To compare the efficacy of three 12-month training programmes on headache and upper extremity pain in patients with chronic neck pain.
A total of 180 female office workers, with chronic, non-specific neck pain were randomly assigned to 3 groups. The strength group performed isometric, dynamic and stretching exercises. The endurance group performed dynamic muscle and stretching exercises. The control group performed stretching exercises. Pain was assessed with a visual analogue scale. Each group was divided into 3 subgroups according to headache intensity.
At the 12-month follow-up headache had decreased by 69% in the strength group, 58% in the endurance group and 37% in the control group compared with baseline. Neck pain diminished most in the strength group with the most severe headache (p < 0.001). In the dose analysis, one metabolic equivalent per hour of training per week accounted for a 0.6-mm decrease in headache on the visual analogue scale. Upper extremity pain decreased by 58% in the strength group, 70% in the endurance group and 21% in the control group.
All of the training methods decreased headache. However, stretching, which is often recommended for patients, was less effective alone than when combined with muscle endurance and strength training. Care must be taken in recommending the type of training to be undertaken by patients with severe cervicogenic headache.
A cervicogenic headache is one that originates from tissues in the neck, as opposed for instance to a migraine, and is often the result of holding the neck and head in stressful daily postures, often looking down (cervical flexion) or a forward head posture (lower cervical flexion combined with upper cervical extension). Both postures increase muscular strain and strain on cervical joints and discs much more so than a neutral cervical posture with the head level and centered (front to back) over the shoulders. Keeping a neutral posture requires a degree of awareness and also some muscular strength and endurance. These researchers found both strength and endurance exercises helped to decrease headache intensity, as well as neck, shoulder and arm pain more than stretching alone.
The strength group was slightly better off than the endurance group. The cervical strength exercises were all isometric against a theraband in all directions, while the endurance group did dynamic exercise in supine only. Both groups also did upper body weight training exercises with dumbbells, the endurance group for 3 sets of 20 reps with a 2 kg (4.4 lb) dumbbell, while the strength group did 1 set of 15 but with ever increasing intensities as they got stronger. Both groups also did bodyweight and core exercises including squats, sit-ups, and back extensions. All three groups did the same stretches.
With some of the differing variables it’s hard to say what part of the strength and endurance programs led to the reduction in headaches, so those with cervicogenic headaches have no reason to be apprehensive about weight training. While the results were good, the study was over a year long. I have noticed considerably faster reductions in pain in my physical therapy programs when exercises performed in this study are combined with specific postural exercises, biomechanical counseling, and ergonomic adjustments at home and in the work place. EMS helps a lot to decrease pain and increase strength in the near term while the patient is waiting for the exercises and ergonomic changes to take effect.
As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.
Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.