Muscle-Specific Strength Training Reduces Neck Pain

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This may be helpful for physical therapists.

Ralph Giarnella MD

Southington Ct USA

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Muscle-Specific Strength Training Reduces Neck Pain

By  Bankhead, Staff Writer, MedPage Today

Published: January 04, 2008

Reviewed by Dori F. Zaleznik, MD; Associate Clinical

Professor of Medicine, Harvard Medical School, Boston.

Earn CME/CE

COPENHAGEN, Jan. 4 -- Women who suffer occupationally

related chronic neck pain had marked and prolonged

relief with regular strength training focused on the

affected muscles, investigators here found.

General fitness training also led to pain relief but

brought substantially less improvement than with

muscle-specific strength training, Lars L. Andersen,

M.Sc., of the National Research Center for the Working

Environment, and colleagues reported in the January

issue of Arthritis Care & Research.

" The marked reduction in pain … is of major clinical

importance, " the authors concluded. " Based on the

present results, supervised high-intensity dynamic

strength training of the painful muscle three times a

week for 20 minutes should be recommended for the

treatment of trapezius myalgia. "

More than half of all adults report episodes of neck

pain and women are more likely than men to develop

persistent pain, the authors noted.

In particular, working at a computer has been

associated with neck symptoms and, more specifically,

with pain in the descending portion of the trapezius

muscle (trapezius myalgia).

Results from studies of nonspecific forms of exercise

have shown little or no impact on neck pain, the

researchers said. However, some studies have

demonstrated pain relief with strength training,

endurance training, and muscle coordination training.

To investigate further, they compared the effects of

two types of exercise on chronic pain in 48 women with

a clinical diagnosis of trapezius myalgia. The women

came from seven different work environments, but 82%

worked at a computer, and 79% reported using a

keyboard for more than 75% of their work day.

The participants were randomized to three

interventions: specific strength training, general

fitness training, and health counseling with no

physical training. Those assigned to the two exercise

groups had supervised high-intensity training for 20

minutes, three times a week, for 10 weeks.

General fitness training consisted of riding an

exercise bike. Specific strength training involved

five different dumbbell exercises designed to increase

strength in the neck and shoulder muscles. The

training load was gradually increased over the course

of the study.

The primary outcome measure was the degree and

duration of acute change in neck muscle pain as

assessed by a 100-mm visual analog scale (VAS).

Participants assigned to specific strength training

had an average decrease in worst VAS pain score of 35

mm (~79%, P0.001 versus baseline) and a 20-mm decrease

in general pain. Of the 18 patients, 17 had a decrease

in pain, which averaged 1.03 mm per training session

for worst pain and 0.58 mm per session for general

pain.

General fitness training resulted in only a 5-mm

decrease in worst pain score and a 6-mm improvement in

general pain (P0.05 versus baseline), which the

investigators did not consider clinically relevant.

The initial improvement in pain scores did not last

until the end of the intervention period in the

general fitness training group, but the decreases in

pain scores for those receiving specific strength

training persisted throughout the intervention and

during a post-intervention period.

Participants assigned to the control group had no

improvement in pain.

The improvement in pain score in the specific

strength-training group was associated with a

significant increase in muscle strength related to

shoulder elevation and shoulder abduction (P0.001),

the researchers said. Neither the general fitness nor

the control group had improvement in muscle strength.

Participants assigned to general fitness training had

significant improvement in aerobic fitness at the end

of 10 weeks (P0.001), whereas neither of the other two

groups improved in that area.

The major limitation of this study was the small

sample size, especially in the group receiving no

exercise training. The researchers also noted that the

study focused on patients with trapezius myalgia as

opposed to non-specific chronic neck pain.

The study was supported by the Danish Medical Research

Council and the Danish Rheumatism Association.

The authors reported no disclosures.

Primary source: Arthritis Care & Research

Source reference:

Andersen LL, et al " Effect of two contrasting types of

physical exercise on chronic neck muscle pain "

Arthritis Care Res 2008; 59: 84-91.