Clinical Research Directory

Mobile App-Assisted Home Exercise for Musculoskeletal Disorders

Overview This study evaluates the effectiveness of a dedicated mobile health (mHealth) application in supporting home exercise programs for patients with musculoskeletal disorders, such as neck, shoulder, back, or knee pain. The research aims to address the widespread challenge of low patient adherence to unsupervised home-based exercises. Study Design The project employs a dual-methodology approach: Clinical Trial: 30 participants presenting with neck, shoulder, back, or knee pain will be randomly assigned to either an app-assisted group or a traditional home exercise group. Both groups will undergo 4 weeks of physiotherapy. The study will compare pain intensity, physical function, and exercise adherence between the two cohorts. Retrospective Analysis: To complement the trial, the study will analyze a large-scale database containing approximately 700,000 anonymized real-world data entries. This analysis aims to observe real-time pain fluctuations before and after exercise sessions within routine clinical settings. Goal The primary objective is to determine if integrating mHealth technology into traditional rehabilitation can enhance clinical outcomes and improve patient adherence to home-based exercise routines.

Wearable Spine Assessment in Adults With and Without Low Back or Neck Pain

This is a single-site, prospective, observational, single-visit feasibility and validity study. Adult participants with and without low back or neck pain will be screened, consented, and enrolled to undergo a structured wearable-sensor-based spine assessment in a single on-site visit. Approximately 20 participants will be enrolled at a single site: * Approximately 10 adults with self-reported chronic or subacute low back or neck pain (LBP/Neck Pain group) * Approximately 10 adults without current back or neck pain (Control group) The AxiSens battery includes the Fingertip-to-Floor (FTF) test for lumbar flexion, the Chin-to-Chest (CTC) test for cervical flexion, a seated Trunk Stability Test on an unstable surface, the Cervical Flexor Endurance Test, the five-times sit-to-stand F5xSTS) test, and a brief functional task module covering overhead and forward reach. To support intra-rater repeatability characterization, the AxiSens wearable assessment is performed twice within the same visit by a single trained operator, with sensor doffing and re-donning between the two assessments. A short rest interval is provided between the two assessments. Following the on-site assessment, participants complete a brief end-of-session usability and tolerability questionnaire and the Technology Acceptance Model (TAM) questionnaire.

ACUTE EFFECT OF DIAPHRAGMATIC BREATHING ON POSTOPERATIVE UPPER TRAPEZIUS PAIN

This randomized controlled trial aims to investigate the acute effects of diaphragmatic breathing exercises added to soft tissue mobilization and percussive therapy on pain intensity, functional disability, and pressure pain threshold in operating room nurses experiencing upper trapezius pain after surgery-related work activities. Participants will be operating room nurses working in a hospital operating theater who report upper trapezius pain and tenderness within 30 minutes after completing a surgical procedure. Eligible participants will be randomly assigned to either an intervention group receiving soft tissue mobilization, percussive therapy, and diaphragmatic breathing exercises, or a control group receiving soft tissue mobilization and percussive therapy alone. Pain intensity will be assessed using the Visual Analog Scale (VAS), functional disability using the Neck Disability Index (NDI), and mechanical pain sensitivity using Pressure Pain Threshold (PPT) measurements. Assessments will be performed immediately before and after a single treatment session. The study aims to determine whether the addition of diaphragmatic breathing exercises provides additional benefits in reducing pain and improving function in the acute postoperative working period of operating room nurses.

Comparison of Suboccipital Release and Muscle Energy Technique in Subjects With Mechanical Neck Pain and Forward Head Posture

This study will compare two physiotherapy treatments for adults with long-lasting neck pain and tender muscle spots, called trigger points, in the upper trapezius muscle between the neck and shoulder. The aim is to find out which treatment was more effective in reducing pain, improving neck movement, and reducing difficulty with daily activities. The study will includ 76 adults aged 20-40 years at Mayo Hospital, Lahore, Pakistan. Participants will be assigned by chance to one of two treatment groups. One group will receive a cooling spray followed by gentle stretching of the affected muscle. The other group will receive sustained pressure applied by a therapist to the tender muscle spots. Both groups also will receive routine physiotherapy, including heat, exercises, and advice about neck care and posture. Participants will receive six treatment sessions over two weeks. Pain, neck movement, and difficulty with daily activities will be assessed before treatment, immediately after the first session, and after the sixth session.

Comparing Patient-Reported Symptoms to Objective Neck Range of Motion and Physical Capacity in Women With Chronic Neck Pain.

Chronic neck pain is a common health condition that causes disability and functional limitations, and while clinicians frequently rely on patient-reported questionnaires to assess symptoms, it remains unclear how accurately these self-reported measures reflect actual physical capacity. This study aims to investigate the relationship between patient-reported outcome measures and objective physical performance assessments in 98 women aged 18-45 years with chronic nonspecific neck pain. Participants will complete questionnaires evaluating perceived neck mobility (S-ROM-Neck), fear of movement (Tampa Scale for Kinesiophobia), and pain intensity (Visual Analog Scale), which will be compared against objective measurements including active cervical range of motion using a CROM device, controlled box-lifting capacity (PILE test), timed unloaded and loaded walking performance, and deep cervical flexor and extensor muscle endurance tests. Ultimately, the findings will clarify whether self-reported questionnaires are sufficient for evaluating physical capacity or if objective performance testing should be routinely integrated into clinical practice

Thermotherapy in Acute Nonspecific Neck Pain

Neck pain is one of the most common musculoskeletal pain disorders secondary to low back pain. Medical and non-medical treatments such as physiotherapy are applied in its treatment. Patients with nonspecific neck pain (NBA) can be treated with various interventions such as drug therapy, manual therapy, heat and exercise. Although it is frequently used in clinical practice, there is no evidence that superficial thermotherapy (hot or cold) methods effectively relieve neck pain. Therefore, this study aims to compare the short-term effects of superficial hot or cold applications on pain, range of motion and functional status in patients with NBA.

Comparison Of Different Physiotherapy Methods In People With Non-Specific Neck Pain

The study will include 45 people between the ages of 25-55 with non-specific neck pain. The patients will be randomly divided into three groups. Group 1 will receive 5 minutes of ultrasound, 20 minutes of transcutaneous electrical nerve stimulation (TENS), and hot pack application. Group 2 will receive 5 minutes of ultrasound, 20 minutes of transcutaneous electrical nerve stimulation (TENS), and hot pack application in addition to the Mulligan mobilization technique. Group 3 will receive 5 minutes of ultrasound, 20 minutes of transcutaneous electrical nerve stimulation (TENS), and hot pack application in addition to graston treatment for 5 minutes to the upper and lower trapezius, rhomboid major and minor muscles.

Common Pain Mechanisms in Migraine, Migraine-Related Neck Pain, and Lower Back Pain: A Cross Sectional Study

Migraine is one of the primary headache disorders with a high prevalence worldwide, leading to significant disability and reduced quality of life. Trigeminal nerve activation and alterations in central pain processing mechanisms play a crucial role in the pathophysiology of migraine. Recent studies suggest that migraine may not only be a headache disorder but also a systemic pain disorder associated with changes in central pain processing mechanisms. Central sensitization is defined as increased sensitivity of nociceptive neurons in the central nervous system to afferent stimuli and is considered a key mechanism in the development and maintenance of chronic pain conditions. This condition is characterized by pain hypersensitivity, allodynia, and generalized pain sensitivity. In addition to headaches, other musculoskeletal pains are also frequently reported in migraine patients. Spinal pain, particularly neck and lower back pain, can occur in migraine sufferers, with central sensitization contributing to the condition, considering the spine as a chain. Large population-based studies have shown a significant association between primary headaches and persistent low back pain, and a higher prevalence of concomitant low back pain has been reported in individuals with chronic migraine and chronic tension-type headaches. This association is suggested to be explained by the shared nociceptive pathways of the head and spinal structures and the changes in central pain processing seen in chronic pain conditions. This relationship between migraine and musculoskeletal pain is also explained by the presence of shared neuroanatomical structures such as the trigemino-cervical complex. Nociceptive afferents from the upper cervical spine and cranial structures converge at the trigemino-cervical complex level in the brainstem, creating a predisposition to the co-occurrence of head and neck pain. This mechanism suggests that pain or dysfunction in the cervical region in migraine patients may be related to headache symptoms. Studies have shown that neck pain is more common in individuals with migraine than in the general population, and research suggests this rate may be approximately 10-12 times higher compared to healthy individuals. Furthermore, it has been reported that individuals with migraine more frequently experience tenderness in cranio-cervical muscles such as the upper trapezius, sternocleidomastoid, and suboccipital muscles, myofascial trigger points, and increased muscle sensitivity. The literature also emphasizes that these cervical symptoms may be related to migraine frequency, attack severity, and headache-related disability. These findings suggest that migraine should be considered not only as a primary headache disorder but also as a complex neurobiological condition associated with widespread pain sensitivity and musculoskeletal symptoms. A better understanding of the relationship between migraine and musculoskeletal pain could be important for developing multidisciplinary treatment approaches. However, clinical studies in the literature that evaluate migraine, accompanying neck pain, and lower back pain together in terms of common pain mechanisms are quite limited. Therefore, the rationale for this study is that examining factors such as central sensitization, pain threshold, pain catastrophizing, psychological factors, body awareness, and regional disability together in migraine patients can lead to a better understanding of the pathophysiology of migraine-related musculoskeletal pain. Based on all these reasons and evidence, the aim of this study is to investigate the possible common pain mechanisms and musculoskeletal pathophysiological processes of migraine-related neck and back pain in migraine patients with accompanying neck and/or back pain by evaluating factors such as central sensitization, pain threshold, pain catastrophizing, psychological factors, body awareness, and regional disability together.

Chiropractic Care for Chronic Neck Pain: A Pilot Study

This pilot randomized controlled trial will evaluate the feasibility and preliminary clinical effects of multimodal chiropractic care for adults with chronic neck pain. Forty participants will be randomized to receive either multimodal chiropractic care plus enhanced usual care or enhanced usual care alone. Feasibility outcomes include recruitment, retention, adherence, and safety. Clinical outcomes include pain intensity, neck-related disability, physical and psychological function, and quality of life. Exploratory electroencephalography (EEG) and gait assessments will examine potential neurophysiological and biomechanical biomarkers associated with treatment response.

Myofascial Release and Dynamic Cupping in Children

Neck pain is a common musculoskeletal disorder that significantly affects quality of life and daily activities, with an annual prevalence of 30-50% worldwide. This randomized clinical trial aims to compare the effects of myofascial release therapy and dynamic cupping on neck pain and posture in school-based children aged 7-12 years. A total of 40 children with neck pain and postural deviations will be recruited from schools and randomly assigned to either a myofascial release group or a dynamic cupping group (20 participants each) for a 6-week intervention. Children with skin conditions, neurological symptoms, recent analgesic use, or assistive device use will be excluded. Outcomes will be assessed using the Visual Analog Scale, goniometer, and plumb line test, and data will be analyzed using SPSS version 27 to determine the effectiveness of both interventions in reducing pain and improving posture.

Response to Massage in Neck Pain

This study is interested in whether baseline measures of pain sensitivity i.e. the amount of pressure required to feel pain predicts pain relief following a pain inducing massage AND whether pain relief following a pain inducing massage is different than a pain free massage or placing your hand in a cold water bath. Participants with neck pain will be randomly assigned to receive a pain inducing massage, pain free massage, or to place their hand in a cold water bath.

Effects of SNAGs & CBT on Pain, Craniovertebral Angle & Disability in Non Specific Neck Pain

Non-specific neck pain is a prevalent condition causing discomfort, reduced craniovertebral angle, and disability. This randomized controlled trial will evaluate the combined effects of Sustained Natural Apophyseal Glides (SNAGs) and Cognitive Behavioral Therapy (CBT) on pain, posture, and function. Group A will receive SNAGs and CBT, while Group B will undergo SNAGs with cervical stabilization exercises, twice weekly for four weeks. Outcomes will include pain, craniovertebral angle, and disability, analyzed using SPSS.

Electrical Stimulation in Individuals With Chronic Neck Pain

The primary objective of the study was to evaluate the effects of diadynamic current and transcutaneous electrical nerve stimulation on pain and function in participants with chronic neck pain. The secondary objective of the research was to strengthen the neck muscles and enable participants with chronic neck pain to carry out everyday tasks on their own.

Kinesio Taping for Upper Trapezius Myofascial Trigger Points

Myofascial pain syndrome is one of the most common causes of musculoskeletal pain, and the upper trapezius is the muscle most frequently affected in the neck and shoulder region. Kinesio taping is a non-invasive, painless and low-cost method that is increasingly used in the treatment of myofascial trigger points, but its true therapeutic effect beyond placebo has not been clearly established. The purpose of this randomized, sham-controlled trial is to evaluate the effectiveness of kinesio taping applied with the muscle inhibition technique on myofascial trigger points of the upper trapezius muscle. Forty patients with an active myofascial trigger point in the upper trapezius will be randomly assigned in a 1:1 ratio to receive either therapeutic kinesio taping or sham taping (20 patients per group). Both groups will receive four applications over two weeks (twice weekly). The primary outcome is the pressure pain threshold measured with a digital algometer. Secondary outcomes are pain intensity, trapezius muscle thickness measured by B-mode ultrasonography, and muscle stiffness assessed by strain elastography. All outcomes are assessed at baseline, on day 3, and at the end of the two-week treatment period.

Sleep Hygiene Plus Physiotherapy for Sleep and Disability in Chronic Neck Pain

This study investigates the effectiveness of a combined intervention that integrates sleep hygiene education with physiotherapy exercises in patients suffering from chronic neck pain. Chronic neck pain is often associated with both musculoskeletal dysfunction and secondary sleep disturbances, which in turn may exacerbate pain perception, fatigue, and disability. Traditional physiotherapy exercise programs focus primarily on improving cervical mobility, muscle strength, and postural control, but they do not typically address sleep-related problems that can hinder recovery. The intervention in this study consists of two main components: Physiotherapy Exercise Program - A structured regimen targeting cervical spine mobility, deep cervical flexor strengthening, scapular stabilization, and postural correction. These exercises aim to reduce pain, restore function, and improve overall physical performance. Sleep Hygiene Education - A structured educational module covering principles of healthy sleep habits, including maintaining consistent sleep-wake schedules, creating an optimal sleep environment, limiting stimulants before bedtime, and adopting relaxation strategies to promote better sleep initiation and maintenance. By combining these approaches, the intervention addresses not only the physical impairments associated with chronic neck pain but also the psychosocial and behavioral factors contributing to poor sleep quality. Outcome Measures: Primary Outcomes: Sleep quality, assessed using validated tools such as the Pittsburgh Sleep Quality Index (PSQI). Secondary Outcomes: Disability and functional limitations, measured by the Neck Disability Index (NDI), along with pain intensity assessed using a Visual Analog Scale (VAS). Fatigue will be assessed by fatigue inventory index Study Hypothesis: The combined intervention of sleep hygiene education and physiotherapy exercise will lead to greater improvements in sleep quality and reductions in disability and fatigue compared to physiotherapy exercise alone. Clinical Significance: If effective, this integrative approach may provide a cost-effective, non-pharmacological management strategy for patients with chronic neck pain, targeting both physical and behavioral contributors to their condition.

Cervical Paraspinal Muscle Twitching and Cervical Facet Radiofrequency Ablation Outcomes

The investigators aim to determine whether cervical paravertebral muscle twitching during motor testing as part of performing cervical RFAs is associated with a greater likelihood of treatment success, and greater magnitude or duration of analgesia. The investigators propose a straightforward grading scale based on visual and tactile information readily available during RFA procedures as part of routine practice (per radiofrequency electrode: 0 = no twitches palpated or observed; 1 = twitches palpated but not observed; 2 = twitches palpated and observed at 1-2 levels; 3= twitches palpated and observed at \>2 levels). If a higher weighted score (total score divided by number of radiofrequency lesion sites) correlates with a greater likelihood of treatment success, or magnitude or duration of analgesia following cervical RFA, cervical paraspinal muscle twitching may serve as a readily obtainable prognostic factor (marker) for effectiveness.

The Effect of Osteopathic Treatment on Craniocervico-Mandibular Dysfunction

The goal of this clinical trial is to measure the effects of osteopathic manipulative treatment (OMT) on tissues of the craniocervico-mandibular unit (CCMU) in individuals with neck pain and headaches. The main questions to answer are: 1. How does OMT affect CCMU muscle stiffness 2. How does OMT affect jaw motion 3. How does OMT affect autonomic function 4. Is pain pressure threshold affected by OMT of the CCMU Participants will undergo the following interventions: 1. Photos taken to measure head and neck angles 2. Ultrasound 3. Smooth Pursuit Neck Torsion Test 4. Motion Capture 5. Autonomic Protocol 6. Algometry 7. Surveys

Mulligan Mobilization and Stabilization Exercises for Sensorimotor Function in Women With Text Neck Syndrome

Text message neck syndrome represents a significant epidemiological and musculoskeletal concern arising from repetitive strain and prolonged cervical flexion during mobile device operation. Anatomical deviations associated with this syndrome, such as anterior head translation and altered lower cervical alignment, substantially increase the gravitational load exerted on the cervical spine. This progressive mechanical overload predisposes individuals to microtraumas, paraspinal muscle imbalances, and secondary proprioceptive impairments. Kinematic variations further heighten the clinical vulnerability of female populations, as distinct sagittal and thoracic parameters accelerate the progression of postural dysfunction.Conventional therapeutic strategies frequently target localized cervical symptoms, often neglecting the broader kinetic chain and the interdependent relationship between the cervical and thoracic segments. To address these limitations, this clinical trial evaluates a holistic "joint-by-joint" rehabilitation framework by incorporating thoracic spine interventions into both active protocols. The Mulligan Mobilization Technique combines passive manual facet joint glides with active physiological movements to restore biomechanical alignment and reduce nociceptive mechanical stress. Conversely, the Spinal Stabilization Training Protocol focuses on neuromuscular control, utilizing a pressure biofeedback unit and progressive resistance to enhance the endurance of deep cervical flexors and stabilize the scapulothoracic region.A major gap in text neck syndrome literature is the reliance on subjective pain scales, leaving the underlying neurobiological mechanisms under-investigated. This study introduces an objective biochemically validated assessment model by quantifying objective biomarkers of neurogenic inflammation, nociception, and central sensitization. By analyzing pre- and post-intervention serum concentrations of Calcitonin Gene-Related Peptide (CGRP) and Substance P via enzyme-linked immunosorbent assay (ELISA), this trial aims to correlate clinical sensorimotor and postural improvements with neurochemical changes. Ultimately, the findings will clarify whether passive manual joint mobilization or progressive active stabilization exercise provides superior efficacy in restoring sensorimotor function, optimizing postural stability, and mitigating chronic neurogenic pain pathways.

Comparative Effects of Gong's Mobilization and Maitland Mobilization in Patients With Cervical Spondylosis

Cervical spondylosis is a degenerative condition of the cervical spine that may cause neck pain, reduced cervical range of motion, muscle weakness, and functional disability. Manual therapy is commonly used as part of conservative physiotherapy management. This randomised controlled trial compares Gong's mobilisation with Maitland cervical mobilisation in patients with cervical spondylosis. This randomised controlled trial aims to compare the effects of Gong's mobilisation and Maitland's mobilisation on pain intensity, cervical range of motion, cervical muscle strength, and functional disability in individuals with cervical spondylosis. A total of 50 participants diagnosed with cervical spondylosis were randomly allocated into two equal groups using a computer-generated randomisation method. Group A received Gong's mobilisation combined with conventional physiotherapy, while Group B received Maitland mobilisation combined with the same conventional physiotherapy programme. Conventional treatment included transcutaneous electrical nerve stimulation (TENS) and cervical isometrics. Outcome measures included the Numeric Pain Rating Scale (NPRS) for pain intensity, a universal goniometer for cervical range of motion, Manual Muscle Testing (MMT) for cervical muscle strength, and the Neck Disability Index (NDI) for functional disability. Assessments were performed at baseline and after completion of the treatment period. The findings of this study were intended to determine the comparative effectiveness of Gong's mobilisation and Maitland mobilisation and to provide evidence-based recommendations for the physiotherapy management of patients with cervical spondylosis.

The Inspiratory Muscle Training in Patients With Non-Specific Chronic Neck Pain

The aim of the present study is to investigate the effects of additional functional inspiratory muscle training in individuals with non-specific chronic neck pain.

Combined Effect of Kendall Exercises With Wearable Vibrotactile Feedback Sensor in Forward Head Posture

The aim of this research is to determines Combined Effect of Kendall exercises with Wearable vibrotactile feedback Sensor on Forward Head Posture correction on neck pain, and improving craniovertebral angle and muscle thickness. Randomized controlled trials at Fauji Foundation Hospital and Margalla Institute of health sciences . The sample size was 64. The subjects were divided in two groups, 32 subjects will be included in wearbable sensors and kendall exercises group and 32 will be in Kendell exercise alone . Study duration will be 12 months. Sampling technique applied will be non probability convinience sampling technique. Participants eligible for recruitment in this study will include young adults between the ages of 18 and 30 years. Eligible participants must also present with a craniovertebral angle (CVA) of less than 50 degrees, a body mass index (BMI) within the range of 18.5-30 kg/m², and a daily screen time of less than five hours. Data will be analyzed through SPSS version 26.

Effectiveness of Transcutaneous Electrical Nerve Stimulation and Interferential Current in Chronic Neck Pain

The aim of this study was to determine and compare the efficacy of transcutaneous electrical nerve stimulation (TENS), interferential current (IFC), and sham therapy in patients with chronic neck pain. A total of 57 patients diagnosed with chronic mechanical neck pain were included in the study. Patients were randomized into three groups. Each group received 10 sessions of physiotherapy over a two-week period: one group received conventional TENS, one group received IFC, and one group received sham therapy. Pain was assessed using the Visual Analog Scale (VAS), disability and functionality using the Copenhagen Neck Disability Index, quality of life using the SF-36, depression using the Beck Depression Inventory (BDI), and pain characteristics using the SF-McGill Pain Questionnaire.

Dry Needling vs Electrical Dry Needling for Myofascial Neck Pain

Neck pain caused by myofascial trigger points (MTrPs) is common and is associated with pain, psychological distress, and kinesiophobia (fear of movement). This randomized clinical trial compared Dry Needling (DN) and Electrical Dry Needling (EDN), each delivered once weekly for six weeks, in adults with neck pain due to MTrPs. The study measured changes in pain intensity, psychological distress (depression, anxiety, stress), and kinesiophobia before and after treatment, to determine whether adding electrical stimulation to dry needling provides additional benefit over dry needling alone.

The Importance of the Number of Incisions in the Effectiveness of Dry Needling

The dry needling technique is a procedure increasingly used by health professionals. Dry needling consists of the use of a filiform needle to treat musculoskeletal pain. Currently, the mechanisms by which it is an effective technique are not well understood. One of the aspects not yet evaluated is the best dose in terms of the number of times it is necessary to insert the needle into the patient to achieve the best result. This research work aims to assess which treatment obtains the best results in the management of patients with chronic neck pain.