Exercise therapy for chronic non-specific neck pain_West China Medical Journal

Authors：

CHEN Xinyi , WANG Haonan ,  NI Guoxin

School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, P. R. China;

Corresponding author：

NI Guoxin, Email: niguoxin@bsu.edu.cn

Keywords：

Chronic non-specific neck pain; Dysfunction; Exercise therapy

DOI：

10.7507/1002-0179.202002419

Video：

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Non-specific neck pain is the most common type of neck pain. Without timely and effective treatment, majority of patients might develop chronic non-specific neck pain. In addition to pain, patients also suffer multiple dysfunctions. Considering the individual differences of patients, strategies of targeted exercise therapy based on the specific dysfunction of patients have attracted attention. In this paper, exercise therapies for common dysfunctions of patients with chronic non-specific neck pain, such as decreased mobility of cervical and thoracic spine, insufficient activation of deep cervical flexors, poor muscle strength and endurance, abnormal breathing pattern, and impaired proprioception are introduced, in order to provide clinical guidance for individual rehabilitation.

Citation： CHEN Xinyi, WANG Haonan, NI Guoxin. Exercise therapy for chronic non-specific neck pain. West China Medical Journal, 2020, 35(5): 603-607. doi: 10.7507/1002-0179.202002419 Copy

1.	GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet, 2018, 392(10159): 1789-1858.
2.	Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ, 2017, 358: j3221.
3.	McLean SM, May S, Klaber-Moffett J, et al. Risk factors for the onset of non-specific neck pain: a systematic review. J Epidemiol Community Health, 2010, 64(7): 565-572.
4.	Tsakitzidis G, Remmen R, Dankaerts W, et al. Non-specific neck pain and evidence-based practice. Eur Sci J, 2013, 9(3): 1-19.
5.	Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc, 2015, 90(2): 284-299.
6.	Chiu TT, Sing KL. Evaluation of cervical range of motion and isometric neck muscle strength: reliability and validity. Clin Rehabil, 2002, 16(8): 851-858.
7.	O’Leary S, Hoogma C, Solberg ØM, et al. Comparative strength and endurance parameters of the craniocervical and cervicothoracic extensors and flexors in females with and without idiopathic neck pain. J Appl Biomech, 2019, 35(3): 209-215.
8.	de Vries J, Ischebeck BK, Voogt LP, et al. Joint position sense error in people with neck pain: a systematic review. Man Ther, 2015, 20(6): 736-744.
9.	de Vries J, Ischebeck BK, Voogt LP, et al. Cervico-ocular reflex is increased in people with nonspecific neck pain. Phys Ther, 2016, 96(8): 1190-1195.
10.	Wolsko PM, Eisenberg DM, Davis RB, et al. Patterns and perceptions of care for treatment of back and neck pain: results ofa national survey. Spine (Phila Pa 1976), 2003, 28(3): 292-297.
11.	吴晶晶, 邱博凡, 朱丽军, 等. 龙氏正骨手法治疗慢性非特异性颈痛效果分析. 山西中医学院学报, 2018, 19(4): 50-51, 54.
12.	Iversen VM, Vasseljen O, Mork PJ, et al. Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomized controlled trial. J Rehabil Med, 2018, 50(8): 743-750.
13.	Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 2008, 38(9): A1-A34.
14.	Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. J Orthop Sports Phys Ther, 2017, 47(7): A1-A83.
15.	Bier JD, Scholten-Peeters WGM, Staal JB, et al. Clinical practice guideline for physical therapy assessment and treatment in patients with nonspecific neck pain. Phys Ther, 2018, 98(3): 162-171.
16.	Ylinen J, Kautiainen H, Wirén K, et al. Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. J Rehabil Med, 2007, 39(2): 126-132.
17.	Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil, 2016, 30(1): 64-72.
18.	Borstad JD, Ludewig PM. Comparison of three stretches for the pectoralis minor muscle. J Shoulder Elbow Surg, 2006, 15(3): 324-330.
19.	Coulter ID, Crawford C, Vernon H, et al. Manipulation and mobilization for treating chronic nonspecific neck pain:a systematic review and meta-analysis for an appropriateness panel. Pain Physician, 2019, 22(2): E55-E70.
20.	Durall CJ. Therapeutic exercise for athletes with nonspecific neck pain: a current concepts review. Sports Health, 2012, 4(4): 293-301.
21.	Li Y, Li S, Jiang J, et al. Effects of yoga on patients with chronic nonspecific neck pain: a PRISMA systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(8): e14649.
22.	王雪强, 王于领, 张志杰, 等. 运动疗法治疗颈痛的中国专家共识. 上海体育学院学报, 2020, 44(1): 59-69.
23.	Cramer H, Lauche R, Hohmann C, et al. Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain. Clin J Pain, 2013, 29(3): 216-223.
24.	崇玉萍, 陈香仙, 薛才宽. Hatha 瑜伽对颈型颈椎病康复的影响. 北京体育大学学报, 2014, 37(2): 71-75.
25.	Sterling M, Jull G, Vicenzino B, et al. Development of motor system dysfunction following whiplash injury. Pain, 2003, 103(1/2): 65-73.
26.	Panjabi MM, Cholewicki J, Nibu K, et al. Critical load of the human cervical spine: an in vitro experimental study. Clin Biomech (Bristol, Avon), 1998, 13(1): 11-17.
27.	Harrison DE, Harrison DD, Betz JJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther, 2003, 26(3): 139-151.
28.	Blomgren J, Strandell E, Jull G, et al. Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. BMC Musculoskelet Disord, 2018, 19(1): 415.
29.	Ghaderi F, Jafarabadi MA, Javanshir K. The clinical and EMG assessment of the effects of stabilization exercise on nonspecific chronic neck pain: a randomized controlled trial. J Back Musculoskelet Rehabil, 2017, 30(2): 211-219.
30.	Kim JY, Kwag KI. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain. J Phys Ther Sci, 2016, 28(1): 269-273.
31.	Nazari G, Bobos P, Billis E, et al. Cervical flexor muscle training reduces pain, anxiety, and depression levels in patients with chronic neck pain by a clinically important amount: a prospective cohort study. Physiother Res Int, 2018, 23(3): e1712.
32.	Abdel-aziem AA, Draz AH. Efficacy of deep neck flexor exercise for neck pain: a randomized controlled study. Turk J Phys Med Rehab, 2016, 62(2): 107-115.
33.	O’Leary S, Jull G, Kim M, et al. Specificity in retraining craniocervical flexor muscle performance. J Orthop Sports Phys Ther, 2007, 37(1): 3-9.
34.	Falla D, Farina D, Dahl MK, et al. Muscle pain induces task-dependent changes in cervical agonist/antagonist activity. J Appl Physiol (1985), 2007, 102(2): 601-609.
35.	Cagnie B, O’Leary S, Elliott J, et al. Pain-induced changes in the activity of the cervical extensor muscles evaluated by muscle functional magnetic resonance imaging. Clin J Pain, 2011, 27(5): 392-397.
36.	Kim W, Kim SK, Nabekura J. Functional and structural plasticity in the primary somatosensory cortex associated with chronic pain. J Neurochem, 2017, 141(4): 499-506.
37.	Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain, 2011, 152(3 Suppl): S90-S98.
38.	Cuenca-Martínez F, La Touche R, León-Hernández JV, et al. Mental practice in isolation improves cervical joint position sense in patients with chronic neck pain: a randomized single-blind placebo trial. PeerJ, 2019, 7(1): e7681.
39.	Waling K, Sundelin G, Ahlgren C, et al. Perceived pain before and after three exercise programs--a controlled clinical trial of women with work-related trapezius myalgia. Pain, 2000, 85(1/2): 201-207.
40.	Ylinen JJ, Häkkinen AH, Takala EP, et al. Effects of neck muscle training in women with chronic neck pain: one-year follow-up study. J Strength Cond Res, 2006, 20(1): 6-13.
41.	Mortensen P, Larsen AI, Zebis MK, et al. Lasting effects of workplace strength training for neck/shoulder/arm pain among laboratory technicians: natural experiment with 3-year follow-up. Biomed Res Int, 2014, 2014(1): 845851.
42.	Li X, Lin C, Liu C, et al. Comparison of the effectiveness of resistance training in women with chronic computer-related neck pain: a randomized controlled study. Int Arch Occup Environ Health, 2017, 90(7): 673-683.
43.	Yildiz TI, Cools A, Duzgun I. Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain. Clin Biomech (Bristol, Avon), 2019, 70(70): 97-106.
44.	Im B, Kim Y, Chung Y, et al. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. J Phys Ther Sci, 2016, 28(3): 951-955.
45.	Durall CJ, Hermsen D, Demuth C, et al. Systematic review of single-set versus multiple-set resistance-training randomized controlled trials: implications for rehabilitation. Crit Rev Phys Rehabil Med, 2006, 18(2): 107-116.
46.	American College of Sports Medicine. Position stand on progression models in resistance training for healthy adults. Med Sci Sports Exerc, 2002, 41(3): 687-708.
47.	Dimitriadis Z, Kapreli E, Strimpakos N, et al. Respiratory dysfunction in patients with chronic neck pain: what is the current evidence?. J Bodyw Mov Ther, 2016, 20(4): 704-714.
48.	Yeampattanaporn O, Mekhora K, Jalayondeja W, et al. Immediate effects of breathing re-education on respiratory function and range of motion in chronic neck pain. J Med Assoc Thai, 2014, 97(Suppl 7): S55-S59.
49.	Kahlaee AH, Ghamkhar L, Arab AM. The association between neck pain and pulmonary function: a systematic review. Am J Phys Med Rehabil, 2017, 96(3): 203-210.
50.	Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Exp Brain Res, 2004, 157(1): 43-48.
51.	Uremovi¢ M, Cvijeti¢ S, Pasi¢ MB, et al. Impairment of proprioception after whiplash injury. Coll Antropol, 2007, 31(3): 823-827.
52.	Saadat M, Salehi R, Negahban H, et al. Traditional physical therapy exercises combined with sensorimotor training: the effects on clinical outcomes for chronic neck pain in a double-blind, randomized controlled trial. J Bodyw Mov Ther, 2019, 23(4): 901-907.
53.	Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther, 2008, 13(1): 2-11.
54.	Beinert K, Taube W. The effect of balance training on cervical sensorimotor function and neck pain. J Mot Behav, 2013, 45(3): 271-278.

1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet, 2018, 392(10159): 1789-1858.
2. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ, 2017, 358: j3221.
3. McLean SM, May S, Klaber-Moffett J, et al. Risk factors for the onset of non-specific neck pain: a systematic review. J Epidemiol Community Health, 2010, 64(7): 565-572.
4. Tsakitzidis G, Remmen R, Dankaerts W, et al. Non-specific neck pain and evidence-based practice. Eur Sci J, 2013, 9(3): 1-19.
5. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc, 2015, 90(2): 284-299.
6. Chiu TT, Sing KL. Evaluation of cervical range of motion and isometric neck muscle strength: reliability and validity. Clin Rehabil, 2002, 16(8): 851-858.
7. O’Leary S, Hoogma C, Solberg ØM, et al. Comparative strength and endurance parameters of the craniocervical and cervicothoracic extensors and flexors in females with and without idiopathic neck pain. J Appl Biomech, 2019, 35(3): 209-215.
8. de Vries J, Ischebeck BK, Voogt LP, et al. Joint position sense error in people with neck pain: a systematic review. Man Ther, 2015, 20(6): 736-744.
9. de Vries J, Ischebeck BK, Voogt LP, et al. Cervico-ocular reflex is increased in people with nonspecific neck pain. Phys Ther, 2016, 96(8): 1190-1195.
10. Wolsko PM, Eisenberg DM, Davis RB, et al. Patterns and perceptions of care for treatment of back and neck pain: results ofa national survey. Spine (Phila Pa 1976), 2003, 28(3): 292-297.
11. 吴晶晶, 邱博凡, 朱丽军, 等. 龙氏正骨手法治疗慢性非特异性颈痛效果分析. 山西中医学院学报, 2018, 19(4): 50-51, 54.
12. Iversen VM, Vasseljen O, Mork PJ, et al. Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomized controlled trial. J Rehabil Med, 2018, 50(8): 743-750.
13. Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 2008, 38(9): A1-A34.
14. Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. J Orthop Sports Phys Ther, 2017, 47(7): A1-A83.
15. Bier JD, Scholten-Peeters WGM, Staal JB, et al. Clinical practice guideline for physical therapy assessment and treatment in patients with nonspecific neck pain. Phys Ther, 2018, 98(3): 162-171.
16. Ylinen J, Kautiainen H, Wirén K, et al. Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. J Rehabil Med, 2007, 39(2): 126-132.
17. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil, 2016, 30(1): 64-72.
18. Borstad JD, Ludewig PM. Comparison of three stretches for the pectoralis minor muscle. J Shoulder Elbow Surg, 2006, 15(3): 324-330.
19. Coulter ID, Crawford C, Vernon H, et al. Manipulation and mobilization for treating chronic nonspecific neck pain:a systematic review and meta-analysis for an appropriateness panel. Pain Physician, 2019, 22(2): E55-E70.
20. Durall CJ. Therapeutic exercise for athletes with nonspecific neck pain: a current concepts review. Sports Health, 2012, 4(4): 293-301.
21. Li Y, Li S, Jiang J, et al. Effects of yoga on patients with chronic nonspecific neck pain: a PRISMA systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(8): e14649.
22. 王雪强, 王于领, 张志杰, 等. 运动疗法治疗颈痛的中国专家共识. 上海体育学院学报, 2020, 44(1): 59-69.
23. Cramer H, Lauche R, Hohmann C, et al. Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain. Clin J Pain, 2013, 29(3): 216-223.
24. 崇玉萍, 陈香仙, 薛才宽. Hatha 瑜伽对颈型颈椎病康复的影响. 北京体育大学学报, 2014, 37(2): 71-75.
25. Sterling M, Jull G, Vicenzino B, et al. Development of motor system dysfunction following whiplash injury. Pain, 2003, 103(1/2): 65-73.
26. Panjabi MM, Cholewicki J, Nibu K, et al. Critical load of the human cervical spine: an in vitro experimental study. Clin Biomech (Bristol, Avon), 1998, 13(1): 11-17.
27. Harrison DE, Harrison DD, Betz JJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther, 2003, 26(3): 139-151.
28. Blomgren J, Strandell E, Jull G, et al. Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. BMC Musculoskelet Disord, 2018, 19(1): 415.
29. Ghaderi F, Jafarabadi MA, Javanshir K. The clinical and EMG assessment of the effects of stabilization exercise on nonspecific chronic neck pain: a randomized controlled trial. J Back Musculoskelet Rehabil, 2017, 30(2): 211-219.
30. Kim JY, Kwag KI. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain. J Phys Ther Sci, 2016, 28(1): 269-273.
31. Nazari G, Bobos P, Billis E, et al. Cervical flexor muscle training reduces pain, anxiety, and depression levels in patients with chronic neck pain by a clinically important amount: a prospective cohort study. Physiother Res Int, 2018, 23(3): e1712.
32. Abdel-aziem AA, Draz AH. Efficacy of deep neck flexor exercise for neck pain: a randomized controlled study. Turk J Phys Med Rehab, 2016, 62(2): 107-115.
33. O’Leary S, Jull G, Kim M, et al. Specificity in retraining craniocervical flexor muscle performance. J Orthop Sports Phys Ther, 2007, 37(1): 3-9.
34. Falla D, Farina D, Dahl MK, et al. Muscle pain induces task-dependent changes in cervical agonist/antagonist activity. J Appl Physiol (1985), 2007, 102(2): 601-609.
35. Cagnie B, O’Leary S, Elliott J, et al. Pain-induced changes in the activity of the cervical extensor muscles evaluated by muscle functional magnetic resonance imaging. Clin J Pain, 2011, 27(5): 392-397.
36. Kim W, Kim SK, Nabekura J. Functional and structural plasticity in the primary somatosensory cortex associated with chronic pain. J Neurochem, 2017, 141(4): 499-506.
37. Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain, 2011, 152(3 Suppl): S90-S98.
38. Cuenca-Martínez F, La Touche R, León-Hernández JV, et al. Mental practice in isolation improves cervical joint position sense in patients with chronic neck pain: a randomized single-blind placebo trial. PeerJ, 2019, 7(1): e7681.
39. Waling K, Sundelin G, Ahlgren C, et al. Perceived pain before and after three exercise programs--a controlled clinical trial of women with work-related trapezius myalgia. Pain, 2000, 85(1/2): 201-207.
40. Ylinen JJ, Häkkinen AH, Takala EP, et al. Effects of neck muscle training in women with chronic neck pain: one-year follow-up study. J Strength Cond Res, 2006, 20(1): 6-13.
41. Mortensen P, Larsen AI, Zebis MK, et al. Lasting effects of workplace strength training for neck/shoulder/arm pain among laboratory technicians: natural experiment with 3-year follow-up. Biomed Res Int, 2014, 2014(1): 845851.
42. Li X, Lin C, Liu C, et al. Comparison of the effectiveness of resistance training in women with chronic computer-related neck pain: a randomized controlled study. Int Arch Occup Environ Health, 2017, 90(7): 673-683.
43. Yildiz TI, Cools A, Duzgun I. Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain. Clin Biomech (Bristol, Avon), 2019, 70(70): 97-106.
44. Im B, Kim Y, Chung Y, et al. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. J Phys Ther Sci, 2016, 28(3): 951-955.
45. Durall CJ, Hermsen D, Demuth C, et al. Systematic review of single-set versus multiple-set resistance-training randomized controlled trials: implications for rehabilitation. Crit Rev Phys Rehabil Med, 2006, 18(2): 107-116.
46. American College of Sports Medicine. Position stand on progression models in resistance training for healthy adults. Med Sci Sports Exerc, 2002, 41(3): 687-708.
47. Dimitriadis Z, Kapreli E, Strimpakos N, et al. Respiratory dysfunction in patients with chronic neck pain: what is the current evidence?. J Bodyw Mov Ther, 2016, 20(4): 704-714.
48. Yeampattanaporn O, Mekhora K, Jalayondeja W, et al. Immediate effects of breathing re-education on respiratory function and range of motion in chronic neck pain. J Med Assoc Thai, 2014, 97(Suppl 7): S55-S59.
49. Kahlaee AH, Ghamkhar L, Arab AM. The association between neck pain and pulmonary function: a systematic review. Am J Phys Med Rehabil, 2017, 96(3): 203-210.
50. Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Exp Brain Res, 2004, 157(1): 43-48.
51. Uremovi¢ M, Cvijeti¢ S, Pasi¢ MB, et al. Impairment of proprioception after whiplash injury. Coll Antropol, 2007, 31(3): 823-827.
52. Saadat M, Salehi R, Negahban H, et al. Traditional physical therapy exercises combined with sensorimotor training: the effects on clinical outcomes for chronic neck pain in a double-blind, randomized controlled trial. J Bodyw Mov Ther, 2019, 23(4): 901-907.
53. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther, 2008, 13(1): 2-11.
54. Beinert K, Taube W. The effect of balance training on cervical sensorimotor function and neck pain. J Mot Behav, 2013, 45(3): 271-278.

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