Evidence Summary (Updated 2022)
There is moderate quality evidence that strengthening the scapulothoracic and upper extremity muscles improves pain immediately post-treatment and in the short-term. Using a standardised exercise programme which includes cervical strengthening, rotations and flexibility has been shown to improve pain, with the number needed to treat four. Moderate pain relief can be achieved with a combination of stretching and strengthening exercises of the cervical and scapulothoracic muscles immediately post-treatment, at intermediate follow up and at long-term follow up. Exercise interventions have been shown to be more effective at reducing pain than other interventions, including acupuncture, spinal manipulation and TENS (1).
Combined strengthening and stretching interventions had a positive effect on pain in people with chronic neck pain, however the evidence supporting this was of a very low quality(2,3). Yoga, Pilates, Tai Chi and similar exercises showed a similar large effect on reducing pain but had better quality evidence (2,4). In those patients with cervical radiculopathy significant improvements in pain were seen as evidence by reduced VAS scores (SMD = 0.89, 95%CI 1.34 – 0.44, p <0.001) in the exercise intervention compared to control groups (5).
Whilst the evidence for managing neck pain with physical activity or exercise interventions is inconsistent at times, Ireland et al have found that there is fair to good quality evidence showing that people who regularly exercise have a reduced prevalence of neck pain (6).
Quality of Evidence
Grade B – moderate quality
Strength of recommendation
Grade 2 – weak recommendation
Conclusion
Physical activity should be encouraged in those with neck pain, but it is important to include specific stretching and strengthening exercises of the musculature throughout the neck and shoulder.
References
- Gross AR, Paquin JP, Dupont G, Blanchette S, Lalonde P, Cristie T, et al. Exercises for mechanical neck disorders: A Cochrane review update. Man Ther [Internet]. 2016 Aug 1 [cited 2022 Aug 24];24:25–45. Available from: https://pubmed.ncbi.nlm.nih.gov/27317503/
- Mj De Zoete R, Armfield NR, Mcauley JH, Chen K, Sterling M. Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. Available from: http://bjsm.bmj.com/
- Chen X, Coombes BK, Sjøgaard G, Jun D, O’leary S, Johnston V. Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis [Internet]. Vol. 98, Physical Therapy. 2018. Available from: https://academic.oup.com/ptj
- Denham-Jones L, Gaskell L, Spence N, Pigott T. A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions. Musculoskeletal Care [Internet]. 2021 May 24 [cited 2022 Jan 5]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/34028164
- Liang L, Feng M, Cui X, Zhou S, Yin X, Wang X, et al. The effect of exercise on cervical radiculopathy A systematic review and meta-analysis The effect of exercise on cervical radiculopathy: A systematic review and meta-analysis Systematic Review and Meta-Analysis Medicine ® OPEN 1. Medicine (Baltimore) [Internet]. 2019;98:45. Available from: http://dx.doi.org/10.1097/MD.0000000000017733