BACKGROUND: The purpose of this study was to evaluate the short- and intermediate-term effects of the combined application of instrument-assisted soft tissue mobilization (IASTM) techniques and neuromuscular exercises of the cervical and thoracic area on the improvement of the functionality of patients with mechanical neck pain and accompanying forward head posture (FHP). METHODS: Twenty patients with neck pain and FHP were randomized and received eight treatment sessions of either targeted IASTM in combination with neuromuscular exercises (group A) or a classical massage and the same set of exercises (group B). The cervical vertebral angle (CVA), cervical range of motion (ROM) and strength, pain (visual analogue scale-VAS), and neck disability index (NDI) were measured throughout the treatment period and in the two- and four-week post-treatment periods. RESULTS: The combined application of IASTM and neuromuscular exercises contributed to a significantly greater improvement in CVA (group A +7.2 degrees versus group B +1.1 degrees) and NDI (group A -25.2 versus group B -5.8) than massage and the application of the same exercises. Both interventions improved cervical ROM and strength in the short term. Pain was also significantly improved in both groups in both the short (group A VAS -5.97 versus group B VAS -3.1) and intermediate term (group A VAS -5.5 versus group B -1.5). CONCLUSIONS: Combining IASTM and exercises for the cervical and thoracic area can induce positive postural adaptations and improve the functional status of neck pain patients. TRIAL REGISTRATION: ISRCTN, ISRCTN54231174. Registered 19 March 2020 Retrospectively registered.

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