Effectiveness of Specific Neck Exercise for Nonspecific Neck Pain; Usefulness of Strategies for Patient Selection and Tailored Exercise-A Systematic Review With Meta-Analysis

Knowledge, Attitude and Practice of Italian Physiotherapists When Prescribing Exercise for People With Non-Specific Neck Pain: A National Survey

BACKGROUND AND OBJECTIVE

Exercise is a crucial component of a multimodal treatment for improving function and reducing pain in patients with non-specific neck pain. This study aims to investigate the knowledge, attitudes, practices and the influence of professional characteristics of Italian specialised musculoskeletal physiotherapists compared with non-specialised physiotherapists. The influence of professional characteristics on exercise prescription for individuals with non-specific neck pain was also investigated.

MATERIALS AND METHODS

This observational study was reported according to the CHERRIES checklist. A 30-question survey was conducted from August 2023 until January 2024.

RESULTS

A total of 446 Italian physiotherapists participated; 57.3% were Orthopaedic Manipulative Physical Therapists (OMPTs). Most (84%) reported being trained in exercise prescription for neck pain, but many were unfamiliar with certain muscular assessment tests which have been described in the literature (e.g., cervical extensor endurance test [35%], scapular holding test [41%]). 79% of the OMPTs and 56% of non-specialised physiotherapists (non-OMPTs) prescribed exercise for patients with neck pain, with 84% of the OMPTs and 68% of non-OMPTs agreeing that exercise should be part of neck pain management. 81% of the OMPTs and 63% of non-OMPTs reported being trained in the prescription of resistance training for patients with neck pain. However, OMPTs prescribed it less frequently.

CONCLUSIONS

Italian physiotherapists are trained in exercise prescription for neck pain but lack familiarity with key muscle assessment tests. There is a need for enhanced training in aerobic and resistance exercise prescription to align with international guidelines and ultimately improve patient outcomes.

Limited association between central pain processing and clinical outcomes in non-specific chronic neck pain after a manual therapy intervention: A secondary analysis

BACKGROUND

Non-specific chronic neck pain (NSCNP) is a prevalent condition causing significant disability. While manual therapy is recommended, its clinical benefits are limited. The relationship between central pain processing and treatment outcomes in NSCNP remains unclear.

OBJECTIVES

To assess whether central pain processing measures could predict manual therapy outcomes in NSCNP patients.

DESIGN

Pre-planned secondary analysis.

METHODS

Sixty-three NSCNP patients underwent a four-week manual therapy regimen. Central pain processing mechanisms were assessed using Pressure Pain Threshold (PPT), Temporal Summation of Pain (TSP), and Conditioned Pain Modulation (CPM). Clinical outcomes were measured using the Neck Disability Index (NDI), pain intensity, and the Global Rating of Change Scale (GRoC). Univariate and multivariate regression models explored associations between baseline variables and treatment outcomes.

RESULTS

Multivariate analysis identified baseline CPM and neck pain duration as significant predictors of treatment outcome based on GRoC. A weak negative association was found between CPM and GRoC (p < 0.05), suggesting that patients with lower CPM response reported better perceived outcomes. Baseline NDI was inversely associated with changes in disability (p < 0.01). Baseline pain intensity (p < 0.01) and duration (p < 0.05) were inversely related to pain reduction, while baseline CPM narrowly missed significance. No significant associations were found between TSP, PPT, and clinical outcomes.

CONCLUSION

The findings suggest a limited association between pre-treatment central pain processing status and manual therapy outcomes in NSCNP patients. The lower CPM response was modestly predictive of better outcomes, contrary to expectations. Routine use of QST measures to guide treatment decisions in this population is not supported by current data.

Optimizing safety in conservative physical management of the cervical spine: A modified Delphi study

BACKGROUND

Conservative cervical spine treatment is generally safe, but serious adverse events (SAEs) still occur despite various available clinical guidelines. There have been several challenges in understanding the specific circumstances of these events to direct prevention such as inconsistent reporting, misuse of professional titles, and incomplete data. There are also differences in opinions between professions. It is now important to understand expert views and consensus across professions regarding prevention strategies and minimum requirements for reporting standards for future SAEs.

METHODS

A modified Delphi method was used, involving 28 international experts from various allied health professions, including chiropractic, physiotherapy, osteopathy, and medicolegal fields. The experts took part in three rounds of online surveys to reach a consensus on reporting, characteristics, risk factors, and prevention of SAEs associated with neck treatments. An agreement of >74 % was required before consensus was reached.

RESULTS

Consensus was reached for more standardised reporting of SAEs across different types of treatments and professions. Addressing underlying health conditions and improving the recognition of potential risks, precautions, and contraindications during treatment were highlighted. Recommendations for strategies to improve safety, including early identification of risk factors and careful application of techniques, especially in vulnerable populations were also provided.

CONCLUSION

Experts called for the development of universally accepted clinician friendly clinical guidelines that focus on improving SAE reporting, early identification of SAEs, and safer technique application, particularly in special populations. Implementing these recommendations will help reduce the occurrence of SAEs and improve the safety of conservative cervical spine management across professions.

Immediate effects of high-intensity laser therapy for nonspecific neck pain: a double-blind randomized controlled trial

Objectives

The objective of this research was to assess the immediate effects of high-intensity laser therapy (HILT) on nonspecific neck pain (NNP) by evaluating outcome measures such as pain intensity, cervical active range of motion (ROM), stiffness of neck muscles, and functional disability.

Methods

This clinical trial, which was conducted in a double-blind and randomized manner, involved patients diagnosed with NNP who were allocated either to either a HILT group (HILT + exercise) or a placebo group (placebo-laser therapy + exercise). The primary outcome measures encompassed pain intensity via the visual analogue scale (VAS), cervical active ROM, stiffness of neck muscles (splenius capitis, semispinalis capitis, and neck fascia), as well as functional disability via the neck disability index (NDI). Statistical evaluations were carried out using SPSS version 25.0, with a significance threshold established at p < 0.05.

Results

A total of 28 individuals diagnosed with NNP were randomly allocated to either the HILT group (n = 14) or the placebo group (n = 14). Upon initial comparison, no significant differences (p > 0.05) were observed between the two groups. After treatment, both groups showed notable improvements in all outcome measures compared to baseline (p < 0.05); moreover, the HILT group demonstrated greater efficacy compared to the placebo group in terms of VAS scores (29.64 ± 8.43 mm, p = 0.001), cervical lateral flexion (right 22.46 ± 3.62°, p = 0.011; left 22.34 ± 2.74°, p = 0.034) and neck muscle shear modulus (splenius capitis muscle 22.48 ± 4.03 kPa, p = 0.001; semispinalis capitis muscle 23.50 ± 5.59 kPa, p = 0.028); however, no statistically significant differences (p > 0.05) were identified between the groups in cervical flexion, extension, rotation, neck fascia stiffness and NDI scores.

Conclusion

HILT has immediate efficacy for NNP and may be considered as one of the alternative interventions for NNP.

Clinical trial registration

http://www.chictr.org.cn/, identifier ChiCTR2200061008.

Cervical extensor muscle activity during neck tasks in individuals with and without neck pain: A systematic review

BACKGROUND

In the context of neck pain, neck muscle activity adapts through diverse regional coordination modifications during tasks. Although patterns of cervical flexor muscle impairment are well-documented, patterns in the cervical extensor muscles are less clear, hindering assessment and treatment. Despite studies revealing adaptations in the cervical extensor muscles, outcome measure heterogeneity complicates interpretation, particularly between superficial and deep muscles. To address this, we conducted a systematic review comparing neck extensor muscle activity between symptomatic and asymptomatic groups during tasks, aiming to inform clinical practice.

OBJECTIVES

To compare the cervical extensor muscle activity during neck tasks between symptomatic and asymptomatic groups, using complementary examination tools.

METHODS

Up to January 2024, experimental studies assessing cervical extensor muscle activity during neck tasks in adults with idiopathic or traumatic neck pain, or cervicogenic headache compared to healthy controls were included. Study selection involved 2 blinded reviewers. Electronic databases (Medline, Scopus, and Embase), reference lists, and relevant reviews were screened. Data extraction focused on the results of the between-group motor activity comparisons. Critical appraisal used the JBI appraisal checklist for analytical cross-sectional studies.

RESULTS

Twenty-three studies met the inclusion criteria, involving 932 participants and reporting 170 comparative assessments of 8 muscle groups, encompassing 4 main motor activity outcomes: recruitment, timing, fatigue, and directional activation. Significant differences were noted for motor recruitment in 51 % of comparisons, for timing in 35 %, and fatigue in 33 %, with consistent differences in directional activation. Impaired activity in individuals with neck pain compared to those without was found in 47 % of comparisons for superficial muscles and 65 % for deep muscles.

CONCLUSIONS

Motor activity adaptations during neck tasks appear to be unpredictable in individuals with neck pain, with a tendency for change in the deep cervical extensor muscles. Further high-quality studies are needed to confirm these findings, considering various contraction parameters, multiple muscle analyses, and several motor activity outcomes.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Review CRD42022285864.

Effects of neck-exercise and health promotion on headache outcomes in office workers: secondary analysis of the NEXpro stepped wedge cluster randomised controlled trial

BACKGROUND

Headache conditions have a high prevalence worldwide. Office workers with high and demanding workload, but low physical activity levels are considered vulnerable for suffering from headache. This analysis examines whether exercise combined with health promotion at the workplace is effective for headache relief in office workers.

METHODS

This study reports the results of secondary outcomes of a stepped wedge cluster randomized controlled trial. Office workers (n = 120) were randomly assigned to a twelve-week supervised intervention period, consisting of neck and shoulder girdle exercises with health promotion interventions performed at the workplace. Secondary outcomes were analysed and modelled for headache occurrence, frequency, and the Headache Impact Test-6 (HIT-6), accounting for possible effects for the intervention, the period it had been introduced, and interactional and nested effects.

RESULTS

At baseline, 88 of the 120 participants reported ≥ one headache episode in the past four weeks, with a mean headache frequency of 3.58 days for that period. The mean HIT-6 score for the entire cohort amounted to 53.6 points. For headache occurrence and HIT-6, the simplest model with the intervention only, showed the best statistical fit with an odds ratio for headache occurrence of 0.46 (95% confidence interval: 0.25 to 0.84), and - 2.23 (95% confidence interval: -3.35 to -1.12) points on the HIT-6 questionnaire. For headache frequency, the model accounting for interaction effects (intervention x period) had the best statistical fit and showed an incidence rate ratio of 0.57 (95% confidence interval: 0.44 to 0.74) for the first period, but not for later ones.

CONCLUSIONS

Neck exercises and health promotion had a positive impact on headache occurrence, headache frequency and HIT-6, with the latter not reaching clinical importance. Although only statistically significant for headache frequency, larger effects were found during earlier periods or shorter interventional exposure for all outcomes, necessitating refresher sessions at later periods.

TRIAL REGISTRATION

NCT04169646.

Acute and long-term effect of specific and non-specific exercises in patients with chronic neck pain: A protocol for a randomized controlled trial

Exercise therapy is the most common approach for people with chronic neck pain (CNP). Although well-established, it remains unknown which type of exercise is the best for treating this condition. Moreover, pain processing can play a role in the persistence of pain and in the response to interventions. Thus, the aim of this randomized controlled trial is to compare the acute and long-term effects of two exercise protocols (specific and non-specific) on pain and pain processing in individuals with CNP. One hundred and ten participants aged between 18 and 65 years who have had non-specific neck pain for more than 3 months will be recruited. They will be randomized and allocated into two groups (specific exercises and non-specific exercises) and both groups will perform an exercise programme twice a week for 8 weeks. Both programmes are divided into two progressive and individualized phases. The primary outcomes are change in pain intensity after 8 weeks of exercise and exercise-induced hypoalgesia, and secondary outcomes are pressure pain threshold, temporal summation of pain, conditioned pain modulation, the Neck Disability Index, the Baecke Physical Activity Questionnaire, and the Global Perception of Change Scale. Outcomes will be assessed at baseline, after 8 weeks of intervention, and at 6-month follow-up.

High-frequency laser therapy: a new alternative to physiotherapy in the treatment of cervical disk hernia

Introduction

High-frequency laser therapy has been increasingly used in several musculoskeletal disorders, but there is still a lack of evidence for the usage of the device in neck pain. This study aimed to compare the effectiveness of physiotherapy, high-frequency laser, and exercise therapy methods in the treatment of pain in cervical disk herniation.

Methods

It was a multicenter, randomized, controlled clinical trial. Patients aged between 18 and 65 with neck pain and a diagnosis of cervical disk hernia were included in the study. Patients with a history of cervical surgery, rheumatism, cancer, or pacemaker were excluded from the study. The patients were randomized into 15 sessions of physiotherapy, high-frequency laser, or exercise therapy groups and evaluated with a range of motion, visual analog score, Neck Disability Index, and Short Form Health Survey-36 before treatment, after treatment, and in 1st and 3rd months. p < 0.05 was considered statistically significant.

Results

In total, 150 patients were analyzed. There was a significant improvement in range of motion, visual analog score, Neck Disability Index, and Short Form Health Survey-36 scores in three groups after 3-month follow-up (p < 0.05). The improvement was statistically greater in the physiotherapy and high-frequency laser therapy groups (p < 0.05), but there was no significant difference between these two groups (p > 0.05).

Discussion

The results in the physiotherapy and high-frequency laser therapy groups were better than the exercise group. They may be alternatives to each other in cervical disk hernia treatment.

Effects of matched vs. unmatched physical therapy interventions on pain or disability in patients with neck pain - a systematic review and meta-analysis

BACKGROUND

The interventions performed in most randomized controlled trials (RCTs) on neck pain patients are standardized, irrespective of the high heterogeneity of patients. However, clinicians tend to choose an intervention based on the patients' clinical characteristics, and thus match the treatment to the patient.

OBJECTIVES

To investigate the effectiveness of interventions matched to the clinical characteristics of patients with neck pain versus the same, but unmatched treatment for improving pain or disability.

DESIGN

A systematic review and meta-analysis conducted following Cochrane guidelines.

METHODS

Databases searches were performed from inception to September 2023. RCTs were included if the patients in the experimental group received a treatment matched to clinical presentation or to clinicians' assessment, if the patients in the control group received a similar but unmatched treatment, and if pain or disability were reported as outcome measures.

RESULTS

The literature search produced 9516 records of which 27 met the inclusion criteria. Matched exercise therapy was superior to unmatched exercise for pain (SMD -0.57; 95% CI -0.95, -0.18) and for disability (SMD -0.69; 95% CI -1.14, -0.23) at short term, but not at intermediate-term follow-up. Matched manual treatment was not superior to unmatched manual therapy for pain or for disability at short or intermediate-term follow-up.

CONCLUSIONS

Results suggest that matching exercise to movement limitation, trapezius myalgia, or forward head position may lead to better outcomes in the short term, but not in the intermediate-term. Matched manual therapy was not superior to unmatched treatment either short or intermediate-term. Further research is warranted to verify if those criteria are potentially useful matching criteria.

A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer-reviewed physiotherapy publications: A methodology review

RATIONALE

The physiotherapy profession strives to be a leader in providing quality care and strongly recognizes the value of research to guide clinical practice. Adherence to guidelines for research reporting and conduct is a significant step towards high-quality, transparent and reproducible research.

AIM/OBJECTIVE

Assess integrity between planned and conducted methodology in randomized controlled trials (RCTs) and systematic reviews (SRs) published in physiotherapy journals.

METHODS

Eighteen journals were manually searched for RCTs and SRs published from 1 July 2021 through 31 December 2021. Studies were included if the journal or specific study was indexed in PubMed and published/translated in English. Descriptive statistics determined congruence between preregistration data and publication.

RESULTS

Forty RCTs and 68 SRs were assessed. Forty-three SRs included meta-analysis (MA). Of the 34 registered RCTs, 7 (20.6%) had no discrepancy between the registration and publication. Two trials (5.9%) addressed all discrepancies, 4 (11.8%) addressed some and 21 (61.8%) did not address any discrepancies. Of the 36 registered MAs, 33 (91.7%) had discrepancies between the registration and publication. Two (5.6%) addressed all discrepancies and three (8.3%) had no discrepancies. Eight SRs without MA published information not matching their registration, and none provided justification for the discrepancies.

CONCLUSION

Most RCTs/SRs were registered; the majority had discrepancies between preregistration and publication, potentially influencing the outcomes and interpretations of findings. Journals should require preregistration and compare the submission with the registration information when assessing publication suitability. Readers should be aware of these inconsistencies and their implications when interpreting and translating results into practice.

Exercise therapy including the cervical extensor muscles in individuals with neck pain: A systematic review

OBJECTIVE

To review the use (dosage parameters and combination with other therapeutic interventions) of cervical extensor muscle exercises and their effect on pain, disability (primary outcomes), range of motion, endurance and strength (secondary outcomes) in people with neck pain.

DATA SOURCES

An extensive literature search was conducted through MEDLINE (Ovid), Scopus (Elsevier) and Physiotherapy Evidence Database (PEDro) up to May 2023. The reference lists of all included studies and relevant reviews were screened for additional studies.

REVIEW METHODS

Randomised controlled trials reporting the use of cervical extensor muscle exercises (alone or combined) applied to adults with idiopathic or traumatic neck pain were included. Study selection, data extraction and critical appraisal (PEDro assessment scale) were performed by two blinded reviewers. Data extraction included dosage parameters, other modalities combined with these exercises and outcomes.

RESULTS

Thirty-five randomised controlled trails (eight of which were complementary analyses) with 2409 participants fulfilled the inclusion criteria. Twenty-six were of moderate to high quality. In most studies, cervical extensor muscle exercises were combined with various other therapeutic modalities and applied at different dosages. Only two studies (one high and one low quality) specifically assessed their effectiveness. The high-quality study showed significant improvements in neck pain and disability, pressure point threshold and neck mobility after both low load and high load training for 6 weeks.

CONCLUSION

The results suggest cervical extensor muscle exercises may reduce neck pain and disability; however firm conclusions cannot be drawn because of the few studies that addressed this question and the heterogeneity of the dosage parameters.

Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews

BACKGROUND

To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence.

METHODS

We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible.

RESULTS

Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available.

CONCLUSION

Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality.

TRIAL REGISTRATION

Prospero CRD42022336014.

Patient-reported outcome measures in physical therapy practice for neck pain: an overview of reviews

BACKGROUND

Understanding which patient-reported outcome measures are being collected and utilized in clinical practice and research for patients with neck pain will help to inform recommendations for a core set of measures that provide value to patients and clinicians during diagnosis, clinical decision-making, goal setting and evaluation of responsiveness to treatment. Therefore, the aim of this study was to conduct a review of systematic reviews using a qualitative synthesis on the use of patient-reported outcome measures (PROMs) for patients presenting with neck pain to physical therapy.

METHODS

An electronic search of systematic reviews and guideline publications was performed using MEDLINE (OVID), Embase (Elsevier), CINAHL Complete (EBSCOhost), and Web of Science (Clarivate) databases to identify reviews that evaluated physical therapy interventions or interventions commonly performed by a physical therapist for individuals with neck pain and included at least one patient-reported outcome measure. The frequency and variability in which the outcome measures were reported among the studies in the review and the constructs for which they measured were evaluated. The evaluation of a core set of outcome measures was assessed. Risk of bias and quality assessment was performed using A Measurement Tool to Assess systematic Reviews 2.

RESULTS

Of the initial 7,003 articles, a total of 37 studies were included in the final review. Thirty-one PROMs were represented within the 37 reviews with eleven patient-reported outcome measures in three or more reviews. The eleven PROMs assessed the constructs of disability, pain intensity, psychosocial factors and quality of life. The greatest variability was found amongst individual measures assessing psychosocial factors. Assessment of psychosocial factors was the least represented construct in the included studies. Overall, the most frequently utilized patient reported outcome measures were the Neck Disability Index, Visual Analog Scale, and Numeric Pain Rating Scale. The most frequently used measures evaluating the constructs of disability, pain intensity, quality of life and psychosocial functioning included the Neck Disability Index, Visual Analog Scale, Short-Form-36 health survey and Fear Avoidance Belief Questionnaire respectively. Overall risk of bias and quality assessment confidence levels ranged from critically low (2 studies), low (12 studies), moderate (8 studies), and high (15 studies).

CONCLUSION

This study identified a core set of patient-reported outcome measures that represented the constructs of disability, pain intensity and quality of life. This review recommends the collection and use of the Neck Disability Index and the Numeric Pain Rating Scale or Visual Analog Scale. Recommendation for a QoL measure needs to be considered in the context of available resources and administrative burden. Further research is needed to confidently recommend a QoL and psychosocial measure for patients presenting with neck pain. Other measures that were not included in this review but should be further evaluated for patients with neck pain are the Patient Reported Outcomes Measurement Information System (PROMIS) Physical function, PROMIS Pain Interference and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool.

Immediate neck hypoalgesic effects of craniocervical flexion exercises and cervical retraction exercises among individuals with non-acute neck pain and a directional preference for retraction or extension: preliminary pretest-posttest randomized experimental design

BACKGROUND

Selective deep neck flexor muscle activation through craniocervical flexion exercises has been considered to be different from cervical retraction exercises.

OBJECTIVE

To compare the immediate analgesic effect of craniocervical flexion versus cervical retraction exercises in individuals with nonacute, directional preference (DP) for cervical retraction or extension.

METHODS

A two-arm, assessor-blinded, pretest-posttest randomized experiment was conducted. Participants were randomly assigned to either craniocervical flexion or cervical retraction exercises and those who were confirmed at the post-intervention examination to have a DP for cervical retraction or extension were analyzed. The primary outcome measure was pressure pain thresholds at the C2 and C5-C6 levels.

RESULTS

A total of 10 (mean age = 20.6 years) and nine participants (mean age = 19.4 years) undertook craniocervical flexion and retraction exercises, respectively. One-way analysis of variance demonstrated no statistically significant (p > 0.05) interaction effect regardless of the neck level. In the pre-post change percentages, retraction exercises provided greater analgesic effects compared to craniocervical flexion exercises at the C2 (Hedges' g = 0.679) and C5-C6 levels (g = 0.637).

CONCLUSION

This study showed a comparable or greater immediate neck analgesic effect from cervical retraction exercises compared to craniocervical flexion exercises in individuals with a DP for cervical retraction or extension.

Efficacy of Combining Traditional Chinese Manual Therapy (Tuina) and Specific Therapeutic Neck Exercise in Young Adults with Non-Specific Chronic Neck Pain: Study Protocol for a Randomized Controlled Trial

Purpose

Non-specific chronic neck pain (NSCNP) is an increasingly common musculoskeletal disease and an important issue in the global healthcare system. Some studies have shown that the combination of manual therapy and exercise is effective in treating NSCNP but still with several limitations. Traditional Chinese manual therapy (tuina) is a Chinese manual therapy that consists of soft tissue manipulation and spinal manipulation. This study aims to design a randomized controlled trial to assess the effect of a tuina combined with specific therapeutic neck exercise modified protocol for NSCNP patients.

Patients and Methods

This is a study protocol for a randomized, participant-, assessor- and analyst-blinded controlled trial. Eighty-eight eligible NSCNP patients will be randomly allocated into tuina combined with specific therapeutic neck exercise group (TSTE group) and tuina combined with sham therapeutic neck exercise group (TS group) in a ratio of 1:1. All participants will receive 8 treatment sessions applied in 4 weeks and then be followed up for another 12 weeks. Clinical data will be collected at baseline, during treatment phase (at the 2- and 4-week) and at the 8-, 12-, 16-week follow-ups. The primary outcome is the changes in neck pain intensity (visual analogue scale). The secondary outcomes include neck disability (Neck Disability Index), cervical range of motion (ROM), neck muscle endurance, cervical muscle cross-sectional area, cervical curvature and analgesic consumption. Adverse events will be collected and recorded throughout the study.

Conclusion

We will discuss whether our tuina combined with specific therapeutic neck exercise modified protocol is more effective at improving pericervical muscle endurance, ROM, cervical muscle cross-sectional area and cervical curvature than tuina alone, thereby decreases neck pain and disability in individuals with NSCNP more effectively.

Trial Registration

Chinese Clinical Trials Registry, ChiCTR2300067903. Registered on 31 January 2023.

Women with migraine presents similar altered performance in the craniocervical flexion test than women with chronic nonspecific neck pain: An observational study

BACKGROUND

Although patients with migraine show cervical muscle impairments previous studies investigating motor performance have not characterized the sample of patients with migraine according to the presence/absence of neck pain complaints.

OBJECTIVE

To verify if there are differences in the clinical and muscular performance of the superficial neck flexors and extensors during Craniocervical Flexion Test in women with migraine, considering the presence or absence of concomitant symptoms of neck pain.

METHODS

The cranio-cervical flexion test performance was assessed by its clinical stage test and by the surface electromyographic activity of the sternocleidomastoid, anterior scalene muscles upper trapezius and splenius capitis. It was assessed in 25 women with migraine without neck pain, 25 women with migraine and neck pain, 25 women with chronic neck pain and 25 pain-free control women.

RESULTS

Poorer performance of the cervical muscles was found during the execution of the cranio-cervical flexion test, in addition to higher muscle activity, especially in the sternocleidomastoid, splenius capitis, and upper trapezius muscles in the neck pain, migraine without neck pain, and migraine with neck pain groups in comparison with the results obtained for healthy women in the control group. No difference was observed between the groups of women experiencing pain. Analysis of the extensor/flexor muscle electromyographic ratio showed that there was no difference between the groups.

CONCLUSION

Poor cervical muscle performance was observed in both women with chronic nonspecific neck pain and women with migraine regardless of the presence of neck pain.

Can baseline features predict a reduction in pain and disability following neck-specific exercise in people with chronic non-specific neck pain?: A systematic review and meta-analysis protocol

INTRODUCTION

Neck-specific exercises (NSEs) are commonly used for the treatment of chronic non-specific neck pain (CNSNP). However, it remains unclear whether baseline features can predict the response to neck-specific exercise (NSE) in people with CNSNP. This systematic review aims to assess whether baseline features such as age, gender, muscle activity, fatigability, endurance and fear of movement can predict pain and disability reduction following a NSE intervention.

METHODS AND ANALYSIS

This systematic review and meta-analysis will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols guidelines checklist. The Web of Science, PubMed, Scopus, MEDLINE, Embase and CINAHL databases; key journals; and grey literature will be searched up until June 2023, including medical subject heading terms and keywords combinations. Included studies will investigate an association between the baseline features and pain and disability outcomes following NSE in people with CNSNP. Two independent reviewers will oversee the searching, screening, data extraction and assessment of risk of bias. The risk of bias will be assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) and Risk-Of-Bias tool for randomised trials 2 (ROB 2). The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Using standardised forms, details regarding study characteristics, baseline features (predictive factors), intervention, primary outcome and effect size (OR and 95% CI of each predictive factor and p value) will be extracted from included studies. Meta-analyses will be considered, if the studies are sufficiently homogeneous and if three or more studies investigate the same or comparable factors that predict the same response (pain intensity or disability). In the event that less than three studies investigated the same factors, a narrative synthesis will be conducted.

ETHICS AND DISSEMINATION

Ethical approval will not be required as this review will be based on published studies. The results of this study will be submitted to a peer-reviewed journal and presented at conferences.

PROSPERO REGISTRATION NUMBER

CRD42023408332.

A Novel Device for Assessment and Treatment of Upper Cervical Spine: Test-Retest Reliability Study

INTRODUCTION

Neck pain is one of the most frequent reasons for consultation in primary care. Clinicians evaluate different variables, including movement and cervical strength, to determine the prognosis of patients. Usually, the tools employed for this purpose are expensive and bulky, or more than one is needed. This study aims to describe a novel device designed to assess the cervical spine and describe its test-retest reliability.

METHODS

The Spinetrack device was designed to measure the strength of deep cervical flexor muscles and the chin-in and chin-out movement of the upper cervical spine. A test-retest reliability study was developed. The flexion, extension and strength needed to move the Spinetrack device were registered. Two measurements were developed, with one week between each assessment.

RESULTS

Twenty healthy subjects were evaluated. The strength of the deep cervical flexor muscles in the first measurement was 21.18 ± 3.15 Newtons, the displacement movement during chin-in movement was 12.79 mm ± 3.46 and the displacement during chin-out movement was 35.99 mm ± 4.44. The test-retest reliability of strength was ICC 0.97 (95% CI (0.91-0.99)).

CONCLUSION

The Spinetrack device has shown excellent test-retest reliability values for the measurement of the strength of the cervical flexor muscles and for the chin-in and chin-out movements.

Maintenance effect of corrective exercises on neck-shoulder pain and workability among office workers: A 1-year follow-up

BACKGROUND

While positive short-term effects from corrective exercise on neck-shoulder pain (NSP) are evident, maintenance effects after cessation of the exercise remain unknown.

OBJECTIVE

The objective of the present study was to assess the lasting effects of corrective exercise in NSP and workability after a year of detraining.

METHODS

A cohort study with 1-year follow-up was carried out in two previous training groups (n = 24) using a self-reported paper-based questionnaire, which was completed three times (baseline, 8-week exercise, and 1-year detraining). The subjects (mean±SD age: 39.0±6.4, 38.1±8.0) responded to the Visual Analogue Scale (VAS) for NSP as the primary outcome. A single validated item from the Workability Index determined workability as the secondary outcome. Between and within-group differences of the two groups were investigated using non-parametric tests, including 12 subjects in each group.

RESULTS

The results indicated that 8-week exercise improvements in NSP and mental and physical workability were largely maintained after one year of detraining. The lasting effects of NSP and physical and mental workability were statistically identified in 8-week and 1-year follow-ups. Nevertheless, it is noticeably warranted to adhere to the exercise program.

CONCLUSION

The current study indicates that a brief 8-week exercise period once per year is sufficient to reduce pain and improve workability among workers. This knowledge can make exercise interventions more feasible and cost-effective for companies aiming to improve employee health.