Effect of Therapeutic Exercise on Pain and Disability in the Management of Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis of Randomized Trials

Abstract

Background Given the prevalence of chronic nonspecific neck pain (CNSNP) internationally, attention has increasingly been paid in recent years to evaluating the efficacy of therapeutic exercise (TE) in the management of this condition. Purpose The purpose of this study was to conduct a current review of randomized controlled trials concerning the effect of TE on pain and disability among people with CNSNP, perform a meta-analysis, and summarize current understanding. Data Sources Data were obtained from MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Physiotherapy Evidence Database (PEDro), and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to August 2012. Reference lists of relevant literature reviews also were tracked. Study Selection All published randomized trials without any restriction regarding time of publication or language were considered for inclusion. Study participants had to be symptomatic adults with only CNSNP. Data Extraction Two reviewers independently selected the studies, conducted the quality assessment, and extracted the results. Data were pooled in a meta-analysis using a random-effects model. Data Synthesis Seven studies met the inclusion criteria. Therapeutic exercise proved to have medium and significant short-term and intermediate-term effects on pain (g=−0.53, 95% confidence interval [CI]=−0.86 to −0.20, and g=−0.45, 95% CI=−0.82 to −0.07, respectively) and medium but not significant short-term and intermediate-term effects on disability (g=−0.39, 95% CI=−0.86 to 0.07, and g=−0.46, 95% CI=−1.00 to −0.08, respectively). Limitations Only one study investigated the effect of TE on pain and disability at follow-up longer than 6 months after intervention. Conclusions Consistent with other reviews, the results support the use of TE in the management of CNSNP. In particular, a significant overall effect size was found supporting TE for its effect on pain in both the short and intermediate terms.

Exercise Only, Exercise With Mechanical Traction, or Exercise With Over-Door Traction for Patients With Cervical Radiculopathy, With or Without Consideration of Status on a Previously Described Subgrouping Rule: A Randomized Clinical Trial

“…30,40 Various types of therapeutic exercise have been found to be effective for patients with nonspecific neck pain 2,30 but have been studied only sparsely for patients with cervical radiculopathy. Cervical traction is another frequently recommended, yet inadequately researched, treatment for patients with cervical radiculopathy.…”

Evidence-Based Physical Medicine and Rehabilitation Strategies for Patients with Cervical Radiculopathy Due to Disc Herniation

“…Another systematic review evaluating the effects of exercises in office workers with neck pain (with no definite exclusion criteria for discogenic neck pain) advocated muscle strengthening or muscle endurance exercises (20). The most recent systematic review confirmed the short-and intermediate-term pain-relieving effects of therapeutic exercise in patients with nonspecific chronic neck pain in general (21). A recent exercise trial for neck pain patients, including those with pain radiating to the upper extremity, yielded similar results in terms of pain relief in the short term and global perceived effect, with supervised neck and upper body strengthening exercise (the intensity of which was individualized to the specific patient) with and without cervical and thoracic spine manipulation using high-velocity, low-amplitude thrust techniques (22).…”

Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes

“…The PA&E in this trial were based and modified from previous studies [193,216] which reported improvements in pain intensity and strength for women with pain in the neck-and shoulder muscles. PA&E in various combinations are often used for the treatment of chronic pain [3,[33][34][35][36][37][38][39]. However, despite the large amount of research on PA&E as treatment for chronic pain, there is still a lack of knowledge on physiological effects mechanisms behind the positive effects.…”

“…However, in accordance with the suggestion that chronification of pain might be related to an imbalance between facilitating and inhibitory neurobiological systems [47,236], it is important to highlight the potential of PA&E to impact both ascending pain inducing activities as well as pain modulatory and descending activities in the nervous system. In future studies, the clinical effect on pain intensity and function as a result of different types of PA&E might not be of main interest to evaluate further, as several reviews [3,33,34,[36][37][38][39] and a metaanalyse [35] consistently shows that PA&E of different types are beneficial for chronic pain. To advance the research field, it might instead be interesting to add a focus on the physiological and neurobiological effect mechanisms associated to acute and long-term effects of PA&E in chronic pain.…”

“…Management of chronic pain is instead aiming at increase bodily and vocational functioning, increase psychological well-being, and limit pain intensity [15]. The effects of the best available chronic pain treatment, such as pharmacological treatment [20,30], multimodal rehabilitation [31,32], PA&E [3,[33][34][35][36][37][38][39] and psychological treatment [40][41][42] have in general been weak to moderate. Thus, it is important to improve the treatment for chronic pain.…”