The goal of this randomized clinical trial is to compare the effectiveness of Nerve Flossing and Deep Neck Flexor strengthening exercises in individuals with cervical spinal stenosis. The study aims to determine which treatment is more effective in reducing neck pain, improving cervical range of motion, and enhancing the ability to perform daily activities. Participants will be randomly assigned to receive either Nerve Flossing or Deep Neck Flexor exercises for specified duration. Both groups will attend physiotherapy sessions 3 times per week as assigned. Outcomes such as pain intensity, neck disability, and range of motion will be measured before and after the intervention using standard assessment tools. This study will help identify a more effective physiotherapy approach for managing symptoms of cervical spinal stenosis.

Cervical spinal stenosis is a condition characterized by narrowing of the spinal canal in the cervical region, leading to compression of neural structures. This often results in neck pain, reduced cervical range of motion, and functional disability that affects daily activities and quality of life. Conservative management through physiotherapy is the preferred initial approach before considering surgical intervention. Among conservative techniques, Nerve Flossing and Deep Neck Flexor strengthening are commonly used but their comparative effectiveness remains unclear. Nerve Flossing involves controlled, low-amplitude movements of the neck and upper limb to mobilize neural tissues and reduce nerve-related pain and sensitivity. Deep Neck Flexor strengthening uses specific low-load exercises to improve the activation and endurance of the deep cervical flexors that support head and neck posture. This study is conducted to address the gap in evidence by directly comparing these two interventions in patients with cervical spinal stenosis. The findings will help physiotherapists and clinicians select the most effective treatment approach for reducing pain and improving function in this population.

Inclusion Criteria:

• Adults aged 20-50 years, both male and female.
• Clinical and radiological (MRI) diagnosis of cervical spinal stenosis.
• Cervical pain with or without radiating to the upper limb.
• At least one neurological sign, such as sensory disturbance, muscle weakness or diminished reflexes.
• Symptoms present for more than 4 weeks but less than 6 months.
• Ability to understand and follow exercise instructions.
• VAS pain score ≥ 3/10 at baseline.

Exclusion Criteria:

• History of cervical spine surgery
• Recent trauma, fracture, or cervical instability.
• History of disc herniation involving surgery.
• Other neurological or musculoskeletal conditions, including peripheral neuropathy, thoracic outlet syndrome, and rheumatoid arthritis.
• Pregnancy.
• Recent medication use that may impact nerve function (e.g., systemic steroids).

Only IPD used in the results publication will be shared

It will be available after the completion of the study.

Through the corresponding author.

This study uses single masking in which the outcome assessor is blinded to group allocation. Participants will be assigned to either the nerve flossing group or the deep neck flexor muscle strengthening group by an independent researcher who is not involved in assessment. The assessor responsible for recording baseline and post intervention outcomes (VAS, Range of motion and NDI scores) will not be informed of the participants intervention group. To maintain blinding, participants will be instructed not to disclose their group assignment during assessments.