Effects of Combining Diaphragmatic Exercise with Physiotherapy on Chronic Neck Pain: A Randomized Clinical Trial
Abstract
Introduction: Chronic neck pain (CNP) is of the most common symptoms of musculoskeletal disorder. Diaphragmatic exercises can reduce pain, and disability, improve proprioception, and correct forward head posture (FHP) in patients with CNP. The present study aims to determine the effect of combining diaphragmatic exercises with physiotherapy on pain, disability, and active range of motions of cervical and FHP in individuals with CNP.
Materials and Methods: Thirty women with CNP were randomly divided into two combined groups of diaphragmatic exercises and physiotherapy (DEPT) and PHYSIOTHERAPY ALONE (PT). Each person received ten sessions of treatment over two weeks. The results were assessed in the first and tenth sessions as well as two weeks later. Pain intensity was measured by visual analogue scale (VAS), disability by neck disability index (NDI), cervical active range of motions (CAROMs) by goniometry, and FHP by a lateral photograph.
Results: The VAS, neck disability index (NDI), CAROMs, and FHP were improved after the tenth session and in a two-week follow-up (P<0.001). A significant difference was observed between the groups for average changes of VAS (P=0.04) and active extension (P<0.001) after the tenth session, while the average changes between the two groups of cervical active left lateral flexion (P=0.82) and left rotation (P=0.11) in the next two weeks was not significant.
Conclusion: Both groups showed improvement in neck pain, disability, CAROMs, and FHP. However, diaphragmatic exercises and physiotherapy (DEPT) seem to have more lasting effects. Therefore, it is recommended to evaluate and modify the breathing patterns in the first line of treatment programs for patients with CNP.
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[17]. Jung JH, Kim NS. Changes in training posture induce changes in the chest wall movement and respiratory muscle activation during respiratory muscle training. Journal of exercise rehabilitation. 2018 Oct;14(5):771. [DOI:10.12965/jer.1836366.183]
[18]. Mohan V, Ahmad NB, Tambi NB. Effect of respiratory exercises on neck pain patients: A pilot study. Polish Annals of Medicine. 2016 Feb 1;23(1):15-20. [DOI:10.1016/j.poamed.2016.01.001]
[19]. Menon VV, Baba MR, Pavankumar SS. Effects of Diaphragmatic Training on Posture and Stability in Asymptomatic Subjects: A Randomized Clinical Trial. Website: www. ijpot. com. 2020 Apr;14(02):2221. [DOI: https://doi.org/10.37506/ijpot.v14i2.2650]
[20]. Obayashi H, Urabe Y, Yamanaka Y, Okuma R. Effects of respiratory-muscle exercise on spinal curvature. Journal of sport rehabilitation. 2012 Feb 1;21(1):63-8. [DOI: 10.1123/jsr.21.1.63]
[21]. Alvandi F, and Letafatkar A. The Effect of Respiratory Exercises on Pain, Disability, Proprioception and Forward Head Angle in Female Patients with chronic Neck Pain. J Anesth Pain. JAP. 2018; 9 (1) :44-54. http://jap.iums.ac.ir/article-1-5356-en.html
[22]. Rampazo ÉP, de Andrade AL, da Silva VR, Back CG, Liebano RE. Photobiomodulation therapy and transcutaneous electrical nerve stimulation on chronic neck pain patients: Study protocol clinical trial (SPIRIT Compliant). Medicine. 2020 Feb;99(8). [DOI:10.1097/MD.0000000000019191]
[23]. Mani S, Sharma S, Omar B, Ahmad K, Muniandy Y, Singh DK. Quantitative measurements of forward head posture in a clinical settings: a technical feasibility study. European Journal of Physiotherapy. 2017 Jul 3;19(3):119-23. [DOI:10.1080/21679169.2017.1296888]
[24]. Mohammadi M, Janani L. Randomization in randomized clinical trials: From theory to practice. HAYAT. 2016; 22(2): 102-114. ttps://www.researchgate.net/publication/305245468
[25]. Boonstra AM, Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International journal of rehabilitation research. 2008 Jun 1;31(2):165-9. [DOI:10.1097/MRR.0b013e3282fc0f93]
[26]. Mousavi SJ, Parnianpour M, Montazeri A, Mehdian H, Karimi A, Abedi M, Ashtiani AA, Mobini B, Hadian MR. Translation and validation study of the Iranian versions of the Neck Disability Index and the Neck Pain and Disability Scale. Spine. 2007 Dec 15;32(26):E825-31. [DOI: 10.1097/BRS.0b013e31815ce6dd]
[27]. Foroutani H, Nakhostin Ansari N, Ansari N, Jalaei S. Investigating the responsiveness of the Persian version of functional rating index in patients with chronic non-specific neck pain: brief report. Tehran University Medical Journal TUMS Publications. 2018 Oct 10;76(7):498-502. http://tumj.tums.ac.ir/article-1-9118-en.html
[28]. Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion—comparison of three methods. Physical therapy. 1991 Feb 1;71(2):98-104. https://doi.org/10.1093/ptj/71.2.98
[29]. Falla D, Jull G, Russell T, Vicenzino B, Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Physical therapy. 2007 Apr 1;87(4):408-17 [DOI: 10.2522/ptj.20060009]
[30] Shaw BS, Shaw I. Static standing posture and pulmonary function in moderate-persistent asthmatics following aerobic and diaphragmatic breathing training. Pak J Med Sci. 2011;27(3):549-552. Pakistan Journal of Medical Sciences Online
[31]. Escortell-Mayor E, Riesgo-Fuertes R, Garrido-Elustondo S, Asúnsolo-del Barco A, Díaz-Pulido B, Blanco-Díaz M, Bejerano-Álvarez E, Group TT. Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain. Manual therapy. 2011 Feb 1;16(1):66-73. [DOI:10.1016/j.math.2010.07.003]
[32]. Chiu TT, Hui-Chan CW, Cheing G. A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clinical rehabilitation. 2005 Dec;19(8):850-60. [DOI: 10.1191/0269215505cr920oa]
[33]. Hanney WJ, Kolber MJ. Improving muscle performance of the deep neck flexors. Strength and Conditioning Journal. 2007 Jun 1;29(3):78. [DOI: 10.1519/00126548-200706000-00012]
[34]. Häkkinen A, Salo P, Tarvainen U, Wiren K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. Journal of rehabilitation medicine. 2007 Sep 5;39(7):575-9. [DOI:10.2340/16501977-0094]
[35]. Comerford M, Mottram S. Kinetic control-e-book: The management of uncontrolled movement. Elsevier Health Sciences; 2012 Jun 15.https://www.elsevier.com/books/kinetic-control/comerford/978-0-7295-4167-1
[36]. Chung S, Jeong YG. Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: A randomized controlled trial. Physiotherapy theory and practice. 2018 Dec 2;34(12):916-25. [DOI: 10.1080/09593985.2018.1430876]
[37]. HR DD, Hadadnezhad M, Letafkar A, Peolsson A. Effects of Adding Respiratory Exercises to the Therapeutic Routine in Smartphone Users With Forward Head Posture and Non-Specific Chronic Neck Pain: A Randomised Controlled Trial. 21 Aug 2020. [DOI:10.21203/rs.3.rs-53984/v1]
[38]. Stromberg SE, Russell ME, Carlson CR. Diaphragmatic breathing and its effectiveness for the management of motion sickness. Aerosp Med Hum Perform 2015; 86: 452–457. [DOI: https://doi.org/10.3357/AMHP.4152.2015]
[39]. M. Mourya, A. S. Mahajan, N. P. Singh, and A. K. Jain, “Effect of slow- and fast-breathing exercises on autonomic functions in patients with essential hypertension,” Journal of Alternative and Complementary Medicine, vol. 15, no. 7, pp. 711–717, 2009. [https://doi.org/10.1089/acm.2008.0609]
[40]. Kolar P, Neuwirth J, Sanda J, et al. Analysis of diaphragm movement during tidal
breathing and during its activation while breath holding using MRI synchronized with spirometry. Physiol Res 2009; 58: 383–392. [DOI: 10.33549/physiolres.931376]
[41]. Seals DR, Suwarno NO, Dempsey JA. Influence of lung volume on sympathetic nerve discharge in normal humans. Circ Res 1990; 67: 130–141. [https://doi.org/10.1161/01.RES.67.1.130].
[2]. Hoy D, March L, Woolf A, Blyth F, Brooks P, Smith E, Vos T, Barendregt J, Blore J, Murray C, Burstein R. The global burden of neck pain: estimates from the global burden of disease 2010 study. Annals of the rheumatic diseases. 2014 Jul 1;73(7):1309-15. [DOI: 10.1136/annrheumdis-2013-204627]
[3]. Khosrokiani Z, Letafatkar A, Sokhanguei Y. Long-term effect of direction-movement control training on female patients with chronic neck pain. Journal of bodywork and movement therapies. 2018 Jan 1;22(1):217-24. [DOI: 10.1016/j.jbmt.2017.06.004]
[4]. Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomized controlled trial. Bmj. 2003 Aug 28;327(7413):475. [DOI: https://doi.org/10.1136/bmj.327.7413.475]
[5]. Hagberg M, Wegman DH. Prevalence rates and odds ratios of shoulder-neck diseases in different occupational groups. Occupational and environmental medicine. 1987 Sep 1;44(9):602-10. [DOI: 10.1136/oem.44.9.602]
[6]. Hush JM, Maher CG, Refshauge KM. Risk factors for neck pain in office workers: a prospective study. BMC musculoskeletal disorders. 2006 Dec;7(1):1-5. [DOI: 10.1186/1471-2474-7-81]
[7]. Im B, Kim Y, Chung Y, Hwang S. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. Journal of physical therapy science. 2015;28(3):951-5. [DOI: 10.1589/jpts.28.951]
[8]. Kapreli E, Vourazanis E, Strimpakos N. Neck pain causes respiratory dysfunction. Medical hypotheses. 2008 Jan 1;70(5):1009-13. [DOI: 10.1016/j.mehy.2007.07.050]
[9]. Lin F, Parthasarathy S, Taylor SJ, Pucci D, Hendrix RW, Makhsous M. Effect of different sitting postures on lung capacity, expiratory flow, and lumbar lordosis. Archives of physical medicine and rehabilitation. 2006 Apr 1;87(4):504-9. [DOI:10.1016/j.apmr.2005.11.031]
[10]. Noh DK, Lee JJ, You JH. Diaphragm breathing movement measurement using ultrasound and radiographic imaging: a concurrent validity. Bio-medical materials and engineering. 2014 Jan 1;24(1):947-52. [DOI: 10.3233/BME-130889]
[11]. Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. Hypocapnia in patients with chronic neck pain: association with pain, muscle function, and psychologic states. American journal of physical medicine & rehabilitation. 2013 Sep 1;92(9):746-54. [DOI: 10.1097/PHM.0b013e31829e74f7]
[12]. Kim JK, Lee SJ. Effect of stretching exercise as work-related musculoskeletal pain of neck and shoulder. J Kor Alliance Health Phys Edu. 2004;43:655-2. [DOI: 10.1177/0269215515575747]
[13]. Letafatkar A, Taghavi M, Alizadeh MH, Hadadnezhad M, Norouzi H. The effect of one period of exercise program on non athlete's neck ROM and chronic neck pain. Journal of Research in Rehabilitation Sciences. 2011 Apr 4;7(1). [DOI: 10.22122/jrrs.v7i1.156]
[14]. Arami J, Rezasoltani A, Khalkhali ZM, Rahnama L. The effect of two exercise therapy programs (proprioceptive and endurance training) to treat patients with chronic non-specific neck pain. Journal of Babol University of Medical Sciences, 2012. 14(1): p. 77-84. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=279329
[15]. Kapreli E, Vourazanis E, Billis E, Oldham JA, Strimpakos N. Respiratory dysfunction in chronic neck pain patients. A pilot study. Cephalalgia. 2009 Jul;29(7):701-10. [DOI:10.1111/j.1468-2982.2008.01787.x]
[16]. Perri MA, Halford E. Pain and faulty breathing: a pilot study. Journal of Bodywork and Movement Therapies. 2004 Oct 1;8(4):297-306. [DOI:10.1016/S1360-8592(03)00085-8]
[17]. Jung JH, Kim NS. Changes in training posture induce changes in the chest wall movement and respiratory muscle activation during respiratory muscle training. Journal of exercise rehabilitation. 2018 Oct;14(5):771. [DOI:10.12965/jer.1836366.183]
[18]. Mohan V, Ahmad NB, Tambi NB. Effect of respiratory exercises on neck pain patients: A pilot study. Polish Annals of Medicine. 2016 Feb 1;23(1):15-20. [DOI:10.1016/j.poamed.2016.01.001]
[19]. Menon VV, Baba MR, Pavankumar SS. Effects of Diaphragmatic Training on Posture and Stability in Asymptomatic Subjects: A Randomized Clinical Trial. Website: www. ijpot. com. 2020 Apr;14(02):2221. [DOI: https://doi.org/10.37506/ijpot.v14i2.2650]
[20]. Obayashi H, Urabe Y, Yamanaka Y, Okuma R. Effects of respiratory-muscle exercise on spinal curvature. Journal of sport rehabilitation. 2012 Feb 1;21(1):63-8. [DOI: 10.1123/jsr.21.1.63]
[21]. Alvandi F, and Letafatkar A. The Effect of Respiratory Exercises on Pain, Disability, Proprioception and Forward Head Angle in Female Patients with chronic Neck Pain. J Anesth Pain. JAP. 2018; 9 (1) :44-54. http://jap.iums.ac.ir/article-1-5356-en.html
[22]. Rampazo ÉP, de Andrade AL, da Silva VR, Back CG, Liebano RE. Photobiomodulation therapy and transcutaneous electrical nerve stimulation on chronic neck pain patients: Study protocol clinical trial (SPIRIT Compliant). Medicine. 2020 Feb;99(8). [DOI:10.1097/MD.0000000000019191]
[23]. Mani S, Sharma S, Omar B, Ahmad K, Muniandy Y, Singh DK. Quantitative measurements of forward head posture in a clinical settings: a technical feasibility study. European Journal of Physiotherapy. 2017 Jul 3;19(3):119-23. [DOI:10.1080/21679169.2017.1296888]
[24]. Mohammadi M, Janani L. Randomization in randomized clinical trials: From theory to practice. HAYAT. 2016; 22(2): 102-114. ttps://www.researchgate.net/publication/305245468
[25]. Boonstra AM, Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International journal of rehabilitation research. 2008 Jun 1;31(2):165-9. [DOI:10.1097/MRR.0b013e3282fc0f93]
[26]. Mousavi SJ, Parnianpour M, Montazeri A, Mehdian H, Karimi A, Abedi M, Ashtiani AA, Mobini B, Hadian MR. Translation and validation study of the Iranian versions of the Neck Disability Index and the Neck Pain and Disability Scale. Spine. 2007 Dec 15;32(26):E825-31. [DOI: 10.1097/BRS.0b013e31815ce6dd]
[27]. Foroutani H, Nakhostin Ansari N, Ansari N, Jalaei S. Investigating the responsiveness of the Persian version of functional rating index in patients with chronic non-specific neck pain: brief report. Tehran University Medical Journal TUMS Publications. 2018 Oct 10;76(7):498-502. http://tumj.tums.ac.ir/article-1-9118-en.html
[28]. Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion—comparison of three methods. Physical therapy. 1991 Feb 1;71(2):98-104. https://doi.org/10.1093/ptj/71.2.98
[29]. Falla D, Jull G, Russell T, Vicenzino B, Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Physical therapy. 2007 Apr 1;87(4):408-17 [DOI: 10.2522/ptj.20060009]
[30] Shaw BS, Shaw I. Static standing posture and pulmonary function in moderate-persistent asthmatics following aerobic and diaphragmatic breathing training. Pak J Med Sci. 2011;27(3):549-552. Pakistan Journal of Medical Sciences Online
[31]. Escortell-Mayor E, Riesgo-Fuertes R, Garrido-Elustondo S, Asúnsolo-del Barco A, Díaz-Pulido B, Blanco-Díaz M, Bejerano-Álvarez E, Group TT. Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain. Manual therapy. 2011 Feb 1;16(1):66-73. [DOI:10.1016/j.math.2010.07.003]
[32]. Chiu TT, Hui-Chan CW, Cheing G. A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clinical rehabilitation. 2005 Dec;19(8):850-60. [DOI: 10.1191/0269215505cr920oa]
[33]. Hanney WJ, Kolber MJ. Improving muscle performance of the deep neck flexors. Strength and Conditioning Journal. 2007 Jun 1;29(3):78. [DOI: 10.1519/00126548-200706000-00012]
[34]. Häkkinen A, Salo P, Tarvainen U, Wiren K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. Journal of rehabilitation medicine. 2007 Sep 5;39(7):575-9. [DOI:10.2340/16501977-0094]
[35]. Comerford M, Mottram S. Kinetic control-e-book: The management of uncontrolled movement. Elsevier Health Sciences; 2012 Jun 15.https://www.elsevier.com/books/kinetic-control/comerford/978-0-7295-4167-1
[36]. Chung S, Jeong YG. Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: A randomized controlled trial. Physiotherapy theory and practice. 2018 Dec 2;34(12):916-25. [DOI: 10.1080/09593985.2018.1430876]
[37]. HR DD, Hadadnezhad M, Letafkar A, Peolsson A. Effects of Adding Respiratory Exercises to the Therapeutic Routine in Smartphone Users With Forward Head Posture and Non-Specific Chronic Neck Pain: A Randomised Controlled Trial. 21 Aug 2020. [DOI:10.21203/rs.3.rs-53984/v1]
[38]. Stromberg SE, Russell ME, Carlson CR. Diaphragmatic breathing and its effectiveness for the management of motion sickness. Aerosp Med Hum Perform 2015; 86: 452–457. [DOI: https://doi.org/10.3357/AMHP.4152.2015]
[39]. M. Mourya, A. S. Mahajan, N. P. Singh, and A. K. Jain, “Effect of slow- and fast-breathing exercises on autonomic functions in patients with essential hypertension,” Journal of Alternative and Complementary Medicine, vol. 15, no. 7, pp. 711–717, 2009. [https://doi.org/10.1089/acm.2008.0609]
[40]. Kolar P, Neuwirth J, Sanda J, et al. Analysis of diaphragm movement during tidal
breathing and during its activation while breath holding using MRI synchronized with spirometry. Physiol Res 2009; 58: 383–392. [DOI: 10.33549/physiolres.931376]
[41]. Seals DR, Suwarno NO, Dempsey JA. Influence of lung volume on sympathetic nerve discharge in normal humans. Circ Res 1990; 67: 130–141. [https://doi.org/10.1161/01.RES.67.1.130].
| Files | ||
| Issue | Vol 17 No 1 (2023) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v17i1.11307 | |
| Keywords | ||
| Diaphragmatic exercise Strength exercise Pain Chronic neck pain (CNP) | ||
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How to Cite
1.
Mosallaiezadeh S, Bashardoust Tajali S, Shadmehr A, Attarbashi Moghadam B. Effects of Combining Diaphragmatic Exercise with Physiotherapy on Chronic Neck Pain: A Randomized Clinical Trial. jmr. 2023;17(1):83-92.
