Exercises for Preventing Neck Pain: How Effective They Are? A 2023 Review

In Sept. 2023, 6 researchers from Germany and Australia published a systematic review which investigated the effectiveness of exercises to prevent neck pain (Teichert F., et al, 2023). Data were collected up to December 2, 2022. 5 trials involving 1722 participants were included, among which 80% were office workers.

Findings

Risk of bias of the trials: 2 trial with some concerns of risk of bias; 3 trials with high risk of bias.

There was moderate-certainty evidence that exercises probably reduce the risk of a new episode of neck pain (OR, 0.49; 95% CI: 0.31, 0.76) compared to no or minimal treatment in the short-term (≤12 months).

However, the clinical significance of such an effect is unclear.

In other words, if we ask a question whether exercises meaningfully benefited patients? The answer is: we are not sure.

The Burdensome Exercises & Clinicians' Headache

Most (if not all) clinicians will understand that exercise programs are burdensome to patients. A home exercise program for neck pain, for example, required patients to work on themself own to do self-mobilization exercise, 5 to 10 repetitions each time up to 6 to 8 times per day!!! And for 12 weeks (3 months)! (Bronfort G et al, 2012).

Few patients, if any, would be able to faithfully and diligently fulfill such a drudgery homework. In the end, patients will complain “that does not work for me”.

Is The Effect Worthwhile to Patient?

Unclear. That was the authors' answer. “Whether the range of possible effects are worthwhile to patients is unclear and should be elaborated on an individual basis.” The review says.

Clinical Implications

Based on their findings, the authors recommended:

Clinicians together with their patients should consider the certainty of the evidence (there is a possibility that the effect is substantially different) and compare the estimated effects with their own thresholds when making treatment decisions.

Unanswered Questions

The authors proposed: Large, high-quality (low-risk of bias) RCTs are needed to reach more certain conclusions (high-certainty evidence). Collectively many limitations in the studies so far make it difficult to draw any firm conclusions.

What Clinicians Can Do Now?

For now, let patients to decide. That is what the authors could say.

Exercise is generally good for fitness & health, but its specific therapeutic effect? No one is sure for any specific conditions, at least for now. But of course we can hope “a possibility that the effect is substantially different” in the future from high quality studies. But to which way will the substantially different outcomes will go in the future? Wonderful effective, or just a waste of resources (in terms of both clinicians and patients)? Let us wait and see.

A Question for A Deeper Thinking

Is there a magic bullet medicine which can erase the burden to patients and the headache of clinicians in a breeze?

References

Bronfort G et al, Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012 Jan 3;156(1 Pt 1):1-10.

Teichert F., et al, Effectiveness of Exercise Interventions for Preventing Neck Pain: A Systematic Review With Meta-analysis of Randomized Controlled Trials. J Orthop Sports Phys Ther 2023;53(10):594-609. Epub: 8 September 2023.

#neckpain #exercise #evidencebased #painrelief