Exercises for mechanical neck disorders

Background Neck disorders are common, limit function, and are costly to individuals and society. Exercise therapy is a commonly used treatment for neck pain. The effectiveness of exercise therapy remains unclear. Objectives To assess the effectiveness of exercise therapy to relieve pain, or improve function, disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND). Search methods We electronically searched CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, without language restrictions, from their beginning up to March 2004, screened reference lists of key articles and authors' personal files. Selection criteria Selected studies were randomised [RCTs] or quasi‐randomised trials and investigated the use of exercise therapy as a treatment in adults with MND with or without headache or radicular findings. Data collection and analysis Two reviewers independently conducted study selection, data abstraction, and methodological quality assessment. Using a random effects model, relative risk and standardized mean differences were calculated. Results were ranked using five levels of evidence. Main results Thirty‐one trials were selected, 19% (van Tulder criteria) to 35% (Jadad scale) were rated as high quality. There is limited evidence of benefit for strengthening, stretching and strengthening or eye‐fixation exercises for neck disorder with headache. There is limited evidence of benefit for active range‐of‐motion exercises or a home exercise program for acute mechanical neck disorder including whiplash associated disorder. There is limited evidence that an eye‐fixation program is beneficial for chronic mechanical neck disorder in the short term but not in the long term. There is unclear evidence of benefit for a stretching and strengthening program in chronic mechanical neck disorder. There is strong evidence of benefit favouring a multimodal care approach of exercise combined with mobilisations or manipulations for subacute and chronic MND with or with headache in the short and long term. Authors' conclusions The evidence summarised in this systematic review indicates that there is a role for exercises in the treatment of acute and chronic mechanical neck disorder and neck disorder plus headache. Exercise for neck disorders with radicular findings is not assessed. The relative benefit of each type of exercise needs extensive research. Phase II trials would help identify the most effective treatment characteristics and dosages.