Exercises for mechanical neck disorders

Specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy appear to be beneficial.

A Cochrane review on the effectiveness of exercise therapy for mechanical neck disorders (MND) in adults included 27 studies with a total of 2485 analyzed /3005 randomized subjects.

For acute neck pain only, no evidence was found.

For chronic neck pain, moderate quality evidence supports 1) cervico-scapulothoracic and upper extremity strength training to improve pain of a moderate to large amount immediately post treatment [pooled SMD (SMDp) -0.71 (95% CI: -1.33 to -0.10)] and at short-term follow-up; 2) scapulothoracic and upper extremity endurance training for slight beneficial effect on pain at immediate post treatment and short-term follow-up; 3) combined cervical, shoulder and scapulothoracic strengthening and stretching exercises varied from a small to large magnitude of beneficial effect on pain at immediate post treatment [SMDp -0.33 (95% CI: -0.55 to -0.10)] and up to long-term follow-up and a medium magnitude of effect improving function at both immediate post treatment and at short-term follow-up [SMDp -0.45 (95% CI: -0.72 to -0.18)]; 4) cervico-scapulothoracic strengthening/stabilization exercises to improve pain and function at intermediate term [SMDp -14.90 (95% CI:-22.40 to -7.39)]; 5) Mindfulness exercises (Qigong) minimally improved function but not global perceived effect at short term. Low evidence suggests 1) breathing exercises; 2) general fitness training; 3) stretching alone; and 4) feedback exercises combined with pattern synchronization may not change pain or function at immediate post treatment to short-term follow-up. Very low evidence suggests neuromuscular eye-neck co-ordination/proprioceptive exercises may improve pain and function at short-term follow-up.

For chronic cervicogenic headache, moderate quality evidence supports static-dynamic cervico-scapulothoracic strengthening/endurance exercises including pressure biofeedback immediate post treatment and probably improves pain, function and global perceived effect at long-term follow-up. Low grade evidence supports sustained natural apophyseal glides (SNAG) exercises. For acute radiculopathy, low quality evidence suggests a small benefit for pain reduction at immediate post treatment with cervical stretch/strengthening/stabilization exercises.

Comment: The quality of evidence is downgraded by imprecise results (wide confidence intervals).

Strong evidence: There is strong evidence of benefit favouring a multimodal care approach of exercise combined with mobilisations or manipulations for subacute and chronic MND with or without headache in the short and long term. Moderate evidence: When the stretching and strengthening program focuses on the cervical or cervical and shoulder/thoracic region, there is moderate evidence of benefit on pain in chronic MND [pooled SMD -0.42 (95%CI: -0.83 to -0.01)] and neck disorder with headache (NDH) in the short and long term. A program of eye-fixation/proprioception exercises imbedded in a more complete program shows moderate evidence of benefit for pain, function, and global perceived effect for chronic MND in short term and on pain and function for acute and subacute whiplash associated disorders (WAD) with or without headache in the long term. Limited evidence: The current results point to limited evidence of benefit that active range-of-motion (AROM) exercises may reduce pain in acute WAD in the short term. There is limited evidence of benefit that neck strengthening exercises will reduce pain, improve function and global perceived effect for chronic NDH in the short and long term. There is limited evidence of benefit on pain relief in the short term for a home mobilisation program with other physical modalities over a program of rest then gradual mobilisation for acute WAD. In the long term, surgical intervention was no better than a program of modalities plus exercise for neck disorders with radicular findings (NDR) based on limited evidence. Unclear evidence: There is unclear evidence regarding the impact of a stretching and strengthening program on pain, function and global perceived effect for MND. It is unclear if exercise therapy is more effective than other types of treatment (manual therapies or modalities) and it is impossible to identify the effective components of these multimodal treatments. There was evidence of no difference between the different exercise approaches.

Ədəbiyyat

1. Gross A, Kay TM, Paquin JP et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev 2015;1():CD004250. .