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Strength training as treatment for chronic neck pain

At a glance:
Active physical training is commonly recommended for patients with chronic
continuing a long time or recurring frequently
 neck pain.

This study investigated the effects of intensive strength training and lighter endurance training on women with chronic neck pain. Participants completed a 12-day neck exercise program and were given advice to exercise regularly at home.

After 12 months:
73% of people who did strength training for their neck reported considerable, or complete relief from their pain
59% of people who did endurance training reported considerable, or complete relief from their pain
21% people who did not train reported considerable, or complete relief from their pain
People who did either strength or endurance training had an improved range of motion and greater neck strength
This study shows that exercising the neck muscles and the rest of the body can help to reduce the pain and disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 of a work-related neck injury. The people in this study had ‘non specific' neck pain.

Participants in the study did an intensive, supervised training program for two weeks, and then continued to do strengthening and stretching exercises at home about twice a week for the following year. Exercising twice a week can help you reduce your symptoms and regain function.

Long term neck pain can be frustrating. As with many other conditions there is much you can do to help the problem. Ask your treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 about whether this type of treatment is appropriate for your condition.
This study shows that exercising the neck muscles and the rest of the body to increase strength can help to reduce the pain and disability of work-related neck injury. If you have an employee with chronic neck pain, encourage them to discuss their condition with their treating doctor. Most people are best off remaining active.

Not all neck conditions are the same and they should discuss exercises with their treating practitioners. Exercise/stretching breaks at work can also assist, especially if they are under physical strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 at work.
This study shows that patients with non-specific neck pain can reduce their pain and disability by strengthening and stretching their muscles, including their neck. Long term benefits were obtained by continuing exercising at home twice a week for a year.

The common approach to musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 conditions has been to restrict tasks. This and other studies provide evidence that increasing activity is an approach that produces good outcomes. Consider asking the physiotherapist to focus on an active strengthening approach for patients with chronic neck pain.
A strength training program can help reduce symptoms of neck pain and aid rehabilitation. Treatment for chronic non specific neck pain should include an active component. This study showed that long term benefits could be obtained by training just two times a week.
Original Article, Authors & Publication Details:
J. Ylinen1, E.-P. Takala2, M. NyKanen3, A. Hakkinen1, E. Malkia4, T. Pohjolainen5, S.-L. Karppi5, H. Kautiamem6 and O. Airaksinen7 (2003).

Active neck muscle training in the treatment of chronic neck pain in women: A randomized controlled trial. JAMAR; 289(19):2509-2516.

1Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
2Finnish Institute of Occupational Health, Helsinki, Finland
3Punkaharju Rehabilitation Centre, Punkaharju, Finland
4Department of Health Sciences, University of Jyväskylä, Finland
5Social Insurance Institution, Helsinki, Finland
6Rheumatism Foundation Hospital, Heinola, Finland
7Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
Background, Study Objectives, How It Was Done:
Neck pain is a common complaint among working-aged women visiting their physicians. Patients with chronic neck pain use health care services twice as much as the average population. Costs associated with neck pain are mainly from sick leave, therapy and specialist care.

Many factors contribute to neck pain. Excessive physical strain may cause problems for the soft tissues
Collection of cells that perform a similar function. e.g. epithelium (skin), connective tissue (blood, bone), muscle
 of the neck and stress may lead to increased muscle tension. In most cases, the precise cause of the pain is unknown. This is known as “non-specific' pain.

When a person has non-specific pain, imaging techniques like X-rays or MRIs
Magnetic resonance imaging (MRI) is used in medical imaging and works by applying a magnetic field to the body and observing how the atoms behave in the field in order to create an image. Whilst an X-ray shows bones, MRI scans can show soft tissues and are used to examine tissues such as discs in the back, cartilage lining a joint, muscles and tendons.
 are not helpful in identifying the problem. This is because visible physical changes to the bones and tissues of the neck are common even in people without pain and people with pain might not show visible changes at all. Rather than targeting a specific problem, treatment for neck pain focuses on relieving symptoms and avoiding disability.

There is not much scientific evidence to support the standard treatments of neck pain (including things like hot and cold packs, ultrasound and massage.) The aim of this study was to investigate whether intensive strength training or endurance training for the neck muscles might improve the symptoms of women with chronic, non-specific neck pain.

180 female office workers were recruited from various workplaces in Finland, between February 2000 and March 2002. Participants that were included in the study were between 25 and 53 years old and permanently employed. They had experienced constant or frequently recurring neck pain for more than six months, but wanted to be rehabilitated and continue working. People who had severe diseases, psychiatric illness or were pregnant were not included.

The participants were randomly assigned into one of three groups, each with 60 patients:

1. Strength training group

2. Endurance training group

Groups 1 and 2 participated in a 12 day rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 program, with five 45-minute sessions per week (nine in total). The exercise program was as follows:
The endurance training group exercised neck muscles by repeatedly lifting the head up from a relaxed position
The strength training group pushed the neck back, forward, left and right against the resistance of a rubber band. In strength training group, the patients worked at 80% of their maximum effort
Both groups exercised the shoulders and upper arms using dumbbell
The endurance group did 3 sets of 20 repetitions with 2kg weights
The strength group did 1 set of 15 repetitions with the highest weight they could manage
Both groups also exercised the trunk and legs by squats, sit-ups and back extensions
Each training session concluded with a program of stretching for the neck, shoulders and arm
After the program, the participants were advised to do aerobic exercise for half an hour three times a week.
Patients received information about strength/stretching exercises they could perform at home. They were encouraged to do these exercises 3 times a week and were taught to keep an exercise diary.

3. Control group

The control group did not complete strength or endurance training. They were:
asked to attend the centre for strength and range of motion measurements and spent 3 days at the rehabilitation centre being tested and relaxing
advised to perform aerobic exercise 3 times a week for half an hour
given training and written information about stretching exercises and were advised to stretch at home for 20 minutes three times a week
were not encouraged to do strength exercises

In order to observe the effects of the exercise on their symptoms, questionnaires and tests were completed by the participants at the beginning of the study, and again after 2, 6 and 12 months.

The tests and questionnaires measured:
Perceived neck pain
Neck strength
Range of motion
General physical function
Grip strength
Bicycle test
At the 12 month follow-up visit, patients were asked to describe how the training had affected their neck pain on a scale of 1 to 6 (1 indicating much more pain and 6 indicating complete relief from pain).
Study Findings:
Perceived neck pain, disability, depression
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 and general physical function were similar between the three groups before the training.

Pain and disability:

Pain and disability were significantly lower in the two training groups compared with the control group 12 months after the training. There were no significant differences between the strength and endurance training groups.

Considerable or complete relief from pain occurred for:
73% of the strength training group
59% of the endurance training group
21% of the control group

Only 3% in all groups felt that their pain had worsened.

Neck strength:

Neck strength was measured for bending the neck forwards (flexion), bending the neck backwards (extension) and rotating the neck.

Neck strength had improved in all groups 12 months after the training, but the strength group showed by far the most improvement and the endurance group also improved more than the controls.

Maximum neck strength was improved by:

110% (flexion), 76% (rotation) and 69% (extension) for the strength training group
28% (flexion), 29% (rotation) and 16% (extension) for the endurance training group
10% (flexion), 10% (rotation) and 7% (extension) for the control group

Range of motion:

Range of motion was improved in all groups 12 months after the training, but only the training groups improved in rotation of the neck. Range of motion in all directions was significantly better in the strength training group compared to the endurance group, and significantly better in the endurance group compared to the controls.

General physical function:

12 months after the program, there were no significant changes in grip strength or aerobic fitness in any of the groups.

The patients exercise diaries showed that the strength and endurance groups had continued their training over the year. The endurance training group exercised 2 days a week on average, while the strength training group exercised 1.7 days a week on average. Both groups did stretching exercises 2 days a week on average.

In all three groups, the number of patients taking analgesics
A drug used to relieve pain
 and the number of visits to a physician decreased in the year after the study began. The two exercise groups, however, showed a greater decrease.
In this study, a 1-year training program in endurance and strength was found to considerably reduce neck pain and disability. Neck function, including neck strength and range of motion, was also improved significantly in both training groups compared with the control group. Participants were only required to train 2 times per week to feel long-term benefits.

Previous studies have not shown a lasting improvement in pain and disability from active training. The authors of this study suggested several reasons that these other program might not have been effective, such as the type of participants involved, the time of training, the type of exercises and a failure to keep the exercise in the long run.
PubMed Abstract
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