Exercise
and Rehabilitation Research
|
| Paper
Title |
Exercises
for Mechanical Neck Disorders |
| Author(s) |
Kay
TM; Gross A; Santaguida PL; Hoving J; Goldsmith C; Bronfort G;
Cervical Overview Group. |
| Journal
Reference |
Cochrane
Database Syst Rev. 2005 Jul 20;3:CD004250 |
| Background |
Neck
disorders are common, limit function, and are costly to individuals and
society. Exercise therapy is a commonly used treatment for neck pain. The
effectiveness of exercise therapy remains unclear. |
| Objectives |
To
assess the effectiveness of exercise therapy to relieve pain, or improve
function, disability, patient satisfaction, and global perceived effect in
adults with mechanical neck disorders (MND). |
| Search
Strategy |
Computerized
bibliographic databases including CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL,
and ICL were searched, without language restrictions, from their beginning
up to March 2004, and reference lists of articles were scanned. |
| Selection
Criteria |
Selected
studies were randomized [RCTs] or quasi-randomized trials and investigated
the use of exercise therapy as a treatment in adults with MND with or
without headache or radicular signs and symptoms. |
| Data
Collection and Analysis |
Two
reviewers independently conducted citation identification, study
selection, data abstraction, and methodological quality assessment. Using
a random effects model, relative risk and standardized mean differences
were calculated. The reasonableness of combining studies was assessed on
clinical and statistical grounds. In the absence of heterogeneity, pooled
effect measures were calculated. When trials were considered homogenous,
results were summarized using a rating system of five levels of evidence. |
| Main
Results |
Thirty-one
trials were selected, 19% (van Tulder criteria) to 35% (Jadad scale) had
high quality. There is limited evidence of benefit that acute range of
motion (AROM) may reduce pain in acute MND (whiplash associated disorder
(WAD)) in the short term. There is moderate evidence of benefit that neck
strengthening exercises reduce pain, improve function and global perceived
effect for chronic neck disorder with headache in the short and long term.
There is unclear evidence regarding the impact of a stretching and
strengthening program on pain, function and global perceived effect for
MND. However, when this stretching and strengthening program focuses on
the cervical or cervical and shoulder/thoracic region, there is moderate
evidence of benefit on pain in chronic MND [pooled SMD -0.42 (95%CI: -0.83
to -0.01)] and neck disorder plus headache, in the short and long term.
There is strong evidence of benefit favouring a
multimodal care approach of exercise combined with mobilization or
manipulation for subacute and chronic MND with or without headache, in the
short and long term. A program of eye fixation or proprioception exercises
imbedded in a more complete program shows moderate evidence of benefit for
pain [pooled SMD -0.72 (95% CI:-1.12 to -0.32)], function, and global
perceived for chronic MND in the short term, and on pain and function for
acute and subacute MND with headache or WAD in the long term. There is
limited evidence of benefit on pain relief in the short term for a home
mobilization program with other physical modalities over a program of rest
then gradual mobilization for acute MND or WAD. There was evidence of no
difference between the different exercise approaches. |
| Authors' Conclusions |
The
evidence summarized in this systematic review indicates that specific
exercises may be effective for the treatment of acute and chronic MND,
with or without headache. To be of benefit, a stretching and strengthening
exercise program should concentrate on the musculature of the cervical,
shoulder-thoracic area, or both. A multimodal care approach of exercise,
combined with mobilization or manipulation for subacute and chronic MND
with or without headache, reduced pain, improved function, and global
perceived effect in the short and long term. The relative benefit of other
treatments (such as physical modalities) compared with exercise or between
different exercise programs needs to be explored. The quality of future
trials should improve through more effective 'blinding' procedures and
better control of compliance and co-intervention. Phase II trials would
help identify the most effective treatment characteristics and
dosages. |
| Clinical
Significance |
Treatment
for mechanical neck disorders (either with or without headaches) should
include some form of exercise (stretching and strengthening) for the
cervical and upper back/shoulder regions. Using those treatments in conjunction
with mobilization and/or manipulation promote decreased pain, improved
function, and global perceived effect in both the short and long term. |
| NOTE:
The clinical significance review is the opinion of Dr Ken Mueller based
upon the information available at the time of posting. Unauthorized
use of the section on clinical significance is prohibited by Canadian
Copyright. The above research abstract is based on information
available through the Cochrane Database.
For further information, please refer to the original article utilizing
the publication information provided. May 31, 2006 |
