Abstract
Background context
In 2008, the Neck Pain Task Force (NPTF) recommended exercise for the management of
neck pain and whiplash-associated disorders (WAD). However, no evidence was available
on the effectiveness of exercise for Grade III neck pain or WAD. Moreover, limited
evidence was available to contrast the effectiveness of various types of exercises.
Purpose
To update the findings of the NPTF on the effectiveness of exercise for the management
of neck pain and WAD grades I to III.
Study design/setting
Systematic review and best evidence synthesis.
Sample
Studies comparing the effectiveness of exercise to other conservative interventions
or no intervention.
Outcome measures
Outcomes of interest included self-rated recovery, functional recovery, pain intensity,
health-related quality of life, psychological outcomes, and/or adverse events.
Methods
We searched eight electronic databases from 2000 to 2013. Eligible studies were critically
appraised using the Scottish Intercollegiate Guidelines Network criteria. The results
of scientifically admissible studies were synthesized following best-evidence synthesis
principles.
Results
We retrieved 4,761 articles, and 21 randomized controlled trials (RCTs) were critically
appraised. Ten RCTs were scientifically admissible: nine investigated neck pain and
one addressed WAD. For the management of recent neck pain Grade I/II, unsupervised
range-of-motion exercises, nonsteroidal anti-inflammatory drugs and acetaminophen,
or manual therapy lead to similar outcomes. For recent neck pain Grade III, supervised
graded strengthening is more effective than advice but leads to similar short-term
outcomes as a cervical collar. For persistent neck pain and WAD Grade I/II, supervised
qigong and combined strengthening, range-of-motion, and flexibility exercises are
more effective than wait list. Additionally, supervised Iyengar yoga is more effective
than home exercise. Finally, supervised high-dose strengthening is not superior to
home exercises or advice.
Conclusions
We found evidence that supervised qigong, Iyengar yoga, and combined programs including
strengthening, range of motion, and flexibility are effective for the management of
persistent neck pain. We did not find evidence that one supervised exercise program
is superior to another. Overall, most studies reported small effect sizes suggesting
that a small clinical effect can be expected with the use of exercise alone.
Keywords
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References
- The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine. 2008; 33: S39-S51
- The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.JAMA. 2013; 310: 591-608
- Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine. 2008; 33: S75-S82
- Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.J Manipulative Physiol Ther. 2009; 32: S141-S175
- Neck pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopedic Section of the American Physical Therapy Association.J Orthop Sports Phys Ther. 2008; 38: A1-A34
- Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash.J Can Chiropr Assoc. 2005; 49: 158-209
- Exercise prescription for chronic back or neck pain: who prescribes it? Who gets it? What is prescribed?.Arthritis Rheum. 2009; 61: 192-200
- A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.Spine. 2001; 26 (discussion 798–99): 788-797
- Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain.Spine. 2002; 27: 2383-2389
- A randomized clinical trial of TENS and exercise for patients with chronic neck pain.Clin Rehabil. 2005; 19: 850-860
- A randomized controlled trial on the efficacy of exercise for patients with chronic neck pain.Spine. 2005; 30: E1-E7
- Rehabilitation of neck-shoulder pain in women industrial workers: a randomized trial comparing isometric shoulder endurance training with isometric shoulder strength training.Arch Phys Med Rehabil. 2000; 81: 1051-1058
- Effect of long-term neck muscle training on pressure pain threshold: a randomized controlled trial.Eur J Pain. 2005; 9: 673-681
- Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial.JAMA. 2003; 289: 2509-2516
- Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial.BMJ. 2003; 327: 475
- Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial.Spine. 2003; 28: 2491-2498
- Exercises for mechanical neck disorders.Cochrane Database Syst Rev. 2012; 8: CD004250
- Exercise therapy for office workers with nonspecific neck pain: a systematic review.J Manipulative Physiol Ther. 2011; 34: 62-71
- Efficacy of postural and neck-stabilization exercises for persons with acute whiplash-associated disorders: a systematic review.Physiother Can. 2008; 60: 215-223
- Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations.Spine. 2008; 33: S199-S213
- Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management.Spine. 1995; 20: 1S-73S
- The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain.Spine. 2000; 25: 1S-33S
- An evidence based checklist for the peer review of electronic search strategies (PRESS EBC).Evidence Based Library Inform Pract. 2010; 5: 149-154
- An evidence-based practice guideline for the peer review of electronic search strategies.J Clin Epidemiol. 2009; 62: 944-952
- A new system for grading recommendations in evidence based guidelines.BMJ. 2001; 323: 334-336
- The sensitivity of review results to methods used to appraise and incorporate trial quality into data synthesis.Spine. 2007; 32: 796-806
- Systematic search and review procedures: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004; : 11-14
- Methods for the best evidence synthesis on neck pain and its associated disorders: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.J Manipulative Physiol Ther. 2009; 32: S39-S45
- A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature.Spine. 2001; 26: E445-E458
- Evaluation of the quality of prognosis studies in systematic reviews.Ann Intern Med. 2006; 144: 427-437
- Assessing bias in studies of prognostic factors.Ann Intern Med. 2013; 158: 280-286
- Best evidence synthesis: an intelligent alternative to meta-analysis.J Clin Epidemiol. 1995; 48: 9-18
- A coefficient of agreement for nominal scales.Educ Psychol Meas. 1960; 20: 37-46
- Meta-analysis of heterogeneously reported trials assessing change from baseline.Stat Med. 2005; 24: 3823-3844
- Variance imputation for overviews of clinical trials with continuous response.J Clin Epidemiol. 1992; 45: 769-773
- How well are you recovering? The association between a simple question about recovery and patient reports of pain intensity and pain disability in whiplash-associated disorders.Disabil Rehabil. 2012; 34: 45-52
- Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain—a reanalysis of 4 randomized controlled trials of cupping therapy.Complement Ther Med. 2013; 21: 342-347
- A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder.Mil Med. 2009; 174: 578-583
- The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire.Eur Spine J. 2007; 16: 2111-2117
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: a randomized study with a 1-year follow-up.Disabil Rehabil. 2012; 34: 1971-1977
- Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study.Clin Rehabil. 2008; 22: 592-600
- Qigong and exercise therapy for elderly patients with chronic neck pain (QIBANE): a randomized controlled study.J Pain. 2009; 10: 501-508
- Effectiveness of specific neck stabilization exercises or a general neck exercise program for chronic neck disorders: a randomized controlled trial.J Rheumatol. 2009; 36: 390-397
- Implementation of neck/shoulder exercises for pain relief among industrial workers: a randomized controlled trial.BMC Musculoskelet Disord. 2011; 12: 205
- Qigong versus exercise versus no therapy for patients with chronic neck pain: a randomized controlled trial.Spine. 2011; 36: 419-427
- Yoga for chronic neck pain: a pilot randomized controlled clinical trial.J Pain. 2012; 13: 1122-1130
- Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain.Ann Intern Med. 2012; 156: 1-10
- Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial.Spine. 2012; 37: 903-914
- Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial.BMJ. 2009; 339: b3883
- Randomized controlled trial of exercise for chronic whiplash-associated disorders.Pain. 2007; 128: 59-68
- Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial.Br J Sports Med. 2012; 46: 1004-1010
- Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial.Man Ther. 2010; 15: 100-104
- A randomized controlled intervention trial to relieve and prevent neck/shoulder pain.Med Sci Sports Exerc. 2008; 40: 983-990
- The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial.Clin Rehabil. 2012; 26: 351-361
- Effect of therapeutic exercise and sleeping neck support on patients with chronic neck pain: a randomized clinical trial.J Rheumatol. 2007; 34: 151-158
- Retraining cervical joint position sense: the effect of two exercise regimes.J Orthop Res. 2007; 25: 404-412
- Qigong and exercise therapy in patients with long-term neck pain: a prospective randomized trial.Spine. 2007; 32: 2415-2422
- Effect of neck strength training on health-related quality of life in females with chronic neck pain: a randomized controlled 1-year follow-up study.Health Qual Life Outcomes. 2010; 8: 48
- A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims.J Rehabil Med. 2007; 39: 252-259
- Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial.J Rehabil Med. 2007; 39: 126-132
- Oxford Handbook of Complementary Medicine. Oxford Medicine Online.Oxford University Press, Oxford, 2010 (Available at:) (Accessed August 21, 2013)
- Health technology assessment: a comprehensive framework for evidence-based recommendations in Ontario.Int J Technol Assess Health Care. 2009; 25: 141-150
Article info
Publication history
Published online: February 18, 2014
Accepted:
February 3,
2014
Received in revised form:
January 20,
2014
Received:
October 9,
2013
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: DS: Consulting: Appraisal of guidelines for the Ontario Chiropractic Association. The appraisals were used to prepare a report to be submitted for consideration by the Workplace Safety and Insurance Board, Canada (A, estimated). MCN: Support for travel to meetings for the study or other purposes (B); Royalties: Wolters Kluwer (B); Speaking/Teaching Arrangements: EuroSpine (B); Trips/Travel: (B); Scientific Advisory Board/Other Office: Palladian Healthcare (B). PC: Grant: Ontario Ministry of Finance—Finance Services Commission of Ontario (I CDN, Paid directly to institution). HMS: Nothing to disclose. SV: Nothing to disclose. HY: Nothing to disclose. JJW: Nothing to disclose. DAS: Nothing to disclose. KAR: Nothing to disclose. GMvdV: Nothing to disclose. SAM: Consulting fee or honorarium: Member of the Guideline Expert Panel; MIG Project (B). LJC: Support for travel to meetings for the study or other purposes: Guideline Expert Panel Meetings (A, Paid directly to institution); Consulting: Government of Alberta Department of Finance (Insurance Branch) (A); Grants: WCB Manitoba Scientific Research Competition endMS Research and Training Network (F, Paid directly to institution), Eurospine (D, Paid directly to institution), WCB Manitoba Scientific Research Competition (F, Paid directly to institution), CIHR (E, Paid directly to institution). CLJ: Nothing to disclose. ALT-V: Nothing to disclose.
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Funding: This study was funded by the Ontario Ministry of Finance and the Financial Services Commission of Ontario (RFP#: No.: OSS_00267175). The funding agency was not involved in the collection of data, data analysis, interpretation of the data, or drafting of the article.
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