Purpose: To determine if patients following an unrestricted pathway after THR with no precautions, report a difference in outcomes, compared with patients following a restricted pathway with precautions.

OBJECTIVE Examination of the construct validity and internal consistency of the Greek version of the Pain Catastrophizing Scale (PCS) in patients with chronic neck pain. METHOD Data from 45 patients with chronic neck pain, who completed the Greek version of the PCS, were used. The patients were aged 35.9 & PLUSMN;14.5 years and had experienced neck pain for longer than 6 months, at least once per week. RESULTS The Greek version of the PCS was found to have very good internal consistency (alpha=0.78-0.95). Confirmatory factor analysis showed that the data had a very good fit to the model (x2=77.71, p=0.09). The loadings of the items to their corresponding subscale were 0.75-0.92 for the rumination subscale, 0.58-0.91 for the magnification subscale and 0.38-0.93 for the helplessness subscale. The scale showed good convergent validity (average variance extracted: 0.63-0.68), but its subscales had questionable divergent validity. The scale can discriminate well between patients with different levels of catastrophizing (male versus female, Mdiff=8.43, p=0.03). No ceiling or floor effects were observed. CONCLUSIONS The Greek version of the PCS has very good construct validity and internal consistency for the assessment of pain catastrophizing in patients with idiopathic chronic neck pain. With the PCS, health professionals, including physicians, psychiatrists, psychologists, and physiotherapists are provided with a valid and reliable tool for monitoring catastrophizing and estimating the effectiveness of their therapeutic interventions in patients with chronic neck pain.

BACKGROUND Paraspinal muscle strength and fatigue are considered important in low back pain (LBP) prevention and rehabilitation. High reliability of paraspinal strength and electromyographic (EMG)-fatigue parameters has not been universally reported. Moreover, the discriminative validity of these parameters requires further exploration, under the threat of potentially poor reliability of the methods examined. AIM To investigate the reliability and discriminative validity of paraspinal strength and EMG-related fatigue in subjects with recurrent LBP and healthy participants. METHODS Test-retest measurements were performed in 26 healthy and 66 LBP volunteers, for reliability. Paraspinal isometric maximal and mean strength were determined with a maximum voluntary isometric contraction (MVIC) protocol, performed in a custom-made device. For the fatigue test, participants performed a 60% MIVC level continuous isometric contraction of the paraspinals, in conjunction with EMG analysis from 4 muscle sites of the lumbar spine. Initial median frequency (IMF), the median frequency slope (MFslope), as well as the root mean square (RMS) slope EMG parameters were used as fatigue measures. Data were analysed with repeated measures ANOVA for test-retest differences. For reliability, the intraclass correlation coefficient (ICC3,1), standard error of the measurement (SEM) and the smallest detectable difference (SDD) were reported. Group-related differences for fatigue measures were analysed with a Multivariate Analysis of Covariance, with age, weight and strength as covariates. RESULTS Isometric strength presented statistically significant between-day differences (P < 0.01), however these did not exceed 10% (healthy: 7.2%/LBP-patients: 9.7%) and ICC reliability values were excellent, yet test-retest error was increased for the patient group (healthy: ICC3,1: 0.92-0.96, SEM: 5.72-5.94 Hz, SDD: 18.51%-18.57%/LBP-patients: ICC3,1: 0.91-0.96, SEM: 6.49-6.96, SDD: 30.75%-31.61%). For the frequency data, IMF reliability was excellent (healthy: ICC3,1: 0.91-0.94, SEM: 3.45-7.27 Hz, SDD: 9.56%-20.14%/patients: ICC3,1: 0.90-0.94, SEM: 6.41-7.59 Hz, SDD: 17.75%-21.02%) and of MF raw and normalised slopes was good (healthy: ICC3,1: 0.78-0.82, SEM: 4.93-6.02 Hz, SDD: 13.66-16.67%/LBP-patients: ICC3,1: 0.83-0.85, SEM: 6.75-7.47 Hz, SDD: 18.69%-20.69%). However, the reliability for RMS data presented unacceptably high SDD values and were not considered further. For discriminative validity, less MVIC and less steep MFslopes were registered for the patient group (P < 0.01). CONCLUSION Reliability and discriminative ability of paraspinal strength and EMG-related frequency parameters were demonstrated in healthy participants and patients with LBP.

Introduction A reliable biomechanical diagnosis is necessary to justify the use of spinal manipulative treatment to correct it. Palpation is considered to be one of the most informative aspects of ...

OBJECTIVE Investigation of the association between physical activity in patients with idiopathic chronic neck pain and their psychological state. METHOD Data were collected from 45 patients with chronic idiopathic neck pain. Three instruments were used: the Hospital Anxiety and Depression Scale to assess their level of anxiety and depression, the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia. Their physical activity level was recorded using the Baecke Questionnaire for Habitual Physical Activity. RESULTS Depression showed significant negative correlation with physical activity (r=-0.39, p<0.01) and sport-related physical activity (r=-0.34, p<0.05). All other relationships were non-significant (p>0.05). Physical activity was predicted by a model, including both depression and kinesiophobia as significant predictors (R=0.5, R-2=0.25, adjusted R-2=0.17, p<0.05). CONCLUSIONS Kinesiophobia and depression appear to be associated with physical activity in patients with chronic neck pain. Limitation in physical activity may further exacerbate the physical and psychological state of these patients. Recognition of the psychological determinants of physical activity can indicate potential therapeutic markers for the management of physical activity limitation in this population.

BACKGROUND: Although low back pain (LBP) is a debilitating problem internationally, there is not a lot of research on its impact on physical, psychosocial and lifestyle factors. Especially in mediterranean countries, such as Greece, it is not sufficiently explored whether physical (pain location, a ctivity limitation etc.), sociodemographic (education, smoking etc.) or lifestyle factors (i.e. quality of life or anxiety) are influenced by LBP. OBJECTIVE: To estimate LBP prevalence in the Greek general population and explore its association with particular sociodemographic, physical and lifestyle factors. METHOD: A sample of 3125 people of the Greek adult population was randomly selected by stratified sampling encompassing rural and urban representation within the Greek mainland. An extended survey form was developed entailing three sections; personal (sociodemographic) information, questions on symptomatology and physical factors (i.e. pain characteristics, recurrence, physical disability etc.) and 3 self-administered questionnaires (including mostly lifestyle factors); Hospital Anxiety and Depression (HAD) scale for anxiety and depression, SF-12 for quality of life (QoL) and Roland-Morris for disability. RESULTS: A total of 471 (15%) people reported LBP (210 males, mean age: 47.04 ± 15.03). Amongst them 60% reported sciatica, 76% suffered recurrent LBP and 70% received specialist care. Low disability levels, moderate to high pain intensity, gender differences and good self-reported QoL and psychosocial status were reported. Sociodemographic characteristics (income, smoking, marital status etc.) were not associated with LBP physical factors, apart from age which correlated with physical disability and wellness (r being 0.446 and 0.405, respectively, p< 0.001). Physical factors (particularly pain intensity and location) correlated with lifestyle factors (QoL) and disability (r ranging between 0.396 and 0.543, p< 0.001). Mental wellness, anxiety and depression (as lifestyle factors) were not associated with sociodemographic or physical factors. CONCLUSIONS: Physical parameters were amongst the most prevalent characteristics of the Greek sample, thus offering a direction towards a more targeted treatment and rehabilitation planning. Unlike previous literature, most sociodemographic characteristics were not correlated with any LBP physical or lifestyle factors, thus possibly indicating a different socioeconomic background and aetiology domain to that of the usual non-specific LBP spectrum.

AIM To explore current diagnostic practice and attitudes of Greek and United Kingdom physiotherapists (PTs) on assessing low back pain (LBP) patients. METHODS Three focus groups were undertaken, followed by a structured questionnaire-type survey comprising 23 health professionals and a random stratified sample of 150 PTs, respectively. Twenty-nine themes relating to LBP diagnostic practice emerged. These were then given to 30 British PTs assessing their level of agreement with their Greek counterparts. Analysis was performed by percentage agreements and χ2 tests. RESULTS The survey was divided into three subsections; PTs’ attitudes on LBP assessment, patients’ attitudes and diagnostic/healthcare issues, each constituting 14, 7 and 8 statements, respectively. Over half of the statements fell within the 30%-80% agreement between Greece and United Kingdom whereas, 5 statements reported low (< 10%) and 8 statements demonstrated high (> 90%) PT percentage agreement. Similarities across British and Greek PTs were detected in history taking methods and in the way PTs feel patients perceive physiotherapy practice whereas, re-assessment was undertaken less frequently in Greece. Diagnosis according to 91% of the Greek PTs is considered a “privilege” which is exclusive for doctors in Greece (only 17% British PTs agreed) and is accompanied with a great overuse of medical investigations. Forty percent of Greek PTs (compared to 0% of British) consider themselves as “executers”, being unable to interfere with treatment plan, possibly implying lack of autonomy. CONCLUSION Although similarities on history taking methods and on patients’ attitudes were detected across both groups, gross differences were found in re-assessment procedures and diagnostic issues between Greek and British physiotherapists, highlighting differences in service delivery and professional autonomy.

Objectives To determine whether adding a physiotherapist-led cognitive-behavioural intervention to an exercise programme improved outcome in patients with chronic neck pain (CNP).Design Multicentre randomised controlled trial.Setting Four outpatient physiotherapy departments.Participants Fifty-seven patients with CNP. Follow-up data were provided by 39 participants [57% of the progressive neck exercise programme (PNEP) group and 79% of the interactive behavioural modification therapy (IBMT) group].Interventions Twenty-eight subjects were randomised to the PNEP group and 29 subjects were randomised to the IBMT group. IBMT is underpinned by cognitive-behavioural principles, and aims to modify cognitive risk factors through interactive educational sessions, graded exercise and progressive goal setting.Main outcome measures The main outcome measure was disability, measured by the Northwick Park Questionnaire (NPQ). Secondary outcomes were the Numeric Pain Rating Scale (NPRS), Pain Catastrophising Scale, Tampa Scale for Kinesiophobia (TSK), Chronic Pain Self-efficacy Scale (CPSS) and the Pain Vigilance and Awareness Questionnaire.Results No significant between-group differences in disability were observed (mean NPQ change: PNEP = -7.2, IBMT = -10.2). However, larger increases in functional self-efficacy (mean CPSS change: PNEP = 1.0, IBMT = 3.2) and greater reductions in pain intensity (mean NPRS change: PNEP = -1.0, IBMT = -2.2; P < 0.05) and pain-related fear (mean TSK change: PNEP = 0.2, IBMT = -4.7, P < 0.05) were observed with IBMT. Additionally, a significantly greater proportion of participants made clinically meaningful reductions in pain (25% vs 55%, P < 0.05) and disability (25% vs 59%, P < 0.05) with IBMT.Conclusions The primary outcome did not support the use of cognitive-behavioural physiotherapy in all patients with CNP. However, superior outcomes were observed for several secondary measures, and IBMT may offer additional benefit in some patients. Clinical Trial Registration Number ISRCTN27611394. (C) 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Respiratory function of patients with neck pain has not been given much consideration in usual clinical practice. The problem has however been highlighted occasionally by renown clinical scientists and recently there is a growing interest in the investigation of respiratory function in this clinical population. The aim of this review is to critically present the emerging evidence and discuss the similarities and differences observed. Although the evidence for some respiratory parameters is conflicting, it seems to be generally agreed that others such as maximal voluntary ventilation, strength of respiratory muscles, chest mechanics and partial pressure of arterial carbon dioxide are affected in patients with chronic neck pain. The effect size of the respiratory dysfunction regarding these respiratory parameters can be approximately described as moderate. These findings not only suggest a more thoughtful drug prescription, but they may lead to consideration of incorporation of respiratory assessment and treatment into routine physiotherapy practice. Indeed preliminary studies exploring the incorporation of such a treatment into usual practice have provided very promising results not only in relation to respiratory function, but also for other parameters of clinical interest. There remains however imminent need for randomized controlled trials to confirm the evidence base for such an approach.

International Journal of Therapy and RehabilitationVol. 22, No. 10 OpinionClinical assessment of the deep neck flexors: Which test is best?Zacharias Dimitriadis, Eleni Kapreli, Nikolaos Strimpakos, Jacqueline OldhamZacharias DimitriadisSearch for more papers by this author, Eleni KapreliSearch for more papers by this author, Nikolaos StrimpakosSearch for more papers by this author, Jacqueline OldhamSearch for more papers by this authorZacharias Dimitriadis; Eleni Kapreli; Nikolaos Strimpakos; Jacqueline OldhamPublished Online:9 Oct 2015https://doi.org/10.12968/ijtr.2015.22.10.458AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Arumugam A, Mani R, Raja K (2011) Interrater reliability of the craniocervical flexion test in asymptomatic individuals A cross-sectional study. J Manipulative Physiol Ther 34(4): 247–53. doi: https://doi.org/10.1016/j.jmpt.2011.04.011 Crossref, Google ScholarCagnie B, Dickx N, Peeters I et al. (2008) The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises. J Appl Physiol 104(1): 230–5 Crossref, Google ScholarComerford MJ, Mottram SL (2001) Movement and stability dysfunction contemporary developments. Man Ther 6(1): 15–26 Crossref, Google Scholarde Koning CH, van den Heuvel SP, Staal JB, Smits-Engelsman BC, Hendriks EJ (2008) Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain: A systematic review. BMC Musculoskelet Disord 9: 142 Crossref, Google ScholarDimitriadis Z, Strimpakos N, Kapreli E, Oldham J (2013) Test-retest reliability of craniocervical flexion test for assessing the endurance of deep neck flexors in healthy individuals. Physiotherapy Issues 9(1): 11–20 Google ScholarDimitriadis Z, Kapreli E, Strimpakos N, Oldham J (2015) Reliability of the chin tuck neck flexion test for assessing endurance of short neck flexors in healthy individuals. Physiother Theory Pract 31(4): 299–302 Crossref, Google ScholarFalla D, Farina D (2008) Neuromuscular adaptation in experimental and clinical neck pain. J Electromyogr Kinesiol 18(2): 255–61 Crossref, Google ScholarGrimmer K (1994) Measuring the endurance capacity of the cervical short flexor muscle group. Aust J Physiother 40(4): 251–4 Crossref, Google ScholarHarris KD, Heer DM, Roy TC, Santos DM, Whitman JM, Wainner RS (2005) Reliability of a measurement of neck flexor muscle endurance. Phys Ther 85(12): 1349–55 Google ScholarJames G, Doe T (2010) The craniocervical flexion test: Intra-tester reliability in asymptomatic subjects. Physiother Res Int 15(3): 144–9 Crossref, Google ScholarJull GA, Sterling M, Falla DL, Treleaven J, O'Leary SP (2008a) Whiplash, Headache and Neck Pain. Churchill Livingstone, China Google ScholarJull GA, O'Leary SP, Falla DL (2008b) Clinical assessment of the deep cervical flexor muscles: The craniocervical flexion test. J Manipulative Physiol Ther 31(7): 525–33 Crossref, Google ScholarKapreli E, Vourazanis E, Strimpakos N (2008) Neck pain causes respiratory dysfunction. Med Hypotheses 70(5): 1009–13 Crossref, Google ScholarPetty NJ (2011) Neuromusculoskeletal Examination and Assessment. 4th edn. Churchill Livingstone, China Google Scholar FiguresReferencesRelatedDetailsCited byDOES MOTIVATION AFFECT THE PERFORMANCE IN CLINICAL TESTS OF ENDURANCE OF DEEP NECK FLEXORS?Journal of Musculoskeletal Research, Vol. 20, No. 04 2 October 2015Volume 22Issue 10ISSN (online): 1759-779X Metrics History Published online 9 October 2015 Published in print 2 October 2015 Information© MA Healthcare LimitedPDF download

Objectives: The aim of the study was to examine of the intra-rater reliability of the chin tuck neck flexion (CTNF) test for assessing the endurance of neck flexors. Materials and methods: The study was performed at the Cardiorespiratory laboratory of the Physiotherapy Department, School of Health and Caring Professions, TEI Lamia, Greece. Twenty healthy volunteers (males/females: 9/11, age: 22.2 +/- 1.7 y ears) with no known musculoskeletal, cardiovascular, pulmonary, neurological, or psychiatric disorder were recruited. The participants were positioned in a supine position and were asked to raise their head 2.5 cm above the plinth and to maintain this position for as long as possible without losing craniocervical or cervical flexion. This test was repeated three times with 5-min intervals between the trials. Results: The results showed that this test could discriminate between neck flexor endurance in men and women. However, although the test seems to be highly reliable (ICC: 0.81-0.88), it presents unsatisfactory standard error of measurement (SEM: 10.7-14.7 s) and smallest detectable differences (SDD: 80.5-110.9%). Furthermore, subgroup analysis showed the test seems to be more reliable for women (ICC: 0.93-0.94) than for men (ICC: 0.68-0.8), but the SEM and SDD values for them remain unsatisfactory (SEM: 4.4-5.3 s, SDD: 57.5-63.99%). Conclusions: Due to high reproducibility and discriminant validity, clinicians and researchers might want to consider using the CTNF test for the assessment of neck flexor endurance. However, they should seek alternative measurement tools when they want to avoid a large measurement error.

BACKGROUND: Chronic neck pain is one of the most usual neuromusculoskeletal pain conditions which can lead patients to chronic disability. Similarly to other pain conditions, the changed psychological status of these patients is believed to be associated with their pain condition and disability. However, the association between the psychological status of patients with idiopathic neck pain and their pain intensity and disability is minimally explored.OBJECTIVE: This study was aimed at investigating the association between psychological states (anxiety, depression, kinesiophobia, catastrophizing) of patients with chronic idiopathic neck pain and self-reported pain and disability.METHODS: Forty five patients with idiopathic chronic neck pain (more than 6 months, at least once a week) participated. Their psychological states were assessed by using the Hospital Anxiety and Depression scale, Pain Catastrophizing scale and Tampa Scale for Kinesiophobia. Self-reported disability was recorded with the Neck Disability Index. Pain intensity was recorded by using a visual analog scale.RESULTS: Neck pain intensity was significantly correlated with anxiety (p < 0.05). Disability was significantly correlated with anxiety, depression and catastrophizing (p < 0.05). Multiple regression analysis showed that pain-induced disability can be significantly predicted by anxiety and catastrophizing (p < 0.05).CONCLUSIONS: It can be concluded that anxiety, depression and catastrophizing of patients with chronic neck pain is associated with their self-reported disability, whereas anxiety is also associated with their pain intensity. Anxiety and catastrophizing may be important predicting markers of patients' self-reported disability.

Objectives: Examination of visual analog scale's [VAS] validity for assessing psychological states in patients with chronic neck pain.Methods: Forty-five patients with chronic neck pain completed the Hospital Anxiety and Depression Scale, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale. Anxiety, depression, kinesiophobia, and catastrophizing were additionally assessed by using a VAS for each.Results: Only the anxiety VAS could correlate high enough with its corresponding questionnaire. This correlation was higher than any other of its correlations with the other psychological instruments.Conclusions: The VAS seems to be a valid scale for assessing anxiety in patients with chronic neck pain.

BACKGROUND: Chronic neck pain is one of the most common musculoskeletal pain conditions experienced by many people during their lives. Although patients with neck pain are managed predominantly as musculoskeletal patients, there are indications that they also have poor pulmonary function. The aim of this study was to examine whether patients with chronic neck pain have spirometric abnormalities and whether neck pain problems and psychological states are associated with these abnormalities. METHODS: Forty-five participants with chronic neck pain and 45 well-matched healthy controls were recruited. Spirometry was used to assess participants' pulmonary function. Neck muscle strength, endurance of deep neck flexors, cervical range of motion, forward head posture, psychological states, disability, and pain intensity were also evaluated. RESULTS: The results showed that patients with chronic neck pain yielded significantly reduced vital capacity, FVC, expiratory reserve volume, and maximum voluntary ventilation (P < .05), but peak expiratory flow, FEV1, and FEV1/FVC ratio were not affected (P > .05). Strength of neck muscles, pain intensity, and kinesiophobia were found to be significantly correlated (r > 0.3, P < .05) with respiratory function. CONCLUSIONS: Patients with chronic neck pain do not have optimal pulmonary function. Cervical spine muscle dysfunction in parallel with pain intensity and kinesiophobia are factors that are associated mainly with this respiratory dysfunction.

This review describes the possible factors that may have contributed to the variability of the results between studies that have assessed the effects of phototherapy on peripheral nerve regeneration. Furthermore, it aims to make recommendations to overcome the methodological shortcomings identified. A search of the literature was conducted. In vitro and in vivo experimental studies and clinical trials were included. Twenty five studies were critically reviewed and showed considerable variability in irradiation parameters, techniques, approaches, length of irradiation courses, experimental injury tools and procedures. Many studies that have investigated the use of phototherapy in nerve regeneration produce positive results. However, the majority of these studies suffered from a number of shortcomings: no evidence of blinding and/or randomizing procedures, lack of specification of irradiation parameters, unspecified and/or inadequate tests in their experimental injury procedures, inappropriate irradiation parameters and/or poor experimental conditions.

OBJECTIVE:The aim of this study was to investigate whether patients with chronic neck pain have changes in their transcutaneous partial pressure of arterial carbon dioxide (PtcCO2) and whether other physical and psychologic parameters are associated.DESIGN:In this cross-sectional study, 45 patients with chronic idiopathic neck pain and 45 healthy sex-, age-, height-, and weight-matched controls were voluntarily recruited. The participants' neck muscle strength, endurance of the deep neck flexors, neck range of movement, forward head posture, psychologic states (anxiety, depression, kinesiophobia, and catastrophizing), disability, and pain were assessed. PtcCO2 was assessed using transcutaneous blood gas monitoring.RESULTS:The patients with chronic neck pain presented significantly reduced PtcCO2 (P < 0.01). In the patients, PtcCO2 was significantly correlated with strength of the neck muscles, endurance of the deep neck flexors, kinesiophobia, catastrophizing, and pain intensity (P < 0.05). Pain intensity, endurance of the deep neck flexors, and kinesiophobia remained as significant predictors into the regression model of PtcCO2.CONCLUSIONS:Patients with chronic neck pain present with reduced PtcCO2, which can reach the limits of hypocapnia. This disturbance seems to be associated with physical and psychologic manifestations of neck pain. These findings can have a great impact on various clinical aspects, notably, patient assessment, rehabilitation, and drug prescription.

OBJECTIVE:To identify potential subgroups amongst patients with non-specific low back pain based on a consensus list of potentially discriminatory examination items.DESIGN:Exploratory study.PARTICIPANTS:A convenience sample of 106 patients with non-specific low back pain (43 males, 63 females, mean age 36 years, standard deviation 15.9 years) and 7 physiotherapists.METHODS:Based on 3 focus groups and a two-round Delphi involving 23 health professionals and a random stratified sample of 150 physiotherapists, respectively, a comprehensive examination list comprising the most "discriminatory" items was compiled. Following reliability analysis, the most reliable clinical items were assessed with a sample of patients with non-specific low back pain. K-means cluster analysis was conducted for 2-, 3- and 4-cluster options to explore for meaningful homogenous subgroups.RESULTS:The most clinically meaningful cluster was a two-subgroup option, comprising a small group (n = 24) with more severe clinical presentation (i.e. more widespread pain, functional and sleeping problems, other symptoms, increased investigations undertaken, more severe clinical signs, etc.) and a larger less dysfunctional group (n = 80).CONCLUSION:A number of potentially discriminatory clinical items were identified by health professionals and sub-classified, based on a sample of patients with non-specific low back pain, into two subgroups. However, further work is needed to validate this classification process.

Neck pain and headache are very common symptoms, especially in western societies. Clinical research is often confounded by the multiplicity of aetiological factors and is usually based on subjective assessment of these symptoms. A comprehensive clinical evaluation of the cervical spine should include both subjective and objective assessment. Quantification of neck function requires evaluation of all parameters, including range of motion, strength, endurance and proprioception. Recently, there has been increased effort towards reliability and validity studies concerning mainly the cervical range of motion and strength. Neck endurance and proprioception have been investigated, but to a smaller extent. A review of the literature has revealed the lack of reliable and valid instruments, as well as flaws regarding the methodologies and statistical techniques of the studies. Thus, further research is needed to establish 'gold standards' with the most appropriate protocols.

Respiratory muscle strength is one parameter that is currently proposed to be affected in patients with chronic neck pain. This study was aimed at examining whether patients with chronic neck pain have reduced respiratory strength and with which neck pain problems their respiratory strength is associated. In this controlled cross-sectional study, 45 patients with chronic neck pain and 45 healthy well-matched controls were recruited. Respiratory muscle strength was assessed through maximal mouth pressures. The subjects were additionally assessed for their pain intensity and disability, neck muscle strength, endurance of deep neck flexors, neck range of movement, forward head posture and psychological states. Paired t-tests showed that patients with chronic neck pain have reduced Maximal Inspiratory (MIP) (r = 0.35) and Maximal Expiratory Pressures (MEP) (r = 0.39) (P < 0.05). Neck muscle strength (r > 0.5), kinesiophobia (r < -0.3) and catastrophizing (r < -0.3) were significantly associated with maximal mouth pressures (P < 0.05), whereas MEP was additionally negatively correlated with neck pain and disability (r < -0.3, P < 0.05). Neck muscle strength was the only predictor that remained as significant into the prediction models of MIP and MEP. It can be concluded that patients with chronic neck pain present weakness of their respiratory muscles. This weakness seems to be a result of the impaired global and local muscle system of neck pain patients, and psychological states also appear to have an additional contribution. Clinicians are advised to consider the respiratory system of patients with chronic neck pain during their usual assessment and appropriately address their treatment.