Exercises for mechanical neck disorders: A Cochrane review update.

Author: Gross AR1, Paquin JP2, Dupont G3, Blanchette S3, Lalonde P3, Cristie T3, Graham N4, Kay TM5, Burnie SJ6, Gelley G7, Goldsmith CH8, Forget M9, Santaguida PL10, Yee AJ11, Radisic GG12, Hoving JL13, Bronfort G, Cervical Overview Group
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Canada. Electronic address: grossa@mcmaster.ca.
2Physio-Santé, Drummondville, Canada; University of Western Ontario, London, Canada.
3University of Western Ontario, London, Canada.
4School of Rehabilitation Science, McMaster University, Hamilton, Canada.
5Women's College Hospital, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada.
6Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada.
7Applied Health Sciences, University of Manitoba, Winnipeg, Canada.
8Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
9Canadian Forces Health Services Group, Groupe de Services de Santé des Forces Canadiennes, National Defence, Défense Nationale, Government of Canada, Gouvernement du Canada, Kingston, Canada.
10Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
11Kinesiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
12Life Science, Faculty of Health Sciences, Queens Univesity, Kingston, Canada.
13Coronel Institute of Occupational Health and Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
14Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN, USA.
Conference/Journal: Man Ther.
Date published: 2016 Aug
Other: Volume ID: 24 , Pages: 25-45 , Special Notes: doi: 10.1016/j.math.2016.04.005. Epub 2016 Apr 20. , Word Count: 271

BACKGROUND: Neck pain (NP) is disabling and costly.

OBJECTIVES: To assess the effectiveness of exercise on pain, disability, function, patient satisfaction, quality of life (QoL) and global perceived effect (GPE) in adults with NP.

METHODS: We searched computerised databases up to May 2014 for randomized controlled trials (RCTs) comparing exercise to a control in adults with NP with/without cervicogenic headache (CGH) or radiculopathy. Two reviewers independently conducted selection, data abstraction and assessed risk of bias. Meta-analyses were performed to establish pooled standardised mean differences (SMDp). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) was used to summarise the body of evidence.

MAIN RESULTS: The following exercises (27 trials) were supported by 'Moderate GRADE' evidence: For chronic NP, 1) cervico-scapulothoracic and upper extremity (UE) strengthening for moderate to large pain reduction immediately post treatment (IP) and at short-term (ST) follow-up; 2) scapulothoracic and UE endurance training for a small pain reduction (IP/ST); 3) cervical, shoulder and scapulothoracic strengthening and stretching exercise for a small to large pain reduction in the long-term (LT) (SMDp -0.45 [95%CI: -0.72 to -0.18]) and function improvement; 4) cervico-scapulothoracic strengthening/stabilisation exercises for pain and function at intermediate-term (IT) (SMDp -14.90 [95%CI: -22.40 to -7.39]). 5) mindfulness exercises (Qigong) for minor improved function but not GPE (ST). For chronic CGH, cervico-scapulothoracic strengthening and endurance exercises including pressure biofeedback for small/moderate improvement of pain, function and GPE (IP/LT).

AUTHORS' CONCLUSIONS: Specific strengthening exercises of the neck, scapulothoracic and shoulder for chronic NP and chronic CGH are beneficial. Future research should explore optimal dosage.

Copyright © 2016 Elsevier Ltd. All rights reserved.

KEYWORDS: Cochrane review; Exercise; Meta-analysis; Neck pain

PMID: 27317503 [PubMed - in process]