Ischemic Compression and Home Exercise in Non-Specific Neck Pain

A total of 52 individuals, aged 18-65, with non-specific neck pain for at least 3 months, will be included in the study. Participants will be randomly assigned to either the treatment group (n=26) or the control group (n=26). Both groups will be prescribed a home exercise program. The treatment group will additionally receive ischemic compression sessions twice a week for 4 weeks.

Ischemic compression will be applied by the therapist using the thumb or a suitable contact surface, exerting controlled and gradually increasing pressure directly on the trigger point. The pressure will be maintained at the participant's pain tolerance limit (uncomfortable but bearable) and will last approximately 90 seconds for each trigger point. Participant feedback will be continuously monitored; pressure will be reduced or terminated in case of excessive pain or discomfort.

Evaluations will include the Numeric Pain Rating Scale (NPRS) for pain, the Neck Disability Index (NDI) for neck disability level, the SF-12 for quality of life, and goniometric measurements for cervical range of motion. Data will be analyzed using SPSS software.

• Ischemic Compression (Other): The intervention group will receive ischemic compression applied to palpable trigger points in the upper trapezius, middle trapezius, levator scapulae, suboccipital muscles (rectus capitis posterior major/minor, obliquus capitis), and splenius capitis muscles for 90 seconds with gradually increasing pressure at the individual's pain tolerance threshold. Ischemic compression will be performed by the therapist applying perpendicular, controlled, and gradually increasing pressure to the trigger point using the thumb or an appropriate contact surface. The pressure will be maintained at the participant's tolerable pain threshold (uncomfortable but bearable) and sustained for approximately 90 seconds per trigger point. Participant feedback will be obtained during the application; in cases of excessive pain or discomfort, the pressure will be reduced or the application will be terminated. The aim of the application is to reduce local tenderness at the trigger point, regulate muscle tone, and
• Home Exercise Program (Other): Participants will perform a structured program consisting of stretching and strengthening exercises for the cervical region. The program will be performed twice daily for the duration of the study.

Primary outcomes

• Pain Intensity [Baseline and post-treatment (week 4)]: Measured by the Numeric Pain Rating Scale (NPRS). The scale ranges from 0 (no pain) to 10 (worst possible pain). Higher scores indicate greater pain intensity.

Secondary outcomes

• Pressure Pain Threshold (PPT) as measured by Baseline Analog Pressure Algometer [Baseline and Post-treatment (Week 4)]: Pressure pain threshold will be assessed using a Baseline Brand Analog Pressure Algometer. Measurements will be taken bilaterally from the suboccipital, upper trapezius, and middle trapezius muscle groups. Pressure will be applied perpendicular to the muscle fibers at specific anatomical points (2 cm lateral to the spinous process of the Axis for suboccipital; between C3-C5 for upper trapezius; and between T2-T4 for middle trapezius). The values will be recorded in kg/cm². Higher values indicate a higher pain threshold.
• Neck Disability [Baseline and Post-treatment (Week 4)]: The Turkish version of the NDI will be used. It is a 10-item questionnaire covering pain, activities of daily living, and sleep. Scores range from 0 to 50, where higher scores represent higher levels of disability.
• Quality of Life as measured by SF-12 Health Survey [Baseline and Post-treatment (Week 4)]: The Turkish version of the SF-12 will be used. It is a 12-item self-report scale assessing physical and mental health. It consists of two main sub-dimensions: Physical Component Summary (PCS) and Mental Component Summary (MCS). Higher scores indicate better quality of life.
• Cervical Range of Motion as measured by Universal Goniometer [Baseline and Post-treatment (Week 4)]: Cervical range of motion (flexion, extension, lateral flexion, and rotation) will be measured in degrees using a universal goniometer according to standard clinical measurement protocols.

Sex: All, ages: 17 Years to 65 Years

Inclusion Criteria:

* Individuals aged between 18 and 65 years.
* Diagnosis of non-specific neck pain for at least 3 months.
* Diagnosis of non-specific neck pain for at least 3 months.
* Voluntarily agreeing to participate and signing the informed consent form.

Exclusion Criteria:

* Presence of specific causes of neck pain (cervical disc herniation, radiculopathy, spinal stenosis, tumor, infection, rheumatic diseases, etc.).
* Having undergone surgical intervention in the neck region within the last 6 months.
* History of neurological disease.
* History of surgery in the cervical or thoracic vertebrae.
* Presence of impaired skin integrity in the application area.