The study provides no insight in favor of replacing general physical exercise with progressive resistance training in multidisciplinary rehabilitation of chronic neck pain

Neck pain in its chronic state contributes to the socio-economic and personal disability across the globe. More efficient ways of management are needed to be identified. . The previous research results indicate the effectiveness of progressive resistance training (PRT) of the shoulder and neck muscles in the management of this chronic condition. However, a recent Cochrane review raises questions on the degree of evidence available to make clear recommendations based on these studies. It has been suggested that PRT targeting whole-body muscle strength could be more beneficial than specific back exercises in low back pain due to overall improved physical functioning. It can be the case of persons with chronic neck pain, as this condition can lead to pain in other body regions, and patients with chronic pain are often deconditioned.

Multidisciplinary rehabilitation (MDR) which includes general physical exercises (GPE), group discussions, patient education and individual meetings with the therapist is often used to address physical and psychosocial aspects of chronic neck patients. In some countries, e.g. in Norway, exercise therapy is given according to patient’s interest and high-intensity strength training is generally not included in the exercise therapy regimen. One advantage of replacing GPE with PRT is that while conventional training pieces of equipment take a lot of space, PRT can be performed easily at home or in small clinics using elastic resistance bands.

Rationale behind research

• Previous studies have evaluated the beneficial effects of progressive resistance training (PRT) in the management of chronic neck pain, but there are insufficient recommendations for the use of PRT. The recent randomized controlled trial has elucidated the role of progressive resistance training as compared to general physical exercises in the treatment of chronic neck pain.

Objective

This study is conducted to compare the effects of progressive resistance training using elastic resistance bands with general physical exercise on the improvement in neck-related disability and rehabilitation of chronic neck pain.

Study outcomes

• Baseline: Patient demographic characteristics were evaluated at baseline

• Primary outcomes: The primary outcome includes assessment of the between-group difference in change in the Neck Disability Index from baseline to 12 weeks

• Secondary outcomes: The secondary outcomes include assessment of the between-group difference in NDI from baseline to 3 & 12 weeks for NPRS, Hopkins symptoms checklist, Work Ability Index, EQ-5D, Fear-Avoidance Beliefs Questionnaire, pressure pain threshold, patient-specific functioning scale, neck flexor and extensor MVC strength

Time Points: 3-12 weeks

Outcomes

Baseline: No significant differences were observed at baseline

Study outcomes:

• At 12-week follow-up from baseline, there was no statistically notable difference observed between the primary outcomes and NDI among the study groups (Fig 2.)

• There were no statistically significant differences found between secondary outcomes at 3 and 12 weeks, including NPRS, Hopkins symptoms checklist, Work Ability Index, EQ-5D, Fear-Avoidance Beliefs Questionnaire, pressure pain threshold, patient-specific functioning scale, extensor MVC strength and neck flexor

These trial results imply that replacing GPE with PRT using elastic resistance bands in MDR for the improvement of neck pain-related disability was not associated with any significant advantage. There is a need for future trials with a higher number of participants that can investigate whether progressive resistance training was effective in reducing pain more than the general physical exercises.