Positional Relaxation Technique and Static Stretching in Nonspecific Neck Pain

Overview

Neck pain is one of the most common and painful musculoskeletal disorders. Between 20% and 70% of adults experience neck pain during their lifetime. The lifetime prevalence ranges from 14.2% to 71%. In the vast majority of neck pain cases, no obvious pathology or anatomical abnormality can be identified, and this condition is defined as "nonspecific neck pain". Although nonspecific neck pain generally has a benign course, it can progress to chronic pain in approximately one-third of individuals. Furthermore, 20-50% of patients still experience limitations in activities of daily living after one year and develop persistent symptoms. It has been suggested that nociplastic pain mechanisms may be involved in nonspecific neck pain, and understanding these mechanisms has become crucial for effective treatment planning. Factors such as non-ergonomic working postures, stress, negative emotions, and carrying heavy loads play a role in the development of nonspecific neck pain. The widespread use of computers, tablets, and smartphones also increases the prevalence of nonspecific neck pain by causing strained postures. The multidimensional and complex nature of risk factors for neck pain indicates that this condition is not usually due to a single factor but rather arises as a result of multiple and persistent exposures. Individuals with neck pain experience decreased cervical muscle strength, impaired intermuscular coordination, myofascial trigger points, decreased cervical range of motion, and increased tone, particularly in the upper trapezius, levator scapulae, and sternocleidomastoideus muscles. These physiological changes can negatively impact participation in school, work, and social life, leading to a decrease in quality of life. Various physiotherapy approaches are used in the management of non-specific neck pain. One of these, the Positional Relaxation Technique, is based on the principle of strain-counterstrain and involves placing dysfunctional tissues in painless, comfortable positions to reduce muscle spasm or tension. This position, held for approximately 90 seconds, facilitates neuromuscular realignment by decreasing muscle spindle sensitivity and gamma motor neuron activity. This technique reduces muscle tension and fascial dysfunction, increases circulation, alleviates edema and pain, and supports muscle strength. Static stretching exercises, on the other hand, involve holding the muscle in a lengthened position for a specific period of time and are a frequently preferred method in musculoskeletal rehabilitation. Static stretching has been shown to have positive effects such as increasing flexibility and reducing pain. This technique has been evaluated in the literature, both alone and in combination with other exercises. Breathing exercises, particularly diaphragmatic breathing, activate the parasympathetic nervous system, promote relaxation, reduce muscle tone, and enhance the therapeutic effect by regulating the physiological stress response. These exercises have been reported to improve neuroimmune responses, reduce sympathetic tone, reduce oxidative stress, and modulate pain. Furthermore, respiratory training provides short-term pain reduction, increased cervical range of motion, and improved neck muscle activation. However, studies comparing the immediate effects of positional relaxation and static stretching exercises, particularly when applied in combination with breathing exercises under the same protocol, in young individuals with nonspecific neck pain are quite limited. Most existing studies have examined these techniques separately or focused on long-term outcomes. The purpose of this study was to compare the immediate effects of positional relaxation and static stretching exercises on muscle viscoelastic properties, pain intensity, and cervical range of motion in young individuals with nonspecific neck pain.