Exercises for mechanical neck disorders: A Cochrane review update.
BACKGROUND
Neck pain (NP) is disabling and costly.


OBJECTIVE
To assess the effectiveness of exercise on pain, disability, function, patient satisfaction, quality of life (QoL) and global perceived effect (GPE) in adults with NP.


METHODS
We searched computerised databases up to May 2014 for randomized controlled trials (RCTs) comparing exercise to a control in adults with NP with/without cervicogenic headache (CGH) or radiculopathy. Two reviewers independently conducted selection, data abstraction and assessed risk of bias. Meta-analyses were performed to establish pooled standardised mean differences (SMDp). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) was used to summarise the body of evidence.


RESULTS
The following exercises (27 trials) were supported by 'Moderate GRADE' evidence: For chronic NP, 1) cervico-scapulothoracic and upper extremity (UE) strengthening for moderate to large pain reduction immediately post treatment (IP) and at short-term (ST) follow-up; 2) scapulothoracic and UE endurance training for a small pain reduction (IP/ST); 3) cervical, shoulder and scapulothoracic strengthening and stretching exercise for a small to large pain reduction in the long-term (LT) (SMDp -0.45 [95%CI: -0.72 to -0.18]) and function improvement; 4) cervico-scapulothoracic strengthening/stabilisation exercises for pain and function at intermediate-term (IT) (SMDp -14.90 [95%CI: -22.40 to -7.39]). 5) mindfulness exercises (Qigong) for minor improved function but not GPE (ST). For chronic CGH, cervico-scapulothoracic strengthening and endurance exercises including pressure biofeedback for small/moderate improvement of pain, function and GPE (IP/LT).


CONCLUSIONS
Specific strengthening exercises of the neck, scapulothoracic and shoulder for chronic NP and chronic CGH are beneficial. Future research should explore optimal dosage.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Canada. Electronic address: grossa@mcmaster.ca.
A R
AR
Gross
Physio-Santé, Drummondville, Canada; University of Western Ontario, London, Canada.
J P
JP
Paquin
University of Western Ontario, London, Canada.
G
G
Dupont
University of Western Ontario, London, Canada.
S
S
Blanchette
University of Western Ontario, London, Canada.
P
P
Lalonde
University of Western Ontario, London, Canada.
T
T
Cristie
School of Rehabilitation Science, McMaster University, Hamilton, Canada.
N
N
Graham
Women's College Hospital, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada.
T M
TM
Kay
Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada.
S J
SJ
Burnie
Applied Health Sciences, University of Manitoba, Winnipeg, Canada.
G
G
Gelley
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
C H
CH
Goldsmith
Canadian Forces Health Services Group, Groupe de Services de Santé des Forces Canadiennes, National Defence, Défense Nationale, Government of Canada, Gouvernement du Canada, Kingston, Canada.
M
M
Forget
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
P L
PL
Santaguida
Kinesiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
A J
AJ
Yee
Life Science, Faculty of Health Sciences, Queens Univesity, Kingston, Canada.
G G
GG
Radisic
Coronel Institute of Occupational Health and Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
J L
JL
Hoving
Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN, USA.
G
G
Bronfort
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy; D006801:Humans; D008875:Middle Aged; D019547:Neck Pain / Q000503:physiopathology / Q000628:therapy*; D026741:Physical Therapy Modalities; D011788:Quality of Life; D014911:Whiplash Injuries / Q000503:physiopathology / Q000628:therapy*
Cochrane review; Exercise; Meta-analysis; Neck pain