Stretching exercises vs manual therapy for chronic neck pain
Two articles on PainSci cite Ylinen 2007: 1. Quite a Stretch 2. The Complete Guide to Neck Pain & Cricks
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.
This examiner-blinded randomized cross-over trial of 125 patients found pretty promising benefits to both stretching exercises and “manual therapy” for a month, and the researchers concluded that “low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain, at least in the short-term.” However, there are several reasons not to get too excited about the significance of this study, perhaps the most important of which is simply that showing some improvement over 4 weeks is hardly an impressive therapeutic accomplishment, and if the study had included a control group it might well have revealed that the “therapeutic” effects weren’t much different than the natural course of the condition — i.e. everyone might have gotten better, with and without therapy of any kind.
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.
OBJECTIVE: To compare the effects of manual therapy and stretching exercise on neck pain and disability.
DESIGN: An examiner-blinded randomized cross-over trial.
PATIENTS: A total of 125 women with non-specific neck pain.
METHODS: Patients were randomized into 2 groups. Group 1 received manual therapy twice weekly and Group 2 performed stretching exercises 5 times a week. After 4 weeks the treatments were changed. The follow-up times were after 4 and 12 weeks. Neck pain (visual analogue scale) and disability indices were measured.
RESULTS: Mean value (standard deviation) for neck pain was 50 mm (22) and 49 mm (19) at baseline in Group 1 and Group 2, respectively, and decreased during the first 4 weeks by 26 mm (95% Confidence Interval 20-33) and 19 mm (12-27), respectively. There was no significant difference between groups. Neck and shoulder pain and disability index decreased significantly more in Group 1 after manual therapy (p=0.01) as well as neck stiffness (p=0.01).
CONCLUSION: Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain. The difference in effectiveness between the 2 treatments was minor. Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain, at least in the short-term.
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.
- “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.
- “Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study,” Ylinen et al, Europa Medicophysica, 2007.
- “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.
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- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
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- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.