Effects of DRT on Neck Pain, ROM, and Chest Expansion in Patients With CR

NCT07628348 | Recruiting

• 1 other identifier: REC/RCR & AHS/25/0131
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to determine the effects of the diaphragmatic release technique on neck pain, cervical range of motion, and chest expansion in patients with cervical radiculopathy. Participants will be randomized to either the baseline treatment or the experimental group for five weeks.

Conditions

Cervical Radiculopathy

Keywords

Neck Pain; Radiculopathy; Range of Motion; Diaphragm; Musculoskeletal Manipulation

Outcome Measures

Primary Outcomes (6)

• Numeric Pain Rating scale

  Change from baseline in neck pain intensity will be measured using the Numeric Pain Rating Scale (NPRS). NPRS is scored from 0 to 10, where 0 indicates no pain and 10 indicates worst imaginable pain.

  4th week

• ROM Cervical Spine (Flexion)

  Change from baseline range of motion in cervical flexion will be measured using a universal goniometer.

  4th week

• ROM Cervical Spine (Extension)

  Change from baseline range of motion in cervical extension will be measured using a universal goniometer.

  4th week

• ROM Cervical Spine (Lateral Flexion)

  Change from baseline range of motion in cervical lateral flexion will be measured using a universal goniometer.

  4th week

• ROM Cervical Spine (Rotation)

  Change from baseline range of motion in cervical rotation will be measured using a universal goniometer.

  4th week

• Chest Expansion

  Change from baseline in chest expansion will be measured using a measuring tape at the axillary level. Normal chest expansion is 4-7 cm.

  4th week

Study Arms (2)

Diaphragmatic Release Technique

EXPERIMENTAL

Diaphragmatic release technique along with cervical distraction, cervical isometrics, and neurodynamic mobilization.

Other: Diaphragmatic Release Technique

Traditional Physical Therapy

ACTIVE COMPARATOR

Cervical distraction, cervical isometrics, and neurodynamic mobilization.

Other: Traditional Physical Therapy

Interventions

Diaphragmatic Release Technique OTHER

The experimental group will be given the diaphragmatic release technique for 5 mins along with cervical distraction. 10 repetitions x 1 set and 10 sec hold for 3 days/week, and cervical isometrics (flexion, extension, lateral flexion, and rotation) 10 reps x 3 sets for 3 days/week, along with neurodynamic mobilization of the median and ulnar nerve 10 reps x 3sets for 3 days/week each session will be of 40 mins for a total of 4 weeks

Diaphragmatic Release Technique

Traditional Physical Therapy OTHER

cervical distraction. 10 repetitions x 1 set and 10 sec hold for 3 days/week, and cervical isometrics (flexion, extension, lateral flexion, and rotation) 10 reps x 3 sets for 3 days/week, along with neurodynamic mobilization of the median and ulnar nerve 10 reps x 3sets for 3 days/week each session will be of 40 mins for a total of 4 weeks

Traditional Physical Therapy

Eligibility Criteria

• Age: 35 Years - 55 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Presence of unilateral neck pain and paresthesia symptoms for about 2 months
• Presence of posterolateral disc herniation at the C4-C7 level.
• A positive spurling test
• Positive upper limb neural tension tests for the median and ulnar nerve
• Cervical rotation towards the painful side of less than 60 degrees
• Chest Expansion of less than 4 cm

You may not qualify if:

• Any tumor
• Fracture
• Osteoporosis
• Scoliosis
• Cervical and shoulder instability
• Diabetic neuropathy
• History or presence of a respiratory disease

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Iffat Anwar Medical Complex

Lahore, Punjab Province, 54600, Pakistan

RECRUITING

Related Publications (18)

• Rafiq S, Zafar H, Gillani SA, Waqas MS, Zia A, Liaqat S, Rafiq Y. Comparison of neural mobilization and conservative treatment on pain, range of motion, and disability in cervical radiculopathy: A randomized controlled trial. PLoS One. 2022 Dec 6;17(12):e0278177. doi: 10.1371/journal.pone.0278177. eCollection 2022.

  PMID: 36472990 BACKGROUND

• Cheng KC, Hii EYX, Lin YN, Kuo YL, Tsai YJ. Effects of manual diaphragm release on pain, disability and diaphragm function in patients with chronic neck pain: a pilot randomized controlled trial. BMC Complement Med Ther. 2025 Oct 1;25(1):349. doi: 10.1186/s12906-025-05090-8.

  PMID: 41034882 BACKGROUND

• Yousefiyan R, Kordi Yoosefinejad A, Jalli R, Rezaei I. Comparison of breathing pattern and diaphragmatic motion in patients with unilateral cervical radiculopathy and asymptomatic group. BMC Pulm Med. 2023 Dec 9;23(1):498. doi: 10.1186/s12890-023-02804-x.

  PMID: 38071289 BACKGROUND

• Anwar S, Arsalan A, Zafar H, Ahmad A, Hanif A. Effects of breathing reeducation on cervical and pulmonary outcomes in patients with non specific chronic neck pain: A double blind randomized controlled trial. PLoS One. 2022 Aug 25;17(8):e0273471. doi: 10.1371/journal.pone.0273471. eCollection 2022.

  PMID: 36006997 BACKGROUND

• Kawabata T, Tobino K. Bilateral Diaphragmatic Nerve Paralysis Secondary to Cervical Spondylosis: A Rare Case. Cureus. 2024 Oct 20;16(10):e71904. doi: 10.7759/cureus.71904. eCollection 2024 Oct.

  PMID: 39564008 BACKGROUND

• McCoss CA, Johnston R, Edwards DJ, Millward C. Preliminary evidence of Regional Interdependent Inhibition, using a 'Diaphragm Release' to specifically induce an immediate hypoalgesic effect in the cervical spine. J Bodyw Mov Ther. 2017 Apr;21(2):362-374. doi: 10.1016/j.jbmt.2016.08.015. Epub 2016 Sep 9.

  PMID: 28532881 BACKGROUND

• Sleijser-Koehorst MLS, Coppieters MW, Epping R, Rooker S, Verhagen AP, Scholten-Peeters GGM. Diagnostic accuracy of patient interview items and clinical tests for cervical radiculopathy. Physiotherapy. 2021 Jun;111:74-82. doi: 10.1016/j.physio.2020.07.007. Epub 2020 Jul 28.

  PMID: 33309074 BACKGROUND

• Marco B, Evans D, Symonds N, Peolsson A, Coppieters MW, Jull G, Lofgren H, Zsigmond P, Falla D. Determining the level of cervical radiculopathy: Agreement between visual inspection of pain drawings and magnetic resonance imaging. Pain Pract. 2023 Jan;23(1):32-40. doi: 10.1111/papr.13147. Epub 2022 Jul 8.

  PMID: 35765137 BACKGROUND

• Tatsios PI, Grammatopoulou E, Dimitriadis Z, Papandreou M, Paraskevopoulos E, Spanos S, Karakasidou P, Koumantakis GA. 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. Diagnostics (Basel). 2022 Jun 30;12(7):1598. doi: 10.3390/diagnostics12071598.

  PMID: 35885502 BACKGROUND

• Jeong GH, Lee BH. Effects of Telerehabilitation Combining Diaphragmatic Breathing Re-Education and Shoulder Stabilization Exercises on Neck Pain, Posture, and Function in Young Adult Men with Upper Crossed Syndrome: A Randomized Controlled Trial. J Clin Med. 2024 Mar 11;13(6):1612. doi: 10.3390/jcm13061612.

  PMID: 38541838 BACKGROUND

• Czepinska A, Zawadka M, Dabkowska I. Immediate diaphragmatic relaxation effect on mobility and pain threshold in smartphone users with non-specific cervical spine pain: a randomized placebo-controlled trial. Wiad Lek. 2025;78(3):522-530. doi: 10.36740/WLek/202427.

  PMID: 40219877 BACKGROUND

• Sadeghi A, Rostami M, Ameri S, Karimi Moghaddam A, Karimi Moghaddam Z, Zeraatchi A. Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2022 Jun 16;14(1):108. doi: 10.1186/s13102-022-00500-7.

  PMID: 35710510 BACKGROUND

• Zhou Y, Wang B, Pei Z, Yang J, Jiang C, Tian X, Qu X, Li L. Facet tropism: Association between cervical disc degeneration and cervical spondylotic radiculopathy in middle-aged patients. J Clin Neurosci. 2022 May;99:89-93. doi: 10.1016/j.jocn.2022.01.011. Epub 2022 Mar 9.

  PMID: 35278934 BACKGROUND

• Alshami AM, Bamhair DA. Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial. Trials. 2021 Oct 18;22(1):716. doi: 10.1186/s13063-021-05690-y.

  PMID: 34663421 BACKGROUND

• Lam KN, Rushton A, Thoomes E, Thoomes-de Graaf M, Heneghan NR, Falla D. Neck pain with radiculopathy: A systematic review of classification systems. Musculoskelet Sci Pract. 2021 Aug;54:102389. doi: 10.1016/j.msksp.2021.102389. Epub 2021 May 6.

  PMID: 33992884 BACKGROUND

• Nugent SM, Lovejoy TI, Shull S, Dobscha SK, Morasco BJ. Associations of Pain Numeric Rating Scale Scores Collected during Usual Care with Research Administered Patient Reported Pain Outcomes. Pain Med. 2021 Oct 8;22(10):2235-2241. doi: 10.1093/pm/pnab110.

  PMID: 33749760 BACKGROUND

• Araujo GGC, Pontes-Silva A, Leal PDC, Gomes BS, Reis ML, de Mello Pereira Lima SK, Fidelis-de-Paula-Gomes CA, Dibai-Filho AV. Goniometry and fleximetry measurements to assess cervical range of motion in individuals with chronic neck pain: a validity and reliability study. BMC Musculoskelet Disord. 2024 Aug 19;25(1):651. doi: 10.1186/s12891-024-07775-6.

  PMID: 39160504 BACKGROUND

• Chen Y, Li P, Wang J, Wu W, Liu X. Assessments and Targeted Rehabilitation Therapies for Diaphragmatic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review. Int J Chron Obstruct Pulmon Dis. 2022 Mar 3;17:457-473. doi: 10.2147/COPD.S338583. eCollection 2022.

  PMID: 35273448 BACKGROUND

MeSH Terms

Conditions

Radiculopathy; Neck Pain

Condition Hierarchy (Ancestors)

Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Zargham Abbas

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Imran Amjad, phd

CONTACT

03324390125; imran.amjad@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 1, 2026
• First Posted: June 5, 2026
• Study Start: January 1, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): August 1, 2026
• Last Updated: June 5, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)