Life is Sometimes “A Pain in the Neck!”
I think that most of you would agree that life is sometimes a “pain in the neck”! The source of the pain is usually multi-factorial and may include such things as emotional stress, muscle weakness, history of trauma, arthritis, herniated discs, and/or poor posture, let alone the screaming child (or boss!) thrown on top of that. Yikes!! Of course, as many of you have experienced, there are many different physical therapy and medical approaches to treating neck pain. So what does the research tell us about the most effective physical therapy treatments? In 2002, a systematic analysis of studies (performed up to that date) showed that passive physical therapy modalities such as ultrasound, heat, electrical stimulation were ineffective in the treatment of chronic neck pain in the long term. Basically, only temporary relief.
Can 2 minutes a day of exercise decrease your neck pain? How many of you experience neck or shoulder pain after using your computers? A study in Denmark evaluated 198 office workers with chronic neck and shoulder pain. The subjects were randomly assigned to either a non-exercising control group, a 2-minute exercise group, or a 12-minute exercise group. The exercise groups performed a lateral raise in the scapular plane to 90 degrees with elastic tubing. The exercises were performed 5 days per week for 10 weeks. After 10 weeks, both exercise groups significantly reduced their neck/shoulder pain and tenderness, and significantly increased their strength compared to the control group. The interesting thing about this study is that there were no differences between the 2 min and 12 min groups. The conclusion is that only 2 minutes (to failure) of the prescribed exercise could control your neck pain.
A Finish researcher by the name of Jari Ylinen has performed many controlled studies on neck pain. He is definitely the GO-TO guy for this research! He notes that several studies have been performed that show an improvement in neck pain within 5-11 weeks of rehabilitation, but that the results usually disappear 2-3 months later. So what he did was demonstrate how YOU, the neck pain sufferer, could maintain the desired results over a 12 month period. One of his studies in 2003 compared 180 female office workers with chronic, non-specific neck pain. They were randomized into two different strengthening groups, one consisting of 4-way isometric neck exercises with Tband at 80% effort, and a control group. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises 3 times a week and were educated in proper posture principles. At a 12 month follow-up, neck pain and disability decreased in both groups, yet maximal isometric neck strength had improved 69-110% in the isometric group, only 16-29% in the other strengthening group, and just 7-10% in the control group. Previous studies have shown either no or only temporary gains with active neck training and this study emphasizes the importance of performing your program at least 2x/wk for a solid year to achieve the described results.
For those of you who have a tendency for finding short cuts, read on! Ylinen in 2008 performed another study comparing the same active neck strength training exercises in the 2003 study to a control group that only performed neck stretches. At a 12 month follow-up, he found NO statistical differences in neck pain or disability between the groups and only minor changes in strength and mobility. Why? The big difference in this study? Patient compliance with the strength training decreased to only 1x per week!! Sound famliar from my Pump You Up post?
So how do you put this all together into a neat package for the BEST approach to neck pain? Education is the key. Number 1, evidence-based exercise will fail if you continue to assume poor posture. Number 2, you need to make time with the time you have. That means choosing the BEST exercises that can be done in a timely fashion and to continue your program 2 times per week. An interdisciplinary group of researchers and clinicians in 2009 reviewed the research to develop a ‘toolkit’ for clinicians to apply the best evidence for treating neck pain. The “Cervical Overview Group” created a clinical practice guideline that includes a therapeutic home exercise program for neck pain. You can view it HERE after signing up for free. In the next four videos, I would like to present 4 evidence-based exercises that incorporate isometric cervical strength training, scapular stabilization exercise, and functional retraining. Do these and you will take control of your neck pain once and for all!