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To the Editor: Dr Ylinen and colleagues¹ found that both strength (isometric) and endurance (isotonic) training were superior to a control regimen of stretching and aerobic exercise for relieving chronic neck pain. The authors also found that isometric training improved strength more than did isotonic training.

I have 3 concerns about this study. First, isometric training is most specifically designed to increase the isometric strength of particular muscles.² Thus, use of isometric strength as an outcome measure could result in significant bias in favor of the isometric group.

Second, there were other important differences between the experimental and control groups that may explain these results. Both isometric and isotonic groups received 9 practice sessions "to enable them to learn the program properly" whereas the control group was trained only once in the proper way to perform the exercise and subsequently received written instruction. Because the participants in the control group . . . [Full Text of this Article]

Scott F. Nadler, DO
Department of Physical Medicine and Rehabilitation
University of Medicine and Dentistry of New Jersey–New Jersey Medical School
Newark

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