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The Effect of Different Exercise Programs on Size and Function of Deep Cervical Flexor Muscles in Patients With Chronic Nonspecific Neck Pain: A Systematic Review of Randomized Controlled Trials

PainSci » bibliography » Arimi et al 2017
Tags: treatment, exercise, neck, strength, self-treatment, head/neck, spine

PainSci commentary on Arimi 2017: ?This page is one of thousands in the 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 is a “garbage in, garbage out” systematic review of clinical trials of deep cervical flexor training, specifically looking at the effect of such training on the function of the musculature and not on neck pain itself. Even a strong positive result here wouldn’t mean that DCF training helps neck pain, just that it actually makes those muscles work better.

But it’s “garbage in” because there simply isn’t enough good quality evidence to meaningfully review. The authors identified only nine trials, five of which they deemed “good” quality and four “moderate.” I think they may have been too generous. Their conclusions are positive: eight of nine studies “gave support” and were “in favor” of specific low-load craniocervical flexion exercise.

This is a weakly positive conclusion coming from mediocre data. The studies they reviewed mostly reported small to modest effect sizes, “technically” positive data but not at all impressive. Low-load DCF training might be doing something, but not a lot.

~ Paul Ingraham

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 pain is one of the major public health problems, which has a great impact on people's lives.

OBJECTIVES: The purpose of this study was to systematically review published studies conducted on the effect of different exercise programs on activity, size, endurance, and strength of deep cervical flexor (DCF) muscles in patients with chronic neck pain.

METHODS: The PubMed, Science Direct, OVID, Google scholar, Cochrane Library, and Physiotherapy Evidence Databases were searched to determine relevant articles published from 1990 to March 2016. The articles were qualitatively assessed based on the Physiotherapy Evidence Databases scale for randomized controlled trials studies.

RESULTS: Nine articles were identified and evaluated in the final analysis. Four studies had moderate quality, and five studies had good quality. From those nine studies, eight studies gave support to the effectiveness of specific low-load exercise training on DCF muscles parameters, while one study reported no significant difference between this exercise and other cervical exercise programs.

CONCLUSION: The results of reviewed studies are in favor of specific low-load craniocervical flexion exercise, which seems to be a highly effective exercise regimen compared to other types of exercises in improving DCF muscles impairments in patients with chronic neck pain.

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