 2 ) was 5.62/10. Specifically, only one study was rated 9/10 [ 20 ], two 8/10 [ 21 , 22 ], five 6/10 [ 23 , 24 , 25 , 26 , 27 ], three 5/10 [ 28 , 29 , 30 ], and five 4/10 [ 31 , 32 , 33 , 34 , 35 ].…”

“…Participant details are presented as Supplementary Material (Table S2) . All the included studies mentioned the exact number of participants allocated to each group, their age, the sex distribution of participants (except for two studies [ 22 , 34 ]), their BMI (except for one study [ 23 ]), and the duration of symptoms. With the exception of two trials, 14 of the 16 included studies conducted an a priori sample size calculation to attain a power level of at least 80% at a significance level of 0.05 for one of their primary outcome measures [ 29 , 32 ].…”

“…A moderate effect size [SMD (95% CI) = −0.76 (−1.5 to −0.03), favoring combined MT] with statistical significance (p < 0.001) and no statistical heterogeneity was noted, based, however, on low-quality evidence (Table 3A). The effects of SE with conventional physiotherapy compared to conventional physiotherapy on pain were evaluated by four studies [22,26,30,33] including 140 participants in total (Figure 4A). A large effect size [SMD (95% CI) = −1.65 (−2.99 to −0.31), favoring SE] with statistical significance (p = 0.01) was noted but with high statistical heterogeneity (I 2 = 93%) and based on very low-quality evidence (Table 3C).…”

“…A large effect size [SMD (95% CI) = −1.65 (−2.99 to −0.31), favoring SE] with statistical significance (p = 0.01) was noted but with high statistical heterogeneity (I 2 = 93%) and based on very low-quality evidence (Table 3C). [22,26,30,33]) and (B) disability (references [26,30,31,33]).…”

“…A large effect size [SMD (95% CI) = −0.91 (−1.45 to −0.36), favoring RRI] with statistical significance (p < 0.001) and no statistical heterogeneity was noted, based, however, on low-quality evidence (Table 3D). [21,22,24,25,27,29,32,35]), (B) disability (references [23,24,27,29,32]), (C) maximum voluntary ventilation (references [25,32]), and (D) chest wall expansion (references [25,32]).…”