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A Randomized Controlled Trial

Jari Ylinen, MD; Esa-Pekka Takala, MD, DMedSc; Matti Nykänen, MD, DMedSc; Arja Häkkinen, PhD; Esko Mälkiä, PhD; Timo Pohjolainen, MD, DMedSc; Sirkka-Liisa Karppi, MSc; Hannu Kautiainen, BA; Olavi Airaksinen, MD, DMedSc

JAMA. 2003;289:2509-2516.

Context  Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies.

Objective  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.

Design  Examiner-blinded randomized controlled trial conducted between February 2000 and March 2002.

Setting  Participants were recruited from occupational health care systems in southern and eastern Finland.

Patients  A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain.

Interventions  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.

Main Outcome Measures  Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures.

Results  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.

Conclusions  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.

Author Affiliations: Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Jyväskylä (Drs Ylinen and Häkkinen); Finnish Institute of Occupational Health, Helsinki (Dr Takala); Punkaharju Rehabilitation Center, Punkaharju (Dr Nykänen); Department of Health Sciences, University of Jyväskylä, Jyväskylä (Dr Mälkiä); Social Insurance Institution, Helsinki (Dr Pohjolainen and Ms Karppi); Rheumatism Foundation Hospital, Heinola (Mr Kautiainen); and Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio (Dr Airaksinen), Finland.

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