Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women: A Randomized Controlled Trial | Physical Therapy | JAMA | JAMA Network
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1.
Rekola K. Health services utilization for musculoskeletal disorders in Finnish primary health care.  Acta Univ Oul.1993;D259:53-59.Google Scholar
2.
Mäntyselkä PT. Patient Pain in General PracticeKuopio, Finland: Kuopio University Publications; 1998.
3.
Côté P, Cassidy JD, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population.  Spine.2000;25:1109-1117.Google Scholar
4.
Aromaa A, Koskinen S. Health and Functional Capacity in Finland: Baseline Results of the Health 2000 Health Examination SurveyHelsinki, Finland: National Public Health Institute; 2002. Publication B3/2002.
5.
Mäntyselka PT, Kumpusalo EA, Ahonen RS, Takala JK. Direct and indirect costs of managing patients with musculoskeletal pain: challenge for health care.  Eur J Pain.2002;6:141-148.Google Scholar
6.
Sjøgaard G, Lundberg U, Kadefors R. The role of muscle activity and mental load in the development of pain and degenerative processes at the muscle cell level during computer work.  Eur J Appl Physiol.2000;83:99-105.Google Scholar
7.
Friedenberg AH, Miller WT. Degenerative disc disease of the cervical spine.  J Bone Joint Surg.1963;45:1171-1178.Google Scholar
8.
Gore DR. Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up.  Spine.2001;26:2463-2466.Google Scholar
9.
Lehto IJ, Tertti MO, Komu ME, Paajanen HE, Tuominen J, Kormano MJ. Age-related MRI changes at 0.1 T in cervical discs in asymptomatic subjects.  Neuroradiology.1994;36:49-53.Google Scholar
10.
Siivola SM, Levoska S, Tervonen O, Ilkko E, Vanharanta H, Keinänen-Kiukaanniemi S. MRI changes of cervical spine in asymptomatic and symptomatic young adults.  Eur Spine J.2002;11:358-363.Google Scholar
11.
Aker PD, Gross AR, Goldsmith CH, Peloso P. Conservative management of mechanical neck pain: systematic overview and meta-analysis.  BMJ.1996;313:1291-1296.Google Scholar
12.
Gross AR, Aker PD, Goldsmith CH, Peloso P. Conservative management of mechanical neck disorders: a systematic overview and meta-analysis.  Online J Curr Clin Trials.1996 Jul 30;Doc No 200-201:[34457 words; 185 paragraphs].Google Scholar
13.
Rush PJ, Shore A. Physician perceptions of the value of physical modalities in the treatment of musculoskeletal disease.  Br J Rheumatol.1994;33:566-568.Google Scholar
14.
Viikari-Juntura E, Takala E-P, Alaranta H. Neck and shoulder pain and disability.  Scand J Rehabil Med.1988;20:167-173.Google Scholar
15.
Wulff HR, Schlichting P. Medstat Version 2.12. Copenhagen, Denmark: The Astra Group A/S; 1991.
16.
Dixon JS, Bird HA. Reproducibility along a 10-cm vertical visual analogue scale.  Ann Rheum Dis.1981;40:87-89.Google Scholar
17.
Vernon H, Mior S. The neck disability index: a study of reliability and validity.  J Manipulative Physiol Ther.1991;14:409-415.Google Scholar
18.
Keltinkangas-Järvinen L, Rimon R. Rimon's brief depression scale, a rapid method for screening depression.  Psychol Rep.1987;60:111-119.Google Scholar
19.
Ylinen JJ, Rezasoltani A, Julin MV, Virtapohja HA, Malkia EA. Reproducibility of isometric strength: measurement of neck muscles.  Clin Biomech (Bristol, Avon).1999;14:217-219.Google Scholar
20.
Peolsson A, Hedlund R, Ertzgaard S, Öberg B. Intra- and inter-tester reliability and range of motion of the neck.  Physiother Can.2000;52:233-245.Google Scholar
21.
Mathiowetz V. Comparison of Rolyan and Jamar dynomaterers for measuring grip strength.  Occup Ther Int.2002;9:201-201.Google Scholar
22.
Lange Anderssen K, Sephard RJ, Denoling H, Varnauskas E, Masinoni R. Fundamentals of Exercising TestingGeneva, Switzerland: World Health Organization; 1971.
23.
Ylinen J, Ruuska J. Clinical use of neck isometric strength measurement in rehabilitation.  Arch Phys Med Rehabil.1994;75:465-469.Google Scholar
24.
Goldie I, Landquist A. Evaluation of the effects of different forms of physiotherapy in cervical pain.  Scand J Rehabil Med.1970;2:117-121.Google Scholar
25.
Takala E-P, Viikari-Juntura E, Tynkkynen E-M. Does group gymnastics at the workplace help in neck pain.  Scand J Rehabil Med.1994;26:17-20.Google Scholar
26.
Lundblad I, Elert J, Gerdle B. Randomized controlled trial of physiotherapy and Feldenkrais interventions in female workers with neck-shoulder complaints.  J Occup Rehabil.1999;9:179-193.Google Scholar
27.
Horneij E, Hemborg B, Jensen I, Ekdahl C. No significant differences between intervention programs on neck, shoulder and low back pain: a prospective randomized study among home-care personnel.  J Rehabil Med.2001;33:170-176.Google Scholar
28.
Levoska S, Keinänen-Kiukaanniemi S. Active or passive physiotherapy for occupational cervicobrachial disorders? a comparison of two treatment methods with a 1-year follow-up.  Arch Phys Med Rehabil.1993;74:425-430.Google Scholar
29.
Jordan A, Bendix T, Nielsen H, Hansen FR, Host D, Winkel A. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: a prospective, single-blinded, randomized clinical trial.  Spine.1998;23:311-318.Google Scholar
30.
Taimela S, Takala E-P, Asklöf T, Seppälä K, Parviainen S. Active treatment of chronic neck pain: a prospective randomized intervention.  Spine.2000;25:1021-1027.Google Scholar
31.
Waling K, Jarvholm B, Sundelin G. Effects of training on female trapezius myalgia: an intervention study with a 3-year follow-up.  Spine.2002;27:789-796.Google Scholar
32.
Karjalainen K, Malmivaara A, van Tulder M.  et al.  Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults: a systematic review within the framework of the Cochrane Collaboration Back Review.  Spine.2001;26:174-181.Google Scholar
33.
Forseth KO, Gran JT. The prevalence of fibromyalgia among women aged 20-40 years in Arendal, Norway.  Scand J Rheumatol.1992;21:74-78.Google Scholar
34.
Takala E-P, Viikari-Juntura E, Moneta GB, Saarenmaa K, Kaivanto K. Seasonal variation in neck and shoulder symptoms.  Scand J Work Environ Health.1992;18:257-261.Google Scholar
35.
Conley MS, Stone MH, Nimmons M, Dudley GA. Resistance training and human cervical muscle recruitment plasticity.  J Appl Physiol.1997;83:2105-2111.Google Scholar
36.
Gore DR, Sepic SB, Gardner GM. Neck pain: a long-term follow-up of 205 patients.  Spine.1987;12:1-5.Google Scholar
37.
Randløv A, Østergaard M, Manniche C.  et al.  Intensive dynamic training for females with chronic neck/shoulder pain: a randomised controlled trial.  Clin Rehabil.1998;12:200-210.Google Scholar
38.
Jordan A, Mehlsen J, Bülow PM, Østergaard K, Danneskiold-Samsøe B. Maximal isometric strength of the cervical musculature in 100 healthy volunteers.  Spine.1999;24:1343.Google Scholar
39.
Staudte HW, Duhr N. Age- and sex-dependent force-related function of the cervical spine.  Eur Spine J.1994;3:155-161.Google Scholar
40.
Chiu TT, Lam TH, Hedley AJ. Maximal isometric muscle strength of the cervical spine in healthy volunteers.  Clin Rehabil.2002;16:772-779.Google Scholar
41.
Mäntyselka PT, Kumpusalo EA, Ahonen RS, Takala JK. Direct and indirect costs of managing patients with musculoskeletal pain: challenge for health care.  Eur J Pain.2002;6:141-148.Google Scholar
Original Contribution
May 21, 2003

Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women: A Randomized Controlled Trial

Author Affiliations

Author Affiliations: Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Jyväskylä (Drs Ylinen and Häkkinen); Finnish Institute of Occupational Health, Helsinki (Dr Takala); Punkaharju Rehabilitation Center, Punkaharju (Dr Nykänen); Department of Health Sciences, University of Jyväskylä, Jyväskylä (Dr Mälkiä); Social Insurance Institution, Helsinki (Dr Pohjolainen and Ms Karppi); Rheumatism Foundation Hospital, Heinola (Mr Kautiainen); and Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio (Dr Airaksinen), Finland.

JAMA. 2003;289(19):2509-2516. doi:10.1001/jama.289.19.2509
Abstract

Context Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies.

Objective To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain.

Design Examiner-blinded randomized controlled trial conducted between February 2000 and March 2002.

Setting Participants were recruited from occupational health care systems in southern and eastern Finland.

Patients A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain.

Interventions Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week.

Main Outcome Measures Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures.

Results At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension.

Conclusions Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain. Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.

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