Effectiveness of breathing re-education and respiratory training on pulmonary function in patients with non-specific chronic neck pain: A systematic review and meta-analysis

Background: Non-specific chronic neck pain is associated with altered breathing patterns and compromised pulmonary function due to dysfunction of accessory respiratory muscles and postural changes. Despite growing interest in breathing re-education as a therapeutic intervention, the specific effects on pulmonary function parameters remain unclear. Objective: To systematically evaluate the effectiveness of breathing re-education and respiratory training interventions on pulmonary function outcomes in patients with non-specific chronic neck pain. Methods: We conducted a comprehensive systematic search of MEDLINE, Embase, CINAHL, PEDro, Cochrane Central Register of Controlled Trials, and Web of Science databases from inception to August 2025. Randomized controlled trials investigating breathing re-education or respiratory training interventions in adults with non-specific chronic neck pain were included. Primary outcomes were pulmonary function parameters (FVC, FEV1, FEV1/FVC ratio). Secondary outcomes included respiratory muscle strength (MIP, MEP), pain intensity, and functional disability. Two reviewers independently screened articles, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Meta-analysis was performed using random-effects models, and evidence quality was assessed using GRADE criteria. Results: Twelve randomized controlled trials involving 486 participants were included. Breathing re-education interventions demonstrated significant improvements in forced vital capacity (FVC) (standardized mean difference [SMD] = 1.24, 95% CI: 0.67-1.81, p < 0.001; I² = 42%), forced expiratory volume in 1 second (FEV1) (SMD = 0.89, 95% CI: 0.34-1.44, p = 0.002; I² = 38%), and FEV1/FVC ratio (SMD = 0.76, 95% CI: 0.21-1.31, p = 0.007; I² = 51%). Maximal inspiratory pressure showed significant improvement (SMD = 1.15, 95% CI: 0.58-1.72, p < 0.001; I² = 35%), as did maximal expiratory pressure (SMD = 0.92, 95% CI: 0.41-1.43, p < 0.001; I² = 29%). Subgroup analysis revealed greater effects with interventions lasting 6-8 weeks compared to shorter durations. The quality of evidence was rated as low to moderate due to methodological limitations and heterogeneity between studies. Conclusions: Breathing re-education and respiratory training interventions appear to have beneficial effects on pulmonary function parameters in patients with non-specific chronic neck pain. These findings support the integration of respiratory training into comprehensive physiotherapy management. However, future high-quality trials with standardized protocols and longer follow-up periods are needed to strengthen the evidence base.