Comparative Effectiveness of Neural Mobilization with and without Breathing Reeducation on Strength and Endurance of Deep Neck Flexors in Cervical Radiculopathy

Background: Cervical radiculopathy is a condition of the cervical spine characterized by compression or irritation of the cervical nerve roots due to various pathological causes. It commonly results in radicular symptoms such as pain, numbness, paresthesia, and muscle weakness in the upper limbs. The condition often leads to functional limitations, psychological distress, and decreased quality of life. Objective: To evaluate the comparative effectiveness of neural mobilization combined with breathing reeducation versus neural mobilization alone on improving the strength and endurance of deep neck flexor muscles in individuals diagnosed with cervical radiculopathy. Methodology: A quasi-experimental study was conducted in the department of physiotherapy, Allied Hospital, Faisalabad, for three months from December 2024 to February 2025. About 40 participants having positive spurling test and Grade 2 strength of cervical flexors, were included in this trial. The participants who had hypertension, malignancy, cervical ribs and those who underwent cervical surgery were excluded. Pain intensity, range of motion, strength of cervical flexors and endurance were assessed through neck disability index, goniometer, manual muscle testing and deep neck flexors endurance test respectively, for pre and post-intervention. Group A received neural mobilization in addition to breathing re-education, while Group B received only neural mobilization. Mean and standard deviation of all variables were calculated. The obtained data were analyzed using a paired-sample t-test. Results: Group A demonstrated statistically significant improvements, with p-values <0.00 for visual analogue scale, manual muscle testing, range of motion, and deep neck flexor endurance. In contrast, Group B showed significant improvement only in pain score and deep neck flexor endurance (p=0.04), while changes in manual muscle testing (p=0.08) and range of motion (p=0.16) were not statistically significant. Conclusion: The combination of neural mobilization with breathing re-education is more effective than neural mobilization alone in enhancing pain relief, muscle strength, range of motion, and endurance of deep neck flexors in patients with cervical radiculopathy.