Neck strength can reduce chronic neck pain long-term
Seven pages on PainSci cite Ylinen 2007: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. The Complete Guide to Chronic Tension Headaches 3. The Complete Guide to Neck Pain & Cricks 4. Endurance Training for Pain & Rehab 5. Strength Training for Pain & Injury Rehab 6. Exercise works, except when it’s ineffective 7. Keep it up! Neck pain reduced by long-term strengthening
PainSci commentary on Ylinen 2007: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
There are only a handful of studies of long-term strength training for neck pain: two by this research group (Ylinen 2003, Ylinen 2006), plus their three-year follow-up to the first. They found that a year of regular neck strength or endurance training meaningfully reduced pain and disability. These benefits were sustained for three years in over a hundred women, even though many people didn’t continue training after the first year.
There are only a handful of other studies of exercise for neck pain, which have all failed to detect any of lasting benefit to exercise for neck pain. The results of these studies suggest that “most training studies seem to have been too short-term producing notable physiological changes.” But duration is the key, not intensity: “a relatively small training load is high enough to produce these changes, as there was no significant difference between the strength and endurance training groups with regard to the primary outcomes,” pain and disability.
Although these results are certainly good news, it’s important to keep in mind that not all patients improved completely, and even those who did achieve lasting results had to exercise diligently for a year (although six months might have done the trick, we can’t tell from this data). So strengthening is not a reliable or easy fix for neck pain (the efficacy vs. effectiveness problem strongly applies, see Beedie).
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
AIM: The objective of the trial was to evaluate whether the positive results achieved with a one-year training regimen in patients with chronic nonspecific neck pain would have long-standing effects.
METHODS: A follow-up study of two neck muscle training groups after a randomized controlled study was carried out. One-hundred and eighteen women included were those who had performed neck strength and endurance exercises in a previous randomised controlled trial. The primary outcome measures were neck pain measured by the visual analogue scale and disability indices. Isometric neck strength, range of motion (ROM) and pressure pain threshold (PPT) were measured and training frequency for the previous month elicited by a questionnaire.
RESULTS: At the 3-year follow-up, neck pain and the disability indices showed no statistically discernible change compared to the situation at the 12-month follow-up. Also, gains in neck strength, ROM and PPT achieved during the training year were largely maintained. However, adherence to the specific home training program faltered considerably.
CONCLUSION: The improvements achieved through long-term training were maintained at the 3-year follow-up. Since a 12-month exercise programme shows a long-term effect, exercise may not need to be performed regularly for the remainder of the subject's life.
related content
- “Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study,” Häkkinen et al, Clinical Rehabilitation, 2008.
- “Dose-Response Relationship of Specific Training to Reduce Chronic Neck Pain and Disability,” Nikander et al, Medicine & Science in Sports & Exercise, 2006.
- “Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial,” Ylinen et al, Journal of Rehabilitation Medicine, 2007.
- “Effect of neck exercises on cervicogenic headache: a randomized controlled trial,” Ylinen et al, Journal of Rehabilitation Medicine, 2010.
- “Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial,” Ylinen et al, Journal of the American Medical Association, 2003.
- “Effects of neck muscle training in women with chronic neck pain: one-year follow-up study,” Ylinen et al, Journal of Strength & Conditioning Research, 2006.
- “Dose-Response Relationship of Specific Training to Reduce Chronic Neck Pain and Disability,” Nikander et al, Medicine & Science in Sports & Exercise, 2006.
- “Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: systematic review and meta-analysis of randomized trials,” Bertozzi et al, Physical Therapy, 2013.
- “Long-term effects of therapeutic exercise on nonspecific chronic neck pain: a literature review,” Cheng et al, J Phys Ther Sci, 2015.
- “Exercises for mechanical neck disorders,” Gross et al, Cochrane Database of Systematic Reviews, 2015.
- “The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: Randomised controlled study,” Ruivo et al, Manual Therapy, 2015.
- “Death by effectiveness: exercise as medicine caught in the efficacy trap!,” Beedie et al, British Journal of Sports Medicine, 2016.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Holden 2023 The Lancet Rheumatology.