Effects of Combined Lower Trapezius Strengthening and Deep Cervical Flexor Exercises on Pain, Posture, and Muscle Properties in Patients with Chronic Neck Pain: A Randomized Controlled Trial

Objective: This study aimed to investigate the effects of combined lower trapezius strengthening and deep cervical flexor exercises on pain and forward head posture (FHP) accommodative forces in patients with chronic neck pain. Design: Single-blind randomized controlled trial Methods: Forty-two young adults (age: 23.12±3.01 years) with chronic neck pain and FHP (craniovertebral angle <48°) were enrolled in this trial. The participants were randomized to either an experimental group (n=21: modified prone cobra + deep cervical flexor training) or a control group (n=21: deep cervical flexor training only). Both groups received interventions twice a week for 4 weeks (eight sessions). The primary outcomes were Neck Disability Index (NDI) and craniovertebral angle (CVA). The secondary outcomes included lower trapezius strength and sternocleidomastoid muscle mechanical properties (Myoton PRO). Results: Both groups demonstrated significant time effects for the NDI (experimental: -5.19±2.77 points, control: -4.19±2.82 points; F=118.28, p<0.001, ηp2=0.747) and CVA (p<0.001), surpassing minimal clinically important differences. The experimental group showed significant advantages in regard toleft lower trapezius strength gain (+1.63 vs +0.62 kg, F=4.09, p=0.050, ηp2=0.093) and sternocleidomastoid muscle tone/stiffness reduction. Conclusions: Adding lower trapezius strengthening exercises to cervical stabilization exercises produced superior improvements in the scapular muscle strength and cervical muscle mechanical properties, with comparable effects on pain and posture. Lower trapezius training is a valuable adjunct to conventional neck rehabilitation programs.