A review of low quality evidence about exercise for neck pain
Two articles on PainSci cite Gross 2015: 1. The Complete Guide to Chronic Tension Headaches 2. The Complete Guide to Neck Pain & Cricks
PainSci commentary on Gross 2015: ?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.
“Specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy may be beneficial,” but “when only stretching exercises were used no beneficial effects may be expected.”
However, “no high quality evidence was found” in the 26 experiments reviewed. The data was also spread thin over many different exercises and ways of measuring success, a lot of apples to oranges comparisons. So overall the results were mostly mixed, confusing, unimpressive and highly subject to interpretation — and therefore also subject to the huge bias in favour of therapeutic exercise.
There’s been no real improvement since the first version of this review in 2005. They keep adding more low quality studies to the pool of data, but the bottom line hasn’t moved: it’s still mediocre results based on poor quality evidence. I don’t trust any conclusions here.
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.
BACKGROUND: Neck disorders are common, disabling and costly. The effectiveness of exercise as a physiotherapy intervention remains unclear.
OBJECTIVES: To improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain.
SEARCH METHODS: Computerized searches were conducted up to February 2012.
SELECTION CRITERIA: We included single therapeutic exercise randomized controlled trials for adults with neck pain with or without cervicogenic headache or radiculopathy.
DATA COLLECTION AND ANALYSIS: Two review authors independently conducted selection, data extraction, 'Risk of bias' assessment, and clinical relevance. The quality of the body of evidence was assessed using GRADE. Relative risk and standardized mean differences (SMD) were calculated. After judging clinical and statistical heterogeneity, we performed meta-analyses.
MAIN RESULTS: Six of the 21 selected trials had low risk of bias. Moderate quality evidence shows that combined cervical, scapulothoracic stretching and strengthening are beneficial for pain relief post treatment (pooled SMD -0.35, 95% confidence interval (CI): -0.60, -0.10) and at intermediate follow-up (pooled SMD -0.31, 95% CI: -0.57, -0.06), and improved function short term and intermediate term (pooled SMD -0.45, 95% CI: -0.72, -0.18) for chronic neck pain. Moderate quality evidence demonstrates patients are very satisfied with their care when treated with therapeutic exercise. Low quality evidence shows exercise is of benefit for pain in the short term and for function up to long-term follow-up for chronic neck pain. Low to moderate quality evidence shows that chronic neck pain does not respond to upper extremity stretching and strengthening or a general exercise program. Low to moderate quality evidence supports self-mobilization, craniocervical endurance and low load cervical-scapular endurance exercises in reducing pain, improving function and global perceived effect in the long term for subacute/chronic cervicogenic headache. Low quality evidence supports neck strengthening exercise in acute cervical radiculopathy for pain relief in the short term.
AUTHORS' CONCLUSIONS: Low to moderate quality evidence supports the use of specific cervical and scapular stretching and strengthening exercise for chronic neck pain immediately post treatment and intermediate term, and cervicogenic headaches in the long term. Low to moderate evidence suggests no benefit for some upper extremity stretching and strengthening exercises or a general exercise program. Future trials should consider using an exercise classification system to establish similarity between protocols and adequate sample sizes. Factorial trials would help determine the active treatment agent within a treatment regimen where a standardized representation of dosage is essential. Standardized reporting of adverse events is needed for balancing the likelihood of treatment benefits over potential harms.
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,” Arja Häkkinen, Hannu Kautiainen, Pekka Hannonen, and Jari Ylinen, Clinical Rehabilitation, 2008.
- “Dose-Response Relationship of Specific Training to Reduce Chronic Neck Pain and Disability,” R Nikander, E Mälkiä, J Parkkari, A Heinonen, H Starck, and J Ylinen, Medicine & Science in Sports & Exercise, 2006.
- “Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial,” Jari Ylinen, Hannu Kautiainen, Kaija Wiren, and Arja Hakkinen, Journal of Rehabilitation Medicine, 2007.
- “Effect of neck exercises on cervicogenic headache: a randomized controlled trial,” Jari Ylinen, Riku Nikander, Matti Nykänen, Hannu Kautiainen, and Arja Häkkinen, Journal of Rehabilitation Medicine, 2010.
- “Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial,” Jari Ylinen, Esa-Pekka Takala, Matti Nykänen, Arja Häkkinen, Esko Mälkiä, Timo Pohjolainen, Sirkka-Liisa Karppi, Hannu Kautiainen, and Olavi Airaksinen, Journal of the American Medical Association, 2003.
- “Effects of neck muscle training in women with chronic neck pain: one-year follow-up study,” J J Ylinen, A H Häkkinen, E P Takala, M J Nykänen, H J Kautiainen, E A Mälkiä, T H Pohjolainen, S L Karppi, and O V Airaksinen, Journal of Strength & Conditioning Research, 2006.
- “Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study,” J Ylinen, A Häkkinen, M Nykänen, H Kautiainen, and E-P Takala, Europa Medicophysica, 2007.
- “Dose-Response Relationship of Specific Training to Reduce Chronic Neck Pain and Disability,” R Nikander, E Mälkiä, J Parkkari, A Heinonen, H Starck, and J Ylinen, 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,” Lucia Bertozzi, Ivan Gardenghi, Francesca Turoni, Jorge Hugo Villafañe, Francesco Capra, Andrew A Guccione, and Paolo Pillastrini, Physical Therapy, 2013.
- “Long-term effects of therapeutic exercise on nonspecific chronic neck pain: a literature review,” Chih-Hsiu Cheng, Hao-Tsung Su, Ling-Wei Yen, Wen-Yu Liu, and Hsin-Yi Kathy Cheng, J Phys Ther Sci, 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,” R M Ruivo, A I Carita, and P Pezarat-Correia, Manual Therapy, 2015.
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:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.