Deep Cervical Flexor and Sensorimotor Training for Chronic Neck Pain

Not Applicable

Recruiting

• Conditions: Mechanical Neck Pain

• Registration Number: NCT07040605
• Lead Sponsor: Al-Neelain University

Brief Summary

This randomized controlled trial aims to investigate the effectiveness of deep cervical flexor muscle training combined with sensorimotor (proprioception) training in patients with chronic mechanical neck pain. The study will be conducted in outpatient clinic of the faculty of physical therapy- Cairo University, involving 60 participants aged 20-40 years with neck pain persisting for more than three months. Participants will be randomly allocated into an experimental group receiving conventional physical therapy plus deep flexor and sensorimotor training, and a control group receiving conventional treatment alone. Outcome measures will include pain intensity, craniovertebral angle (CVA), cervical range of motion (ROM), segmental mobility, neuromotor control, proprioception (head repositioning accuracy), and respiratory function (FEV1 and PEF). Assessments will be performed at baseline and after four weeks of intervention. The study seeks to provide evidence-based recommendations for physiotherapy management of mechanical neck pain, particularly addressing the gaps in literature within the regional context.

Detailed Description

Participants in the experimental group will receive a structured four-week physiotherapy intervention consisting of conventional physical therapy treatment combined with deep cervical flexor muscle training and proprioception (sensorimotor) training. All participants will attend three supervised sessions per week, with each session lasting approximately 45-60 minutes. Conventional physiotherapy will include stretching exercises targeting the sternocleidomastoid, upper trapezius, levator scapulae, scalene, Rhomboids and pectoralis muscles, performed in three repetitions, holding each stretch for thirty seconds, strengthening exercises will be provided Isometrically for the cervical flexors, extensors and at sides using a prescription of three sets of ten repetitions with a ten-second hold and two minutes of rest between sets.

In addition, deep cervical flexor muscle training will be performed according to the protocol of Jull and Falla using a pressure biofeedback unit. Participants will be positioned in a supine crook-lying posture with the neck in a neutral position, and the air bag of the pressure biofeedback unit will be placed beneath the cervical lordosis and inflated to a baseline of 20 mmHg. Patients will be instructed to perform a gentle nodding action, increasing the pressure by 2 mmHg increments up to 30 mmHg. Each increment will be held for ten seconds, repeated in three sets of ten repetitions, with a two-minute rest between sets. To enhance activation of the deep flexors, patients will be instructed to keep their mouth open during the exercise.

Proprioception training will include head relocation practice, oculomotor exercises, and eye-head coordination exercises. Head relocation exercises will be conducted using a laser pointer attached to a helmet, with participants practicing relocating their head to a neutral position or predetermined positions, initially with eyes open using visual feedback and later progressing to eyes closed. Oculomotor exercises will begin with eye movements while keeping the head stationary, progressing to combined head and eye movements following visual targets. Eye-head coordination exercises will involve moving the eyes and head to the same side, followed by movements where the eyes lead and the head follows, and eventually progressing to eyes and head moving in opposite directions. Exercises will be progressed by increasing speed, range, and target difficulty. This proprioceptive training will also be performed three times per week for four weeks.

The control group will receive the conventional physical therapy program alone, without the additional deep cervical flexor or proprioception training components. Outcome measures for both groups will be assessed at baseline and after four weeks, including pain intensity using the Numeric Pain Rating Scale (NPRS), craniovertebral angle measured by the APECS mobile application, cervical range of motion via Digital Inclinometer, Segmental mobility using spinal mouse, neuromotor control using the Craniocervical Flexion Test with a pressure biofeedback unit, proprioception assessed through head repositioning accuracy tests, and respiratory function parameters (FEV1 and peak expiratory flow) measured with the spirometer.

Study Timeline

• Status Verified: 2025-06
• Study Start: 2025-06-19
• Study First Submitted: 2025-06-19
• Study First Submitted QC: 2025-06-19
• Last Update Submitted: 2025-06-26
• Study First Posted: 2025-06-27
• Last Update Posted: 2025-06-29
• Primary Completion: 2025-11
• Study Completion: 2025-12-01

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• Participants aged between 20-40 years.
• participant having neck pain report more than 4 in NPRS, and at least within the last three months known as chronic pain.
• participant with CVA more than 45 degrees and less than 50.
• Participant with poor cervical muscle endurance.

Exclusion Criteria

• Participant with acute neck pain (less than three month).
• Participant with radiated neck pain.
• Participant who undergone recent surgeries within the thoracic, shoulder girdle, and cervical spine regions.
• Participants who were already undergoing treatment for neck pain.
• Participant with fixed spinal deformity.
• Pregnant women.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Change in Pain Intensity Score on the Numeric Pain Rating Scale (NPRS) from Baseline to 4 Weeks	4 weeks	which will be measured using the Numeric Pain Rating Scale (NPRS), a validated 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain).

Secondary Outcome Measures

Name	Time	Method
Change in Cervical Range of Motion (ROM) in Degrees Measured by Digital Inclinometer from Baseline to 4 Weeks	4 weeks	Flexion, Extension and Rotation range will be assessed using the Digital Inclinometer,
Change in Neuromotor Control of the Deep Cervical Flexor Muscles Assessed by Craniocervical Flexion Test (CCFT) from Baseline to 4 Weeks	4 weeks	will be evaluated using the Craniocervical Flexion Test (CCFT) with a pressure biofeedback unit (PBU),
Change in Craniovertebral Angle (CVA) Measured by AI Posture Evaluation and Correction System (APECS) from Baseline to 4 Weeks	4 weeks	will be used as a key postural assessment parameter, measured via the AI Posture Evaluation and Correction System (APECS) mobile application, which provides reliable digital posture analysis using lateral photographic images to quantify forward head posture.
Change in Cervical Proprioceptive Function Assessed by Head Repositioning Accuracy (HRA) Test in centimetre from Baseline to 4 Weeks	4 weeks	will be evaluated through the Head Repositioning Accuracy (HRA) Test,
Change in Respiratory Function Parameters (FEV1 and PEF) Measured by Spirometer from Baseline to 4 Weeks	4 weeks	will be assessed by measuring forced expiratory volume in the first second (FEV1) and peak expiratory flow (PEF) using the spirometer

Trial Locations

Locations (1)

Out-patient clinic- Faculty of physical therapy; 🇪🇬 Cairo, Giza, Egypt