Strength Better than Stretch for Neck Pain AND Range of Motion

This was one of the earlier cervical strength training studies on neck pain that influenced my physical therapy treatments for neck pain.

Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003 May 21;289(19):2509-16. Ylinen J1, Takala EP, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, Karppi SL, Kautiainen H, Airaksinen O.

To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain.
A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain.
Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week.
At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension.
Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain. Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.

“Considerable or complete relief from pain was obtained in 73% of participants in the strength training group, and 21% in the control group. Only 3% in all groups felt their pain had become worse from the training.

“In the strength training group, maximal isometric neck strength increased in flexion by 110%, rotation by 76%, and extension by 69%. The results of the endurance training group improved by 28%, 29%, and 16% and the control group by 10%, 10%, and 7% respectively.”

“The conventional stretching group stretching and aerobic exercises the control group were advised to perform had poor effect on the functional parameters of the neck and they had only a weak effect on chronic neck pain and disability.”

Chad’s comments:

This was one of the earlier strength training studies on women with neck pain, and since then a number of additional studies have collaborated the results, which agrees with my findings as well. While the title emphasizes the neck training, the additional strength performed by the experiment groups includes dumbbell shrugs, presses, curls, bent-over rows, flys and pullovers, with the heaviest dumbbell they could use for 1 set of 15 reps, while the endurance group did 3 sets of 20 reps on the same exercises with 2 kg. Both did squats, sit-ups and back extensions with bodyweight, and stretches to the upper body and neck. It’s worth noting that the neck strengthening was not done in isolation, but rather in conjunction with a fairly extensive upper body PRE program, so it is hard to say how much of the pain reduction was secondary to the neck strengthening alone.

The neck strength group performed isometric holds with a Theraband for 15 reps in forward, obliquely right, left and straight back with 80% of their tested max tension. The endurance group did supine neck flexion, only I think they got short-changed in side bending and extension which could contribute to their lesser improvement. They all did some upper body and neck stretches and aerobic training, while the control group did the stretches and aerobic training only.

For me the most interesting part of the study was that the isometric strength group had a considerably greater increase in range of motion (ROM) over the group that did only stretching. The authors did not speculate as to why, however I think it likely that the increased ROM of isometric strength group came from increased muscular stabilization. This, in turn, decreases injurious stress on the intervertebral discs, facet joints and ligaments. Stretching at some point does the opposite: destabilizing the cervical spine in the same way that flexion and rotation stretches have been shown to decrease stability of the lumbar spine. So counter-intuitively, over-stretching vertebral components often increases pain long term and and does not improve ROM as much as intended.

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember Spinal Flow Yoga for you or someone you know in the future.

Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.

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