Research Review By Dr. Shawn Thistle ©

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Date Posted:

August 2011

Study Title:

Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: Randomised controlled trial

Authors:

Andersen LL et al.

Author's Affiliations:

National Research Center for the Working Environment, Copenhagen, Denmark; Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark

Publication Information:

Pain 2011; 152(2): 440-6.

Background Information:

In the general population, the 1-year prevalence of neck and shoulder pain is about 30-50%, with between 7-22% of women and 5-16% of men reporting chronic neck pain overall. Although perhaps not definitively quantified, most experts would agree that computer use and sedentary posture in most work environments certainly don’t help. Although not as costly or disabling as low back pain, problems in this area can become chronic and bothersome, potentially affecting productivity and quality of life.

We all know that chiropractic is an effective intervention for non-specific mechanical neck pain but for too many of our colleagues treatment of this condition involves only spinal manipulation. Although scientific evidence is generally in our corner for this condition (leaving aside the debate about manipulation vs. mobilization, and assuming readers are aware that thoracic spine adjusting can be helpful for neck pain), some may not be aware that the evidence is also supportive of exercise for neck pain. In fact, as individual treatment options, manipulation, mobilization (1) and exercise (2) are all reasonable. But, the combination of manual therapy and exercise is recommended and represents a more complete treatment approach that engages and activates patients (3).

It is well known that compliance with exercise programs dictates efficacy, but that adherence, particularly to complex programs, is poor. This study investigated a simple approach to self-care, utilizing small amounts of progressive resistance training for (otherwise healthy) adults with neck and shoulder pain.

Pertinent Results:

  • The 3 treatment groups were matched for demographic and clinical characteristics.
  • Compliance in both exercise groups was roughly equal, yet not terribly high: The 2- and 12-minute groups performed on average 3.2 and 3.3 of the 5 intended training sessions per week, respectively, corresponding to a training adherence of 65% and 66%.
  • Compared with the control group, neck/shoulder pain and tenderness, respectively, decreased 1.4 points (95% confidence interval -2.0 to -0.7, p < 0.0001) and 4.2 points (95% confidence interval -5.7 to -2.7, p < 0.0001) in the 2-minute group and 1.9 points (95% confidence interval -2.5 to -1.2, p < 0.0001) and 4.4 points (95% confidence interval -5.9 to -2.9, p < 0.0001) in the 12-minute group.
  • Both exercise groups increased their strength. Interestingly, the increase did not significantly differ between the 2 or 12 minute groups.

Clinical Application & Conclusions:

This study showed that even a small amount of exercise (~2 minutes/day) using minimal equipment (a Theraband) can result in reduced pain and tenderness and increased strength in adults with neck and shoulder pain. We should always strive to provide our patients with instructions for simple exercises, movements or stretches that they can do at home or work. Not only does this engage patients in their own health, it has observable and measurable impact on symptoms and health that will only add to the benefit of the manual treatments we provide. The results of this study are encouraging and remind us all (again) to activate our patients with exercise!

Study Methods:

In this study, 174 women and 24 men (average age ~44) working at least 30 hours per week and with frequent neck/shoulder pain were randomly assigned to resistance training with elastic tubing for 2 or 12 minutes per day 5 times per week, or a control group receiving weekly information on general health. Subjects were excluded if they had a medical history of cardiovascular or cerebrovascular accident, fibromyalgia, rheumatoid arthritis, cervical disc prolapse, whiplash, other serious traumatic injury of the neck or shoulder, other serious chronic disease, pregnancy, worked fewer than 30 hours per week, or performed more than 2 hours per week of vigorous physical exercise. Potential participants were also excluded if the following were observed during the physical examination: blood pressure above 160/100, a positive foramen compression test; subacromial impingement syndrome; or pain of the shoulder, elbow, or wrist during resisted shoulder abduction resulting in severe discomfort for the participant.

The primary outcomes were changes in intensity of neck/shoulder pain (scale 0 to 10), examiner-verified tenderness of the neck/shoulder muscles (total tenderness score of 0 to 32), and isometric muscle strength at 10 weeks.

Interventions:

Both the 2 and 12-minute exercise groups performed progressive resistance training using Theraband tubing. One exercise was utilized in both groups – a standing lateral raise (shoulder abduction to 90° with elbows slightly bent to ~5° and arm in ~30° horizontal flexion). The 12 minute group performed 5-6 sets of 8-12 repetitions, 5 days per week (25-35 sets per week). The 2 minute group performed one set to failure. During the 10-week intervention, the control group received weekly e-mailed information on various aspects of general health (physical exercise, advice to stay active in spite of pain, diet, smoking, alcohol use, stress management, workplace ergonomics, and indoor climate).

Study Strengths / Weaknesses:

Study Strengths:
  • Simple interventions and an appropriate control group
  • Follow-up data was obtained from 97% of participants and they included drop-outs in the intention-to-treat analysis
  • The amount of co-intervention throughout the study period was low and acceptable
Weaknesses:
  • Because blinding of participants in training studies is not possible, we cannot exclude the influence of placebo effects. However, the effect-size of changes in this study exceeds those previously reported in response to placebo.

Additional References:

  1. Gross A, Miller J, D'Sylva J et al. Manipulation or mobilization for neck pain: A Cochrane Review. Manual Therapy 2010; 15(4): 315-333.
  2. Gross A, Miller J, D'Sylva J et al. Manual therapy with or without physical modalities for neck pain: a Cochrane review. Manual Therapy 2010; 15(5): 415-33.
  3. Miller J, Gross A, D’Sylva J et al. Manual therapy and exercise for neck pain: a Cochrane review. Manual Therapy 2010; 15(4): 334-354.