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.

A group of researchers conducted a randomized controlled trial to compare the effects of neural mobilization and conservative treatment on pain, range of motion, and disability in patients with cervical radiculopathy. Eighty-eight patients from the Mayo Hospital, Lahore, were allocated into two groups after meeting the inclusion criteria. Cervical isometrics and a hot pack were applied to the control group. In contrast, the neural mobilization technique of median nerve sliding, along with cervical isometrics and a hot pack, was given to the experimental group over twelve sessions within four weeks. The numeric pain rating scale was used to measure pain intensity, the Neck Disability Index for functional status, and an inclinometer was used to measure the cervical range of motion. The neural mobilization technique was considered more effective for the treatment of median nerve bias and cervical radiculopathy as compared to the conservative treatment of isometrics in managing pain and disability. No difference was seen in the range of motion of the cervical spine in both groups.

A randomized placebo-controlled trial was conducted (2025) to determine the effect of immediate diaphragmatic relaxation on mobility and pain threshold in smartphone users with non-specific cervical spine pain. Thirty-eight women with neck pain were allocated into two groups. Neck range of motion was assessed by a goniometer, and pressure pain threshold by an algometer in participants who were assigned to the therapy group or a placebo group. The intervention consisted of a single manual relaxation of the diaphragm in the supine position. Comparison of pressure pain threshold showed significant differences in the therapy group.

Researchers carried out a pilot randomized controlled trial (2025) to ascertain the effects of manual release of the diaphragm on pain, disability, and function of the diaphragm in patients with chronic neck pain. A total of thirty-three patients were divided into a diaphragmatic manual release group and a placebo release group. A visual analog scale was used to evaluate the intensity of cervical pain, the level of disability with the neck disability index, and the CROM device for the measurement of range of motion. An ultrasound was used to measure the diaphragm excursion, and chest expansion was assessed with a tape ruler. The results of the study showed that the manual release of the diaphragm can have favorable outcomes for patients with neck pain.

A clinical researcher (2024) presented a case report of a sixty-four year old Japanese male diagnosed with bilateral diaphragmatic nerve paralysis secondary to cervical spondylosis. The blood gas analysis showed type 2 respiratory failure. Chest X-ray showed no movement of the diaphragm with respiration. MRI of the cervical spine was done, which showed stenosis at the level of C3-C4 and C4-C5. This case indicated the importance of considering diaphragmatic paralysis as a manifestation of cervical radiculopathy. If left untreated, the radiculopathy at the C3-C4 and C4-C5 levels can cause a time delay in the distal motor response of the phrenic nerve that would ultimately affect the function of the diaphragm, leading to respiratory problems A group of researchers conducted a prospective parallel randomized controlled study (2023) to assess the effect of diaphragmatic release on neck pain and chest expansion in patients with upper crossed syndrome. Thirty patients with upper crossed syndrome aged twenty to twenty-six years were divided into two equal groups. The control group received postural correction exercises. The experimental group received the aforementioned plan as well as the diaphragmatic release exercise. Pain was assessed by a visual analog scale, craniovertebral angle by the photogrammetric method, and chest expansion by tape measurement. The study demonstrated that the diaphragmatic release technique improved chest expansion and neck pain in the upper crossed syndrome.

A group of researchers (2023) performed a cross-sectional study to compare breathing patterns and diaphragmatic movement in patients with cervical radiculopathy and in the asymptomatic group. Twenty-five patients with unilateral cervical radiculopathy were placed in one group, and twenty-five asymptomatic individuals were placed in another group. Diaphragmatic motion was assessed with the help of manual assessment of respiratory motion (MARM), breathing pattern by fluoroscopy, cervical range of motion with the cervical range of motion device, and kinesiophobia by the Tampa scale of kinesiophobia. The results of this study showed an abnormal breathing pattern and a reduction in diaphragmatic excursion on the side of radiculopathy in patients with cervical radiculopathy.

A randomized controlled trial was conducted (2021) to determine the effectiveness of standard physical therapy interventions and manual release of the diaphragm in patients with chronic neck pain. Forty patients were randomly allocated to receive three treatment sessions of baseline treatment and diaphragm manual release in the experimental group and placebo diaphragm technique in the control group. The primary outcome of pain intensity was assessed by the Numeric Pain Rating Scale (NPRS), active range of motion (AROM) by inclinometer, pressure pain threshold by Lizard AHI-O-meter algometer, and disability by the Neck Disability Index (NDI). The inclusion of manual diaphragm techniques in standard cervical treatment gave a better outcome in chronic neck pain patients.

A case-control study was conducted (2020) to evaluate the effect of forward head posture on the excursion of the diaphragm in patients with chronic neck pain. The study took place in the physical therapy department of Cairo University, Egypt. Thirty diagnosed patients with chronic neck pain were distributed into two groups. One group included patients with forward head posture, and another group included patients with no postural changes. The cranio-vertebral angle was evaluated with the bio-photogrammetry method, and the excursion of the diaphragm was measured with ultrasonography. The result of the study showed that patients with forward head posture can have decreased excursion of the diaphragm.

A group of clinical researchers (2017) performed a single-blind, randomized, repeated measures within subject crossover study over seventeen asymptomatic subjects. Pressure-induced pain threshold was evaluated using an algometer on both sides of the paraspinal muscles at the fourth cervical vertebral level, the lateral ends of the clavicle, and the tibialis anterior muscle before and after applying the manual release technique of the diaphragm. The results of the study showed that this intervention could yield a prompt statistical and clinically meaningful analgesic effect on the fourth segment of the cervical spine because of its direct relation with the phrenic nerve.

While there is a growing body of research indicating that physical therapy treatments play an important role in alleviating the signs and symptoms of cervical radiculopathy, neural mobilization, cervical isometrics, and other such methods concentrate more on the cervical problems themselves without considering the effects of respiratory dysfunction. Although previous research has established that diaphragm dysfunction may present itself as a consequence of cervical radiculopathy, as well as emphasized the significance of using a diaphragmatic approach for treating various other conditions, there is no research to date examining the effectiveness of this intervention in cases of cervical radiculopathy.

Inclusion Criteria:

• 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

Exclusion Criteria:

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