COMPARATIVE EFFECTS OF NERVE FLOSSING AND DEEP NECK FLEXOR MUSCLE STRENGTHENING ON PAIN, RANGE OF MOTION AND FUNCTIONAL DISABILITY ON CERVICAL SPINAL STENOSIS
DOI:
https://doi.org/10.71000/zneg1g60Keywords:
Cervical Vertebrae; Exercise Therapy; Neck Pain; Neural Mobilization; Range of Motion, Articular; Spinal Stenosis; Treatment OutcomeAbstract
Background: Cervical spinal stenosis is a degenerative cervical spine disorder that may cause neck pain, restricted mobility, neurological symptoms, and functional limitation. Conservative physiotherapy is commonly recommended before surgical consideration, but the relative benefit of different exercise-based approaches remains unclear. Nerve flossing mainly targets neural mobility, whereas deep neck flexor strengthening focuses on cervical stability and postural control. Comparing these approaches may help guide more focused rehabilitation for patients with cervical spinal stenosis.
Objective: To compare the effects of nerve flossing and deep neck flexor strengthening on pain intensity, functional disability, and cervical range of motion in patients with cervical spinal stenosis.
Methods: This randomized controlled trial assessed 186 patients for eligibility, of whom 62 patients with imaging-confirmed cervical spinal stenosis were randomized into a nerve flossing group or a deep neck flexor strengthening group, with 31 participants in each group. After follow-up losses, 46 participants were included in the final analysis, including 22 in the nerve flossing group and 24 in the deep neck flexor strengthening group. Both groups received supervised treatment for 12 weeks, three sessions per week. Pain was assessed using the Visual Analogue Scale, functional disability using the Neck Disability Index, and cervical range of motion using an inclinometer at baseline, 6 weeks, and 12 weeks. Data were analyzed using mixed-design ANOVA.
Results: Both groups improved over time. VAS decreased from 7.19 ± 0.39 to 3.61 ± 0.22 in the nerve flossing group and from 7.20 ± 0.33 to 2.95 ± 0.41 in the deep neck flexor group, with a significant time × group interaction, F(2,88) = 125.55, p < 0.001. NDI decreased from 30.95 ± 2.68 to 17.36 ± 1.47 in the nerve flossing group and from 31.33 ± 2.50 to 13.04 ± 1.30 in the deep neck flexor group, F(1.21,53.02) = 122.82, p < 0.001. Significant time × group effects were also observed for cervical extension and left rotation, while flexion and right rotation improved comparably.
Conclusion: Both interventions improved pain, disability, and cervical mobility; however, deep neck flexor strengthening produced greater final improvement in pain and functional disability. It may be prioritized as a core rehabilitation strategy for cervical spinal stenosis, while nerve flossing may be considered as an adjunct for patients with neural symptoms.
Keywords: Cervical Vertebrae; Exercise Therapy; Neck Pain; Neural Mobilization; Range of Motion, Articular; Spinal Stenosis; Treatment Outcome
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Copyright (c) 2026 Akasha Khan, Dr. Komal Tehzeeb , Prof Dr Fahad Tanveer , Dr. Izzah Ijaz Syed, Dr. Sehrish Shahzad , Muhammad Hammad Khan (Author)
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