Effects of Connective Tissue Massage and Physical Modalities Combined With Stabilization Exercises in Chronic Neck Pain

Comparative Effects of Connective Tissue Massage and Physical Modalities Added to Cervical and Scapulothoracic Stabilization Exercises on Pain, Function, and Endurance in Individuals With Chronic Neck Pain

This randomized, double-blinded controlled trial aims to investigate the comparative effects of connective tissue massage and physical modalities, when combined with cervical and scapulothoracic stabilization exercises, in individuals with chronic non-specific neck pain. A total of 51 participants aged 18-65 years will be randomly assigned into three groups. Group 1 will perform stabilization exercises alone, Group 2 will receive stabilization exercises plus connective tissue massage, and Group 3 will receive stabilization exercises plus electrotherapy modalities (infrared, continuous ultrasound, and TENS). The interventions will be conducted twice weekly for 8 weeks, and participants will also perform home-based exercises daily. Primary outcomes include pain, disability, and endurance, while secondary outcomes focus on quality of life, cervical range of motion, and scapular function.

Chronic non-specific neck pain is a prevalent musculoskeletal disorder that adversely affects pain, functional capacity, and quality of life. Stabilization-based exercise programs are commonly recommended; however, the added benefits of connective tissue massage and physical modalities require further investigation.

This randomized, double-blinded controlled trial is designed to compare the effects of (1) stabilization exercises alone, (2) stabilization exercises combined with connective tissue massage, and (3) stabilization exercises combined with electrotherapy modalities (infrared therapy, continuous ultrasound, and TENS) on clinical outcomes in individuals with chronic non-specific neck pain.

A total of 51 participants between 18 and 65 years of age will be randomly allocated into three equal groups. All groups will receive supervised exercise sessions twice weekly for 8 weeks, each lasting 50 minutes (10 minutes of warm-up, 30 minutes of cervical and scapulothoracic stabilization, and 10 minutes of cool-down). Additionally, participants will be instructed to perform a one-hour home exercise program daily, supported with illustrated brochures.

The primary outcomes are:

• Pain (Bournemouth Neck Questionnaire)
• Disability (Neck Disability Index)
• Endurance (Deep Cervical Flexor Test)

The secondary outcomes are:

• Quality of life (WHOQOL-BREF)
• Cervical range of motion
• Scapular function (Lateral Scapular Slide Test and Scapular Dyskinesis Test)

By comparing these approaches, the study aims to determine whether the addition of connective tissue massage or physical modalities enhances the therapeutic effects of stabilization exercises on pain, function, and endurance in patients with chronic non-specific neck pain.

Inclusion Criteria:

• Being between 18 and 65 years of age,
• Having non-specific chronic neck pain localized to the posterior cervical spine between the occipital region and the spinous process of the first thoracic vertebra,
• Being able to cooperate with the assessments to be performed in the study.

Exclusion Criteria:

• Neck pain resulting from trauma within the past 6 months;
• A history of surgery related to cervical problems;
• Clinical signs of cervical radiculopathy and/or myelopathy;
• Inflammatory arthritis involving the cervical spine;
• Tumors or infections of the cervical spine;
• Vertebrobasilar artery insufficiency;
• Neurological disorders (such as multiple sclerosis, Parkinson's disease, or syringomyelia);
• Congenital anomalies affecting the spine; systemic diseases (such as diabetes mellitus);
• Shoulder pathologies (including tendinitis, bursitis, or capsulitis).