Neck Exercises for Pain Reduction

Overseen By Kory J Zimney, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of South Dakota

Must not be taking: Pain medications

Disqualifiers: Chronic pain, Neck pain, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

40 Participants Needed

Trial Summary

What is the purpose of this trial?

Exercised induced hypoalgesia (EIH) (reduction in pain) after exercise has been studied in the literature, but no comparisons have been made specifically looking at different types of exercise (isometric/dynamic moving through a range of motion with resistance versus isotonic/applying static resistance to a joint not moving) with neck muscle strengthening. This study will explore to see if one form of exercise is superior to the other in providing EIH. Another benefit of exercise is improving proprioception (knowing where our body is in space). Again no specific investigation has been done comparing isometric versus isotonic exercises for neck muscles. Both of these exercises are often prescribed in physical therapy so further understanding the benefits of them can help improve the prescription of exercises for patients.

Will I have to stop taking my current medications?

The trial requires you to refrain from taking pain medications 24 hours before testing.

What data supports the effectiveness of the treatment Exercise, Physical Activity, Workout, Fitness Training for neck pain?

Research shows that adding aerobic exercise to neck-specific exercises can help reduce neck pain and disability. Additionally, isometric exercises (exercises where muscles contract without movement) have been found to decrease pain and disability in conditions like cervical spondylosis, which is a type of neck pain. ^{1 2 3 4 5}

Is exercise generally safe for reducing neck pain?

Exercise for neck pain is generally safe, but some people, especially older adults, may experience mild muscle soreness or other non-serious issues. In rare cases, more serious events like falls can occur, so it's important to discuss any concerns with a healthcare provider before starting a new exercise program. ^{4 6 7 8 9}

How do neck exercises for pain reduction differ from other treatments for neck pain?

Neck exercises are unique because they focus on strengthening and improving the function of specific neck muscles, which can help reduce pain and improve mobility. Unlike medications or passive treatments, exercises actively engage the muscles, potentially leading to long-term improvements in neck function and pain relief. ^{10 11 12 13 14}

Research Team

Kory J Zimney, PhD

Principal Investigator

University of South Dakota

Eligibility Criteria

This trial is for healthy individuals aged 18-64, of any gender, who do not currently have neck pain. It aims to understand the effects of different types of neck exercises on pain reduction and body awareness.

Inclusion Criteria

I am healthy and do not have neck pain.

My gender does not limit my participation.

Exclusion Criteria

I can avoid alcohol, pain meds, and hard exercise for 24 hours before tests.

Medical restrictions to physical activity

I have had chronic pain for more than 3 months or am currently experiencing acute neck pain.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Isometric Exercise

Participants perform isometric neck exercises at a moderate intensity level, followed by PPT and JPE tests.

1 day

1 visit (in-person)

Isotonic Exercise

Participants perform isotonic neck exercises at a moderate intensity level, followed by PPT and JPE tests.

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after exercise sessions

2-3 days

Treatment Details

Interventions

• Exercise

Trial Overview The study compares two forms of exercise: isometric (static resistance without movement) and isotonic (dynamic resistance with movement), focusing on their ability to reduce pain and improve proprioception in the neck muscles.

Participant Groups

Group I: Isometric Exercise Active Control 1 Intervention

Isometric test protocol. Participants will be asked to perform the exercise at a moderate exercise level (3/10 on the mRPE scale provided to them). They will complete a 1, 10-second isometric hold to their hand dominant side (if ambidextrous, the side the participant would report as the most dominant side) to allow them to find their "moderate" intensity level. The participant will then take a 2-minute rest before beginning the exercise routine and will be instructed to keep a consistent resistance level during the exercise bout. During the exercise, the subjects will hold the rotation contraction for 10 seconds, take a 2-second rest, complete this 5 times, and then change to the left side. They will do this for 3 sets of right and left. Researchers will time the exercises and give verbal instructions to make sure they are performing for the appropriate amount of time and rest periods.

Group II: Isotonic Exercise Active Control 1 Intervention

The resistance level will stay at the participant's selected moderate level during the entire testing unless they need to stop due to pain or difficulty completing the exercise. During the exercise, the participants will be rotating to the right first at a pace of 1 second for concentric contraction to full rotation and 1 second for eccentric contraction, returning the head to the neutral position. The participant will continue this pace to complete 5 repetitions and then take a 2-second rest before continuing this sequence 5 times (a total of 25 reps) before switching and doing left rotation in the same fashion. This will be done for a total of 3 sets for both right and left rotation. The use of a metronome will be used along with the researcher's verbal instructions and cueing to maintain the proper sequence and timing of the exercise.

Who Is Running the Clinical Trial?

University of South Dakota

Lead Sponsor

Trials

16

Recruited

2,000+

Findings from Research

In a study involving 139 patients with nonspecific neck pain, adding aerobic exercise to neck-specific exercises significantly improved outcomes, with 77.4% of the aerobic exercise group reporting successful results after six months compared to only 40% in the control group.

The aerobic exercise group experienced a substantial reduction in pain levels (measured by the Visual Analogue Scale) and improvements in neck disability and fear avoidance beliefs, indicating that aerobic exercise enhances the effectiveness of neck-specific treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of an aerobic exercise training on patients with neck pain during a short- and long-term follow-up: a prospective double-blind randomized controlled trial. Daher, A., Carel, RS., Tzipi, K., et al.[2022]

Patients with nonspecific neck pain (NP) who have had symptoms for 6 months or less, do not experience cervicogenic headaches, and exhibit shoulder protraction are more likely to benefit from stretching and muscle-performance exercises, with success rates of 86% after 6 weeks and 71% after 6 months.

This study analyzed treatment outcomes from 70 patients over a 6-week exercise program, highlighting the importance of identifying specific clinical characteristics to optimize exercise-based treatments for neck pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stretching and muscle-performance exercises for chronic nonspecific neck pain: who may benefit most? Daher, A., Dar, G.[2023]

A systematic review of various studies indicates that multimodal physiotherapy interventions, which include active exercise, lead to better outcomes for chronic neck pain, such as increased strength and reduced pain scores.

Incorporating active strengthening exercises along with stretching and aerobic components enhances the effectiveness of treatment, improving overall function and health-related quality of life for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle. O'Riordan, C., Clifford, A., Van De Ven, P., et al.[2022]

Isometric exercises significantly reduced neck pain and disability in patients with cervical spondylosis, as shown by lower scores on the Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPAD) after 4 weeks of treatment.

The study involved 24 patients (22 females and 2 males, average age 46.7 years) and demonstrated that those who performed isometric exercises had much better outcomes compared to those who received conservative management without exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial. Sadeghi, A., Rostami, M., Ameri, S., et al.[2022]

A study involving 79 participants with chronic neck pain found that home kinematic training (KT) led to a high self-reported response rate of 71% to 73%, indicating its efficacy in reducing pain and disability.

Men with greater neck disability and slower cervical motion at baseline were more likely to benefit from the KT, suggesting that specific baseline characteristics can help predict who will respond best to this type of exercise therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors for Positive Response to Home Kinematic Training in Chronic Neck Pain. Sarig Bahat, H., Hadar, D., Treleaven, J.[2021]

In a study involving 241 elderly participants undergoing spinal manipulative therapy (SMT) and exercise for chronic neck pain, 130 reported non-serious adverse events (AEs), highlighting the prevalence of musculoskeletal issues associated with these treatments.

Participants in the supervised exercise group reported three times more AEs compared to those receiving home exercise alone, indicating that while SMT and exercise can be effective, they also carry a risk of AEs that should be considered in treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial. Maiers, M., Evans, R., Hartvigsen, J., et al.[2022]

A systematic review of 5 randomized controlled trials involving 1722 participants found that exercise interventions likely reduce the risk of developing neck pain by about 51% compared to no or minimal intervention over a short-term period of up to 12 months.

Despite the promising results, the clinical significance of the effect remains uncertain, and the risk of bias in some studies suggests that further research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Exercise Interventions for Preventing Neck Pain: A Systematic Review With Meta-analysis of Randomized Controlled Trials. Teichert, F., Karner, V., Döding, R., et al.[2023]

A systematic review of 17 studies, with 13 rated as high-quality, found limited evidence suggesting no association between physical activity and neck pain in workers and strong evidence for no association in school children.

The relationship between physical activity and low back pain showed conflicting evidence, indicating that more research is necessary to clarify these associations due to the heterogeneity of the existing literature.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The association between physical activity and neck and low back pain: a systematic review. Sitthipornvorakul, E., Janwantanakul, P., Purepong, N., et al.[2022]

An 8-week exercise program significantly reduced neck pain and disability in 46 women with chronic neck pain, as indicated by a decrease in the Neck Disability Index (NDI) score from 18.2 to 14.1.

The exercise training improved the specificity of neck muscle activity, showing a notable increase in muscle activity directionality from 18.6% to 24.7%, while the control group showed no significant changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of an 8-week exercise programme on pain and specificity of neck muscle activity in patients with chronic neck pain: a randomized controlled study. Falla, D., Lindstrøm, R., Rechter, L., et al.[2022]

In a study of 45 patients with chronic neck pain, adding specific exercise training to conventional treatment significantly improved pain, posture, range of motion (ROM), and disability after four weeks of training.

Group 3, which included core stabilization exercises, showed the greatest improvement in pain and posture, while Group 2, which focused on deep cervical flexor training, had the most significant gains in ROM and disability reduction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of three different exercise trainings in patients with chronic neck pain: a randomized controlled study. Gumuscu, BH., Kisa, EP., Kara Kaya, B., et al.[2023]

This systematic review analyzed 25 systematic reviews involving 17,321 participants and found that various exercise types, including motor control exercises, Pilates, resistance training, traditional Chinese exercise, and yoga, have short-term positive effects on pain and disability in individuals with chronic neck pain compared to non-exercise controls.

Despite the positive effects observed, no single exercise type was found to be superior to others, indicating that while exercise is beneficial, there is no consensus on the best type for treating chronic neck pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews. Rasmussen-Barr, E., Halvorsen, M., Bohman, T., et al.[2023]

Specific strength training targeting the trapezius muscle significantly reduced neck muscle pain by approximately 79% over 10 weeks in a study of 48 women with chronic pain, indicating its effectiveness as a treatment.

In contrast, general fitness training (leg bicycling) provided only a small, temporary reduction in pain, highlighting that targeted exercises are more beneficial for work-related neck muscle issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of two contrasting types of physical exercise on chronic neck muscle pain. Andersen, LL., Kjaer, M., Søgaard, K., et al.[2022]

Deep cervical flexor (DCF) training is effective in improving neuromuscular coordination in individuals with neck pain, based on a review of 12 randomized controlled trials.

However, DCF training shows limited effects on strength and endurance at higher loads, suggesting that a combination of training methods may be necessary to address all aspects of neck pain rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. Blomgren, J., Strandell, E., Jull, G., et al.[2019]

In a study involving 100 females with chronic neck pain, three different exercise programs (strength-endurance, craniocervical flexion, and a combination) significantly improved pain and disability levels after 12 weeks compared to a control group.

The exercise interventions led to reduced muscle activity in almost all cervical muscles during tasks, suggesting that these exercises not only alleviate pain but also help in managing muscle tension in the neck.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of strength and endurance training of superficial and deep neck muscles on muscle activities and pain levels of females with chronic neck pain. Borisut, S., Vongsirinavarat, M., Vachalathiti, R., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

The effectiveness of an aerobic exercise training on patients with neck pain during a short- and long-term follow-up: a prospective double-blind randomized controlled trial. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Stretching and muscle-performance exercises for chronic nonspecific neck pain: who may benefit most? [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Predictors for Positive Response to Home Kinematic Training in Chronic Neck Pain. [2021]

6. Scotland pubmed.ncbi.nlm.nih.gov

Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of Exercise Interventions for Preventing Neck Pain: A Systematic Review With Meta-analysis of Randomized Controlled Trials. [2023]

8. Germany pubmed.ncbi.nlm.nih.gov

The association between physical activity and neck and low back pain: a systematic review. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Effectiveness of an 8-week exercise programme on pain and specificity of neck muscle activity in patients with chronic neck pain: a randomized controlled study. [2022]

10. Korea (South) pubmed.ncbi.nlm.nih.gov

Comparison of three different exercise trainings in patients with chronic neck pain: a randomized controlled study. [2023]

11. England pubmed.ncbi.nlm.nih.gov

Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews. [2023]

12. United States pubmed.ncbi.nlm.nih.gov

Effect of two contrasting types of physical exercise on chronic neck muscle pain. [2022]

13. England pubmed.ncbi.nlm.nih.gov

Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. [2019]

14. Japan pubmed.ncbi.nlm.nih.gov

Effects of strength and endurance training of superficial and deep neck muscles on muscle activities and pain levels of females with chronic neck pain. [2022]