Chronic Neck PainDMR-CNPNCT07761793
Diaphragmatic Myofascial Release Added to Neck Exercises for Chronic Neck Pain
A study testing Neck Exercise Program and Diaphragmatic Myofascial Release and Diaphragm-Directed Manual Therapy in people with Chronic Neck Pain, run by Abdelrahman Alghoul at 1 site in Palestinian Territories.
Trial summary
Chronic neck pain can affect daily activities and may be associated with pain, disability, fear of movement, and fatigue. Exercise is commonly used to manage chronic neck pain, but some people continue to experience symptoms despite exercise treatment. Read more about this study
- Who is it for?
- Ages 25 to 60 years
- Conditions the study is for
- Chronic Neck Pain
- What is being tested?
- Neck Exercise Program and Diaphragmatic Myofascial Release and Diaphragm-Directed Manual Therapy
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 sitePalestinian Territories
- Study dates
- Oct 2026to Jan 2027
- Phase
- Interventional
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 25 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Men and women aged 25-60 years.
- Diagnosis of chronic neck pain lasting longer than 3 months.
- Ability to understand and follow instructions.
Who cannot join
- Previous cervical spine surgery.
- Cervical radiculopathy or myelopathy.
- History of fracture, inflammatory disease, malignancy, or neurological disorder.
- Respiratory diseases such as chronic obstructive pulmonary disease (COPD) or severe asthma.
- Current vestibular disorder.
- Pregnancy.
- Receipt of physical therapy or manual therapy during the previous 3 months.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Palestinian Territories1 site
Alnos Street
Gaza
Abdelrahman Alghoul, 0595248697, a.s.alghoul98@gmail.com
About this study
Official title: Effect of Adding Diaphragmatic Myofascial Release to a Neck Exercise Program on Pain, Disability, Fatigue, and Kinesiophobia Among Patients With Chronic Neck Pain in the Gaza Strip: A Randomized Controlled Trial
Chronic neck pain can affect daily activities and may be associated with pain, disability, fear of movement, and fatigue. Exercise is commonly used to manage chronic neck pain, but some people continue to experience symptoms despite exercise treatment.
This study will investigate whether adding diaphragmatic myofascial release, a hands-on manual therapy directed toward the diaphragm and surrounding tissues, to a neck exercise program provides greater benefits than neck exercises alone in adults with chronic neck pain.
Read more
Sixty adults aged 25 to 60 years with chronic neck pain lasting more than three months will be randomly assigned to one of two groups. The control group will receive a supervised neck exercise program, while the intervention group will receive the same neck exercise program combined with diaphragmatic myofascial release and related diaphragmatic manual therapy. Both groups will receive treatment for six weeks, with three supervised sessions per week.
Pain, neck-related disability, fear of movement, and fatigue will be assessed before treatment, immediately after the six-week intervention, and four weeks after completion of treatment. The study will examine whether adding diaphragmatic myofascial release to neck exercises leads to greater improvements in these outcomes compared with neck exercises alone.
Read the detailed description
This study is a prospective, assessor-blinded, parallel-group randomized controlled trial that will be conducted at the outpatient Physical Therapy Clinic of Nasser Medical Complex in the Gaza Strip. The study aims to evaluate the added effect of diaphragmatic myofascial release and diaphragm-directed manual therapy when combined with a standardized neck exercise program in adults with chronic neck pain.
Participants will be randomly allocated in a 1:1 ratio to either an intervention group or a control group using a computer-generated random sequence. The control group will receive a supervised neck exercise program that includes deep cervical flexor training, cervical stabilization, stretching, postural correction, scapular strengthening, and a home exercise program. The intervention group will receive the same neck exercise program in addition to a diaphragm-focused intervention that includes manual diaphragm release, diaphragmatic myofascial release, release of accessory respiratory muscles, and breathing re-education.
The intervention period will last six weeks, with three supervised treatment sessions per week. Outcomes will be assessed at baseline, immediately after the intervention, and at a four-week follow-up. The clinical outcomes include neck-related disability measured using the Neck Disability Index (NDI), pain intensity measured using the Numeric Pain Rating Scale (NPRS), kinesiophobia measured using the Tampa Scale of Kinesiophobia (TSK-17), and fatigue measured using the Fatigue Severity Scale (FSS).
The study will compare changes over time between the intervention and control groups to determine whether adding the diaphragmatic intervention to neck exercises provides additional benefits for patients with chronic neck pain.
- Conditions
- Chronic Neck Pain
- Being tested
- Neck Exercise Program, Diaphragmatic Myofascial Release and Diaphragm-Directed Manual Therapy
- Keywords
- Chronic Neck Pain, Diaphragmatic Myofascial Release, Neck Exercise, Manual Therapy, Physical Therapy, Kinesiophobia, Fatigue, Neck Disability, Pain Intensity, Diaphragmatic Breathing
- Medical subject headings
- Kinesiophobia, Fatigue, Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Neck Exercise ProgramOther
A supervised neck exercise program including deep cervical flexor training, cervical stabilization exercises, stretching of the upper trapezius, levator scapulae, pectoralis major, and sternocleidomastoid muscles, postural correction exercises, scapular strengthening, and a daily home exercise program. Participants will attend 3 supervised sessions per week for 6 weeks.
Diaphragmatic Myofascial Release and Diaphragm-Directed Manual TherapyOther
The diaphragm-focused intervention includes manual diaphragm release using gentle sustained traction under the lower costal margin during exhalation; diaphragmatic myofascial release targeting the lower ribs, xiphoid region, costal margins, and related fascial structures; manual release of accessory respiratory muscles including the sternocleidomastoid, scalenes, upper trapezius, and pectoralis minor; and diaphragmatic breathing re-education.
| Study group | Role | What they receive |
|---|---|---|
| Neck Exercise Program | Active comparator | Participants will receive a supervised neck exercise program consisting of deep cervical flexor training, cervical stabilization exercises, stretching exercises, postural correction, scapular strengthening, and a home exercise program. The intervention will be provided for 6 weeks with 3 supervised sessions per week. Receives: Other: Neck Exercise Program |
| Neck Exercise Program + Diaphragmatic Intervention | Experimental | Participants will receive the same supervised neck exercise program as the active comparator group, combined with a diaphragm-focused intervention consisting of manual diaphragm release, diaphragmatic myofascial release, release of accessory respiratory muscles, and breathing re-education. Treatment will be provided for 6 weeks with 3 supervised sessions per week. Receives: Other: Neck Exercise Program; Other: Diaphragmatic Myofascial Release and Diaphragm-Directed Manual Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Neck Disability Index (NDI) Score
Neck-related disability will be assessed using the Neck Disability Index (NDI), a 10-item self-reported questionnaire assessing the impact of neck pain on daily functioning. Each item is scored from 0 to 5, producing a total score from 0 to 50, which can be expressed as a percentage from 0% to 100%. Higher scores indicate greater neck-related disability.
Measured: Baseline, immediately after the 6-week intervention, and 4 weeks after completion of the intervention
Change in Neck Disability Index (NDI) Score
Neck-related disability will be assessed using the Neck Disability Index (NDI), a 10-item self-reported questionnaire assessing the impact of neck pain on daily functioning. Each item is scored from 0 to 5, producing a total score from 0 to 50, which can be expressed as a percentage from 0% to 100%. Higher scores indicate greater neck-related disability.
Measured: Baseline, immediately after the 6-week intervention, and 4 weeks after completion of the intervention.
Secondary outcomes (3)
Change in Tampa Scale of Kinesiophobia (TSK-17) Score
Kinesiophobia will be assessed using the 17-item Tampa Scale of Kinesiophobia (TSK-17). Each item is rated on a 4-point Likert scale, with total scores ranging from 17 to 68. Higher scores indicate greater fear of movement or reinjury.
Measured: Baseline, immediately after the 6-week intervention, and 4 weeks after completion of the intervention.
Change in Numeric Pain Rating Scale (NPRS) Score
Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS). Participants will rate their average neck pain over the previous week on an 11-point scale from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate greater pain intensity.
Measured: Baseline, immediately after the 6-week intervention, and 4 weeks after completion of the intervention
Change in Fatigue Severity Scale (FSS) Score
Fatigue will be assessed using the 9-item Fatigue Severity Scale (FSS). Each item is rated from 1 to 7. The mean of the nine items will be calculated, resulting in a score from 1 to 7, with higher scores indicating greater fatigue severity.
Measured: Baseline, immediately after the 6-week intervention, and 4 weeks after completion of the intervention.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Aug 2026
- Study startOct 2026 (estimated)
- Primary completionJan 2027 (estimated)
- Study completionJan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Chronic Neck PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Abdelrahman Alghoul
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Abdelrahman Alghoul, Al-Azhar University - Gaza
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07761793
- Sponsor's protocol ID
- ALGHOUL-DMR-CNP-2026
- Acronym
- DMR-CNP
- Status last verified
- Aug 2026
- First submitted
- 8 Aug 2026
- Last updated
- 12 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of myofascial release: systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015 Jan;19(1):102-12. doi: 10.1016/j.jbmt.2014.06.001. Epub 2014 Jun 13.
PubMed 25603749Tatsios PI, Grammatopoulou E, Dimitriadis Z, Koumantakis GA. The Effectiveness of Cervical Spine and Diaphragm Manual Therapy Combined with Breathing Re-Education Exercises on Musculoskeletal, Respiratory and Psychophysiological Outcomes in Patients with Non-Specific Chronic Neck Pain: A Randomized Controlled Trial. J Clin Med. 2026 May 31;15(11):4266. doi: 10.3390/jcm15114266.
PubMed 42279128Tatsios PI, Grammatopoulou E, Dimitriadis Z, Koumantakis GA. 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. Diagnostics (Basel). 2022 Nov 4;12(11):2690. doi: 10.3390/diagnostics12112690.
PubMed 36359533Simoni G, Bozzolan M, Bonnini S, Grassi A, Zucchini A, Mazzanti C, Oliva D, Caterino F, Gallo A, Da Roit M. Effectiveness of standard cervical physiotherapy plus diaphragm manual therapy on pain in patients with chronic neck pain: A randomized controlled trial. J Bodyw Mov Ther. 2021 Apr;26:481-491. doi: 10.1016/j.jbmt.2020.12.032. Epub 2021 Feb 16.
PubMed 33992285