Active neck muscle training for chronic neck pain
Evidence Summaries Level of Evidence = B
Strength and endurance training for 12 months appear to be effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain.
A randomized controlled trial 1 included 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain. Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week. Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures. At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension.
The effect of exercise on neck-shoulder pain was studied in randomized trial 2 in 103 women with work-related trapezius myalgia randomized into three exercise groups and a control group. One group trained strength, the second muscular endurance and the third co-ordination. The exercise groups met three times weekly for 10 weeks. Pain assessment was made on three visual analogue scales, indicating pain at present, pain in general and pain at worst. Pain thresholds were measured in the trapezius muscle with a pressure algometer. A pain drawing was completed. The rated pain decreased significantly (P<0.05) on the VAS describing pain at worst in the strength and endurance groups. Pressure sensitivity decreased significantly (P<0.05) in four triggerpoints in the exercise groups. No changes were seen in the extent of painful body area in any group. Comparison of exercisers (n=82) and controls (n=21) showed significantly larger pain reductions on VAS pain at present and VAS pain at worst among exercisers. All three exercise programs showed similar decreases of pain which indicates that the type of exercise is of less importance to achieve pain reduction.
1. Ylinen J, Takala EP, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, Karppi SL, Kautiainen H, Airaksinen O. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA 2003 May 21;289(19):2509-16. [PMID:12759322]
2. Waling K, Sundelin G, Ahlgren C, Järvholm B. Perceived pain before and after three exercise programs - a controlled clinical trial of women with work-related trapezius myalgia. Pain 2000 Mar;85(1-2):201-7. [PMID:10692619]
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