Diaphragmatic Myofascial Release Added to Neck Exercises for Chronic Neck Pain

This study is a prospective, assessor‐blinded, parallel‐group randomized controlled trialthat will be conducted at the outpatient Physical Therapy Clinic of Nasser MedicalComplex in the Gaza Strip. The study aims to evaluate the added effect of diaphragmaticmyofascial release and diaphragm‐directed manual therapy when combined with astandardized neck exercise program in adults with chronic neck pain.Participants will be randomly allocated in a 1:1 ratio to either an intervention group ora control group using a computer‐generated random sequence. The control group willreceive a supervised neck exercise program that includes deep cervical flexor training,cervical stabilization, stretching, postural correction, scapular strengthening, and ahome exercise program. The intervention group will receive the same neck exercise programin addition to a diaphragm‐focused intervention that includes manual diaphragm release,diaphragmatic myofascial release, release of accessory respiratory muscles, and breathingre‐education.The intervention period will last six weeks, with three supervised treatment sessions perweek. Outcomes will be assessed at baseline, immediately after the intervention, and at afour‐week follow‐up. The clinical outcomes include neck‐related disability measured usingthe Neck Disability Index (NDI), pain intensity measured using the Numeric Pain RatingScale (NPRS), kinesiophobia measured using the Tampa Scale of Kinesiophobia (TSK‐17), andfatigue measured using the Fatigue Severity Scale (FSS).The study will compare changes over time between the intervention and control groups todetermine whether adding the diaphragmatic intervention to neck exercises providesadditional benefits for patients with chronic neck pain.