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 commentary on Arimi 2017: ?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 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.
- “Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review,” Blomgren et al, BMC Musculoskeletal Disorders, 2018.
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:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- 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.
- 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.