title: Effect of strength training in addition to general exercise in the rehabilitation of patients with non-specific neck pain. A randomized clinical trial.
abstract: BACKGROUND
  The optimal type of exercise protocol in the physical rehabilitation of non-specific neck pain has not yet been established. Furthermore, the role of fear-avoidance belief in the maintenance of pain and disability has been highlighted. Research indicates that exercise may be a means to reduce fear-avoidance belief, but evidence is scarce.
  
  
  OBJECTIVE
  To compare the effect of two different exercise programs on pain, strength and fear-avoidance belief.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  A specialized outpatient hospital clinic in Denmark.
  
  
  METHODS
  Twenty-three men and 60 women on sick leave due to non-specific neck pain.
  
  
  METHODS
  Participants were randomized to either general physical activity (GPA group) or GPA and additional strength training of the neck and shoulder (SST group). The primary outcome was pain intensity. Secondary outcomes were muscle strength of the neck and shoulder and fear-avoidance belief.
  
  
  RESULTS
  Pain was significantly reduced within groups with a median of -1 (IQR: -3 to 0, P<0.001) in the SST group and -1 (IQR: -4 to 1, P=0.046) in the GPA group. The difference between groups was not significant. Changes in strength did not differ between groups. Both groups experienced significant increases in neck flexion strength of 14.7 N (IQR: -1 to 28.4, P=0. 001) in the SST group and 6.9 N (IQR: -4.9 to18.6, P=0.014) in the GPA group. Furthermore, the SST group achieved an increase of 18.6 N (IQR: -2.6 to 69.7, P=0.005) in neck extension. Fear-avoidance beliefs improved with 6 (IQR: 3 to 12, P<0.001) in the SST group, while the GPA group improved with 3 (IQR: 0 to 8, P=0.004). This between-group difference was significant (P=0.046).
  This study indicates that in rehabilitation of subjects severely disabled by non-specific neck pain, there is no additional improvement on pain or muscle strength when neck exercises are given as a home-based program with a minimum of supervision. However, strength training of the painful muscles seems to be effective in decreasing fear-avoidance beliefs.
authors: Department of Physiotherapy and Occupational Therapy Aarhus University Hospital, Aarhus, Denmark - nannrasm@rm.dk.
authors: N
authors: N
authors: Rolving
authors: D H
authors: DH
authors: Christiansen
authors: L L
authors: LL
authors: Andersen
authors: J
authors: J
authors: Skotte
authors: J
authors: J
authors: Ylinen
authors: O K
authors: OK
authors: Jensen
authors: C V
authors: CV
authors: Nielsen
authors: C
authors: C
authors: Jensen
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D001362:Avoidance Learning; D059350:Chronic Pain / Q000534:rehabilitation; D003718:Denmark; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D019547:Neck Pain / Q000188:drug therapy / Q000523:psychology / Q000534:rehabilitation*; D010349:Patient Compliance / Q000706:statistics & numerical data; D055070:Resistance Training / Q000379:methods*; D012720:Severity of Illness Index; D018582:Sick Leave / Q000706:statistics & numerical data
chemical_list: D000700:Analgesics