STRENGTH TRAINING FOR NECK MUSCLES DRAMATICALLY INCREASES RANGE OF MOTION AND REDUCES PAIN

Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women: A Randomized Controlled Trial, by Jari Ylinen, MD; Esa-Pekka Takala, MD, DMedSc; Matti Nykänen, MD, DMedSc; Arja Häkkinen, PhD; Esko Mälkiä, PhD; Timo Pohjolainen, MD, DMedSc; Sirkka-Liisa Karppi, MSc; Hannu Kautiainen, BA; Olavi Airaksinen, MD, DMedSc; JAMA, May 21, 2003.


Background
Here is the important background information that the authors give us:

· neck disorders are a common problem in modern, industrialized countries,

· neck pain is the most common chief complaint among working-aged women visiting their physicians,

· a Canadian study showed that 54% of the general population had experienced neck pain during the 6 months prior to the study, and approximately 5% were highly disabled by neck pain,

· the origin of neck pain is thought to be due to several factors. For example, excessive physical strain may cause trauma in connective tissues, and psychosocial stress may lead to increased muscular tension. Moreover, degenerative changes in cervical vertebrae and disks are common and increase with advancing age. Examinations using radiographs or magnetic resonance imaging do not uncover the origin of pain in most cases,

· treatment for neck pain is also elusive. Current strategies for management of neck disorders have not proved to be effective.

Purpose of This Study

The authors undertook this study to investigate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles in rehabilitation of women with chronic, nonspecific neck pain.

Participants and Methodology

This randomized controlled trial was conducted in Finland between February 2000 and March 2002. A total of 180 female office workers, aged 25 to 53 years, participated in the trial. All of the participants were office workers, permanently employed, motivated to continue working, motivated for rehabilitation, and suffered from constant or frequently occurring neck pain for more than 6 months. The participants were randomized into either one of two training groups or a control group, with 60 patients in each group.

The researchers collected the following information from the participants at the beginning of the study: age, weight, height, duration of symptoms, and smoking status. Participants were asked about their use of analgesics before the study and at the 12-month follow-up visit. They were also asked about visits made to a physician and therapies performed to alleviate neck pain during the previous year. Neck pain and disability were assessed at the beginning of the study and at the 12-month follow-up visit, patients were asked to describe how the training affected their neck pain on a 6-point scale (1 indicating much more pain and 6 indicating complete relief from pain).

The researchers divided the participants into 3 groups: a strength training group, an endurance training group, and a control group.

Training Groups

1. Training group 1 - the strength training group. This group used an elastic rubber band (Theraband) to train the neck flexor muscles in each session, performed in a sitting position a single series of 15 repetitions directly forward, obliquely toward right and left, and directly backward. The aim was to maintain the level of resistance at 80% of the participant's maximum isometric strength recorded at the beginning of the study and at follow-up visits.

2. Training group 2 - the endurance training group. This group exercised neck flexor muscles by lifting the head up from the supine position in 3 series of 20 repetitions.

The women in both training groups also performed exercises for the shoulders and upper extremities by doing dumbell shrugs, presses, curls, bent-over rows, flyes, and pullovers. The endurance training group performed 3 sets of 20 repetitions for each exercise with a pair of dumbells each weighing approximately 4 and a half pounds. The strength training group exercised with an individually adjusted single dumbbell. The group performed only 1 set for each exercise with the highest load possible to perform 15 repetitions.

Members in both training groups also did a single series of squats, sit-ups, and back extension exercises. Each training session concluded with stretching exercises for the neck, shoulder, and upper limb muscles for 20 minutes. Training instruction was given by a specially trained physical therapist who had several years of experience.

The exercises for both training groups were planned so that they could be performed at home after the 9-week orientation sessions. The participants received written information about the exercises to be practiced at home and were taught to keep a weekly exercise diary throughout the training year. They were encouraged to exercise regularly 3 times a week at home. Exercise intensity and technique were checked at follow-up visits at 2 and 6 months and at the end of the year.

Control Group

The participants in the control group spent 3 days at a rehabilitation center and performed recreational activities. They were advised to perform aerobic exercise 3 times a week for a half hour. They received written information about the same stretching exercises that were performed by the training groups, which they were to practice at home for approximately 20 minutes regularly 3 times a week. The participants were trained in the proper way to perform these exercises. They were not encouraged to perform any exercises to improve muscle strength, and they received no treatments for this.

Results

Here is what the authors found:

· 73% of participants in the strength training group reported considerable or complete relief from pain,

· 59% of participants in the endurance training group and 21% in the control group reported considererable or complete relief from pain,

· particpants in the strength training group, had an increase in neck strength flexion by 110%, in rotation by 76%, and in extension by 69%,

· for participants in the endurance training group the respective increases were 28%, 29%, and 16%,

· in the control group the respective increases were slight at 10%, 10%, and 7%,

· according to their exercise diaries, which were examined by the researchers at follow-up visits, the patients in the 2 training groups continued their training throughout the year of the study.

Authors’ Summary and Conclusions

The authors note that their study showed that participation in 1-year endurance and strength training programs led to a considerable reduction in average neck pain and disability compared with the control group. Neck function, including neck strength and ROM, was improved significantly in both training groups compared with the control group.

They conclude that both isometric strength training and dynamic endurance training effectively decreased pain and disability in women with chronic neck pain during the 1-year follow-up period. An important practical observation was that long-term benefits could be obtained by training as infrequently as twice a week. Aerobic and stretching exercises proved to be much less effective than controlled endurance and strength training of the neck muscles.

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