Exercise for neck pain

Question 1

Cochrane review

Answer 1

Kay (2009):

1. Limited evidence for benefit of strengthening, stretching/strengthening, or eye fixation exercises for neck pain with headache
2. Limited evidence for benefit of AROM exercises or HEP for acute neck pain
3. Unclear evidence of benefit of stretching and strengthening program over other treatments
4. Strong evidence of benefit favoring multimodal care approach of exercise combined with mob or manip for subacute/chronic neck pain with or without HA in short and long-term

Question 2

Hanney

Answer 2

(2010) : Systematic review of 4 RCT’s evaluating MCE for subacute or chronic neck pain. Conclusion: The addition of MCE to exercise program is not more effective than standard exercise program in the short or long-term
1. Ask (2009): No difference in cervical AROM, disability, or pain between MCE and general exercise groups at any time
2. Griffiths (2009): No difference between DNF or general exercise groups
3. Falla (2006): High-intensity endurance strengthening vs. low-load DNF exercises showed no between group difference in pain or disability
4. Chiu (2005): ?

Question 3

Miller

Answer 3

(2010) : Systematic Review
1. Combination of HVLAT or mob and exercise produces greater improvements in pain, function, quality of lift, and patient satisfaction when compared to manip or mob alone for chronic neck pain
2. Manual therapy and exercise produce greater short-term pain relief than exercise alone but no long-term difference

Question 4

O’Leary

Answer 4

(2007): Compared CCF to CF exercises and said they had immediate decrease in neck pain but it was below MCID.

Question 5

Ylinen

Answer 5

(2003): Compared: 1) Strength training 2) Endurance 3) Control for chronic neck pain. At 12 months both strength and endurance training were effective methods for decreasing pain and disability in women, but no statistically significant differences between groups.

Question 6

DCF dysfunction in patients with WAD II

Answer 6

Jull (2000): WAD II subjects could control pressure (for 5 seconds) on average at 23 mmHg versus controls to 28 mmHg

Question 7

EMG activity with CCFT and pain

Answer 7

Jull (2004): Found higher SCM activity during all stages of CCFT (22-30 mmHg) in both WAD II and insidious neck pain groups as compared to controls. Length of pain didn’t change results.

Question 8

Validity of CCFT

Answer 8

1. Falla (2003): Confirmed validity of CCFT in asymptomatics using oronasopharyngeal suction catheter EMG for DCF (longus colli)
2. Falla (2004): Confirmed validity with those with neck pain. Found stronger linear relationship between EMG amplitude of DCF and incremental stages of CCFT for controls and those with neck pain.

Question 9

Norms for DCF endurance test

Answer 9

Olson (2006): Supine hook-lying, chin tuck and lower cervical flexion holding 2 cm from table (2 fingers). Test ended with pain, loss of tuck, or lift off fingers. Average time was 25 seconds for male and 20 for female. Allowed for one lift off from test position.