Resistance Training Best for Neck Pain

Study: Applying Force Brings Fourfold Improvement Compared With Stretching

From the WebMD Archives

May 20, 2003 -- Although stretching neck muscles is the often-preached advice for relieving chronic neck pain, a new study suggests resistance training is a much better treatment choice.

Finnish researchers say that applying resistance with elastic bands, which are sold at most sporting goods stores, brought a level of improvement in women with chronic neck pain that was up to four times as great as doing similar neck-stretching exercises without the additional force. Still, basic non-resistance stretching was about three times more effective than doing no specific neck exercises, they report in the May 21 issue of TheJournal of the American Medical Association.

This finding is important, since chronic neck pain is especially common among working women, and some studies suggest it is their most frequent complaint to doctors. But men aren't immune: A Canadian study published three years ago found that the majority of both men and women surveyed reported having chronic neck pain, and one in 20 said it resulted in major disability.

"Weakness of neck muscles is a problem -- especially for women, who exhibit about 50% to 60% of strength (in their neck muscles) compared to men," Jari Ylinen, MD, of Jyvaskyla Central Hospital, tells WebMD. "Some women in our study initially had great difficulties holding their heads in a horizontal position (while looking down) because of weak neck muscles."

Ylinen studied 180 women between ages 25 and 53 who worked full time and had neck pain for at least six months. They were randomly assigned to three groups -- those doing 45 minutes of stretching exercises five days a week, such as lifting their head while lying down without any resistance; those who used elastic bands to strengthen neck muscles for the same time period; and a control group that did no specific neck exercises but engaged in regular recreational activities. All the women supplemented their regimens with aerobic and other stretching exercises three times a week at home, and the two training groups also used dumbbells to boost strength in their shoulders, arms, and chest.

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The two exercise groups were then medically evaluated three times over the next year, while the control group was evaluated once, and the researchers compared their outcomes to work disability claims and related factors. They found that study participants using the resistance bands improved their neck flexibility by 110%, rotation by 76%, and extension by 69%, while those on the regimen without resistance improved those functions by 28%, 29%, and 16%. Those not actively doing any neck exercises had improvements of 10%, 10%, and 7%.

Ylinen's study follows another trial done in 1994, in which resistance exercise was also found to be more effective than stretching. In lieu of elastic bands, resistance could be achieved by holding your hands on the back of your head and gently pressing your head while holding your hands firm.

However, the bands are better because they apply more uniform force and may have an advantage in building neck muscle strength, says Scott D. Boden, MD, professor of orthopaedic surgery at Emory University School of Medicine and a spokesman for the American Academy of Orthopaedic Surgeons. He was not involved in Ylinen's study, but he calls it an important finding that could lead to major advances in treatment.

"It's so rare that we see any study on physical therapy and exercise showing a difference in one mode of exercise from another," he tells WebMD. "This is very exciting study, because methods were so meticulous and it really proves what a lot of people thought to be true but had a hard time documenting. There is such little evidence on what we base most of our treatments on in musculoskeletal care, so having a study like this is, in my opinion, is a major advance. Not only did they show a rather dramatic difference in improvement over controls, but also between the two treatment groups."

Actually, Ylinen's study follows the often recommended treatment for back pain; many experts suggest that supplementing basic stretching with resistance training can boost muscle strength faster and lead to more improvement, says Boden. "The concept of improving instability with resistance training isn't a new concept, but showing the impact over and above just stretching is a real value of this study."

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Sources

SOURCES: The Journal of the American Medical Association, May 21, 2003. Spine, May 2000. Jari Ylinen, MD, head of the department of physical and rehabilitation medicine, Jyvaskyla Central Hospital, Jyvaskyla, Finland. Scott D. Boden, MD, professor of orthopaedic surgery, Emory University School of Medicine, Atlanta; spokesman, American Academy of Orthopaedic Surgeons, Rosemont, Ill.
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