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. 2022 Nov 4;12(11):2690.
doi: 10.3390/diagnostics12112690.

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

Petros I Tatsios  1   2 , Eirini Grammatopoulou  1   2 , Zacharias Dimitriadis  3 , George A Koumantakis  1   2
Affiliations

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

Petros I Tatsios et al. Diagnostics (Basel). .

Abstract

Until now, non-specific chronic neck pain has mainly been considered as a musculoskeletal system dysfunction, with associated psychological involvement due to its prolonged or recurrent nature. However, patients with non-specific chronic neck pain frequently additionally exhibit respiratory dysfunction. Emerging evidence suggests that addressing the respiratory dysfunction in these patients will provide additional therapeutic benefits in musculoskeletal and respiratory-related outcomes for several reasons (biomechanical, biochemical, and psychological). Motor control dysfunction of the muscles surrounding the spine (diaphragm included) negatively affects the mechanics and biochemistry of breathing (pH-homeostasis). An impaired and ineffective breathing pattern has been recognized as the primary source of many unexplained symptoms (anxiety, depression, confusion, chest pain, hypocapnia, and breathlessness) in patients with non-specific chronic neck pain. The proposed protocol's purpose is dual: to assess the relative effectiveness of manual therapy in the cervical spine and the diaphragm, in combination with breathing reeducation exercises, along with cervical spine manual therapy or usual physical therapy care on the underlying dysfunctions in patients with non-specific chronic neck pain via a randomized controlled clinical trial, and to validate part of the outcome measures. Several musculoskeletal and respiratory dysfunction outcomes will be employed to delimit the initial extent and level of dysfunction and its resolution with the treatments under study.

Keywords: breathing exercises; breathing reeducation; chronic neck pain; diaphragm; manual therapy; respiratory dysfunction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The three aspects of chronic neck pain dysfunction, with corresponding references. (red arrow mean increase or decrease).
Figure 2
Figure 2
Design of the trial.
Figure 3
Figure 3
Order of outcome assessments.
See this image and copyright information in PMC

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References

    1. Genebra C.V.D.S., Maciel N.M., Bento T.P.F., Simeão S.F.A.P., De Vitta A. Prevalence and factors associated with neck pain: A population-based study. Braz. J. Phys. Ther. 2017;21:274–280. doi: 10.1016/j.bjpt.2017.05.005. - DOI - PMC - PubMed
    1. Cieza A., Causey K., Kamenov K., Hanson S.W., Chatterji S., Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:2006–2017. doi: 10.1016/S0140-6736(20)32340-0. - DOI - PMC - PubMed
    1. Peng B., Yang L., Li Y., Liu T., Liu Y. Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review. Pain Ther. 2021;10:143–164. doi: 10.1007/s40122-020-00230-z. - DOI - PMC - PubMed
    1. MacDermid J.C., Walton D.M., Bobos P., Lomotan M., Carlesso L.A. Qualitative Description of Chronic Neck Pain has Implications for Outcome Assessment and Classification. Open Orthop. J. 2016;10:746–756. doi: 10.2174/1874325001610010746. - DOI - PMC - PubMed
    1. Treede R.D., Rief W., Barke A., Aziz Q., Bennett M.I., Benoliel R., Cohen M., Evers S., Finnerup N.B., First M.B., et al. A classification of chronic pain for ICD-11. Pain. 2015;156:1003–1007. doi: 10.1097/j.pain.0000000000000160. - DOI - PMC - PubMed

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