Mobilization Techniques for Nonspecific Neck Pain: Effects on Cervical Endurance and Function

A.Rationale and Aim of the StudyWith the increasing digitalization of modern life, prolonged desk-based working hours have caused individuals to remain in forward-head and sedentary postures for extended periods. This condition may lead to muscle tension in the cervical region, decreased endurance, and mild functional limitations. Since these early-stage alterations are often not recognized before progressing into clinically significant pain, they have been reported to increase the risk of developing myofascial dysfunctions over time. Therefore, early management of non-specific neck pain is important in terms of reducing both functional impairments and long-term healthcare burden.Mobilization-based approaches are commonly used methods for improving deep cervical flexor endurance, postural control, and cervical stability. While Positional Release Technique (PRT) aims to reduce muscle tension through positional relaxation, Instrument-Assisted Soft Tissue Mobilization (IASTM) is a practical and increasingly widespread technique used in the mobilization of tissue restrictions. Although findings suggest that both approaches may contribute to cervical function and symptom management, studies comparing these two techniques in desk-based workers are limited. Since most existing studies in the literature focus on chronic pain populations, their early preventive effects have not been sufficiently investigated.Therefore, comparing the effects of PRT and IASTM in individuals presenting signs of non-specific neck pain has the potential to fill an important gap in clinical practice.The aim of this study is to comparatively investigate the effects of Positional Release Technique (PRT) and Instrument-Assisted Soft Tissue Mobilization (IASTM), when combined with exercise programs, on muscle endurance, functional status, pain, quality of life, and work performance in desk-based workers with non-specific neck pain.This study aims to identify preventive mobilization approaches that can be implemented in the early stages and to establish an evidence-based decision-making framework for physiotherapy practice .B.HypothesesH0 (Null Hypothesis): There is no significant difference between the groups receiving PRT and IASTM in terms of muscle endurance, functional status, pain, quality of life, and work performance in individuals with non-specific neck pain.H1 (Alternative Hypothesis): There is a significant difference between the groups receiving PRT and IASTM in terms of muscle endurance, functional status, pain, quality of life, and work performance in individuals with non-specific neck pain.C. Main Study FormC.1.1. General InformationNon-specific neck pain (NSNP) is a common musculoskeletal disorder among desk-based working adults and may negatively affect work performance, daily functionality, and quality of life. Prolonged hours spent in a forward-head posture while using computers, sedentary lifestyle, and inadequate workplace ergonomics contribute to muscle tension, trigger point formation, and early functional limitations in the cervical region. Approximately 60% of office workers in Türkiye experience neck pain at some point in their lives; this condition results in work absenteeism and additional burden on the healthcare system.In most individuals, neck pain begins during a "subclinical" stage. Although severe pain may not yet be perceived, active trigger points, soft tissue stiffness, and reduced deep cervical flexor endurance can be identified in muscles such as the upper trapezius, scalene, and levator scapulae. If early intervention is not implemented during this stage, symptoms may become chronic and create long-term negative effects on functional status, quality of life, and occupational adaptation.Manual therapy methods, particularly Positional Release Technique (PRT) and Instrument-Assisted Soft Tissue Mobilization (IASTM), have been found effective in reducing muscle tension and supporting tissue healing during the subclinical stage. PRT provides proprioceptive inhibition by positioning muscles into passive comfort positions, whereas IASTM increases tissue mobility through controlled microtrauma. When both methods are supported with home exercise programs, they enhance postural awareness and muscular endurance. However, no study in the literature has comparatively investigated the effectiveness of these techniques in office workers with non-specific neck pain.This study aims to determine which early preventive physiotherapy approach is more effective and to propose a practical and evidence-based model for supporting cervical health in desk-based workers .Positional Release Technique (PRT)Positional Release Technique (PRT) is a non-invasive manual therapy method used to reduce muscle hypertonicity in myofascial trigger points. The technique is based on identifying the tender point through palpation, passively positioning the muscle into its shortened natural comfort position (generally through a combination of lateral flexion, rotation, and slight extension), and maintaining this position for 90 seconds. During this position, proprioceptive inhibition is stimulated, Golgi tendon organs are activated, muscle spindle tension is neutralized, and the spinal reflex arc is modulated, thereby reducing muscle tone to physiological levels. The role of PRT in non-specific neck pain is mainly limited to the inhibition of early muscle hypertonicity; however, when integrated with exercise programs, it promotes long-term proprioceptive feedback and supports postural alignment.PRT will be individually administered by a physiotherapist in the supine position, and session duration will range between 45-60 minutes. The procedure will be performed as follows:Target muscles (upper trapezius, levator scapulae, sternocleidomastoid, and scalene muscles) will be examined through palpation and sensitive trigger points will be identified.Each trigger point will be passively positioned into a comfort position (combination of lateral flexion, rotation, and shoulder depression) until tenderness significantly decreases, and maintained for 90 seconds.Following the hold period, the participant will be slowly returned to the neutral position; 2-3 repetitions will be performed for each point.During weeks 1-2, the hold duration will be 90 seconds, and during weeks 3-4, it will be increased to 120 seconds.This protocol targets trigger points associated with prolonged sitting in desk-based workers, enhances proprioceptive awareness, corrects muscle fiber orientation, and improves tolerance to repetitive stress. Its advantages include ease of integration and low risk.Randomized controlled studies have confirmed the effects of PRT on cervical muscle endurance, functional status (NDI), and subjective symptoms. Adding PRT to standard treatment in individuals with mechanical neck pain resulted in significant reductions in VAS scores, improvements in NDI scores, and increased pressure pain thresholds (p\<0.001); this effect exceeded the minimum clinically important difference (MCID) threshold within a 4-week protocol. A single session of PRT applied to upper trapezius trigger points significantly reduced local pain threshold and the effect was maintained for 24 hours (p\<0.001). PRT reduced palpation tenderness and increased muscle strength in healthy individuals; improvements in NFET holding duration associated with proprioceptive modulation were also emphasized. Reductions in VAS scores and NDI scores in myofascial trigger points (p\<0.05) were also reported.These studies confirm that PRT is an effective early preventive tool for reducing screen-related fatigue in desk-based populations through three sessions per week and for creating synergistic effects when combined with exercise programs. Overall, PRT provides sustained muscle inhibition in subclinical cervical dysfunctions and preserves functional reserve.Instrument-Assisted Soft Tissue Mobilization (IASTM - Graston Technique)Instrument-Assisted Soft Tissue Mobilization (IASTM) is a non-invasive manual therapy method that uses stainless steel instruments to apply controlled microtrauma to soft tissues in order to resolve fibrotic restrictions and accelerate tissue healing. The technique is based on moving the instrument along the muscle fiber direction at a 30-60° angle using lubricant cream. During application, a localized inflammatory response is stimulated, collagen remodeling occurs, adhesions are reduced, and tissue mobility increases. The role of IASTM in non-specific neck pain is mainly related to resolving soft tissue restrictions during the early stages; when integrated with exercise programs, increased circulation and proprioceptive feedback become more sustainable and support postural alignment.IASTM will be individually administered by a physiotherapist in supine and prone positions, and session duration will range between 45-60 minutes. The procedure will be performed as follows:Target muscles (upper trapezius, levator scapulae, sternocleidomastoid, scalene, and pectoralis minor muscles) will be examined through palpation, and fibrotic bands and restricted areas will be identified.Each region will receive 60-90 seconds of instrument strokes, and total manual contact duration will be maintained for approximately 8-12 minutes.Mild local redness and tenderness are expected following treatment.During weeks 1-2, mild-to-moderate pressure will be applied; during weeks 3-4, both pressure and duration will be increased.This protocol targets fibrotic restrictions associated with prolonged sitting in desk-based workers, increases tissue mobility, improves range of motion, and enhances tolerance to repetitive stress. Its advantages include rapid application and low risk (mild tenderness \<10%).Randomized controlled studies have demonstrated the effects of IASTM on cervical muscle endurance, functional status, and subjective symptoms. Adding IASTM to standard treatment for soft tissue injuries resulted in significant reductions in VAS scores and improvements in NDI scores (p\<0.001); this effect exceeded the clinically important difference threshold in 4-week protocols. A 4-week IASTM intervention in office workers with non-specific neck pain demonstrated superiority over the control group in terms of VAS, NDI, and SF-12 scores (p\<0.01). IASTM increased tissue mobility and improved proprioceptive feedback, emphasizing increases in NFET holding duration. IASTM produced large effect sizes in pain reduction and range of motion improvements in chronic neck pain.These studies confirm that IASTM is an effective early preventive tool for reducing screen-related fatigue in desk-based populations through three sessions per week and for creating synergistic effects when combined with exercise programs.C.1.2.2. Methods to Be Used in the Studya. Laboratory and Clinical Assessment MethodsA total of 51 desk-based workers are planned to participate voluntarily in the study. All participants will be informed about the risks and benefits of the study. Participants will be randomly assigned into three groups:Group 1: Home exercise program supported by Positional Release Technique (PRT)Group 2: Home exercise program supported by Instrument-Assisted Soft Tissue Mobilization (IASTM)Group 3: Home exercise program onlyA researcher-developed assessment form will be used as the data collection tool. Before the study begins, participants will complete a form including demographic information (sex, age, height, weight, education level, weekly desk-working hours) and medical history (chronic disease, previous injury, physical activity level).While distributing the assessment forms, participants will be informed about how to complete the forms, and it will be emphasized that the information obtained will be used solely for scientific purposes. Before the intervention, standard assessment tools will be applied to evaluate cervical parameters, including cervical muscle endurance using the Nec