Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomised controlled trial

Clinical Research 7 min 9

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Created On: 02/03/2020

Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomised controlled trial

Chronic neck pain is a significant cause of disability worldwide, and there is a need for further research in identifying better ways of managing this condition.

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Key take away

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

Background

Chronic neck pain is a significant cause of disability worldwide, and there is a need for further research in identifying better ways of managing this condition. Several studies have indicated the beneficial effects of progressive resistance training (PRT) of the neck and shoulder muscles for the management of chronic neck and shoulder pain. A recent Cochrane review stated that PRT appears to be beneficial in the management of chronic neck pain, but the evidence was insufficient to make clear recommendations. Current guidelines provide vague recommendations regarding the type of exercise to be preferred. 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) is often used to address physical and psychosocial aspects of chronic neck patients. It usually includes general physical exercise (GPE), group discussions, patient education and individual meetings with therapists. In Norway, the exercise therapy of MDR focusses on introduction to activities and exercises that fit patient interests. However, high-intensity strength training such as PRT is not included. The promising results of high-intensity strength training make it possible to improve the effects of MDR by replacing GPE with PRT. While conventional resistance training equipment is relatively spacious and expensive, elastic resistance bands can be used as a viable alternative while performing PRT in small clinics or at home.

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 resent randomised controlled trial has elucidated the role of progressive resistance training as compared to general physical exercises in the treatment of chronic neck pain.

Objective:

The present study was intended to investigate the effectiveness of progressive resistance training using elastic resistance bands in improving neck-related disability more than a general physical exercise in multidisciplinary rehabilitation of chronic neck pain.

Method

Study outcomes:

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

Result

Outcomes:

Baseline: There were no significant differences observed at baseline

Study outcomes:

There were no statistically significant differences found between groups in NDI from baseline to 12-week follow-up (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.

Conclusion

The current randomised trial provides no evidence in favour of replacing GPE with PRT using elastic resistance bands in MDR in the improvement of neck pain-related disability. 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.

Limitations

The study was unable to reach the desired number of participants which might increase the probability for a type II error
The study only included patients with specialised back and neck pain unit. Therefore, the results of this study can't be applied to other populations.

Clinical take-away

The present randomised study advises the clinicians to recommend the use of either of these exercise types in the management of moderate to severe type non-specific neck pain based on the patient`s interests and motivation.