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Neck muscle training in the treatment of

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 EURA MEDICOPHYS 2007;43:161-9

Neck muscle training in the treatment of chronic neck pain:

CA a three-year follow-up study

DI J. YLINEN 1, A. HÄKKINEN 1, M. NYKÄNEN 2, H. KAUTIAINEN 3, E.-P. TAKALA 4

E T®
Aim. The objective of the trial was to evaluate whether 1Department of Physical and Rehabilitation Medicine

M H
the positive results achieved with a one-year training
regimen in patients with chronic nonspecific neck pain
would have long-standing effects.
Jyväskylä Central Hospital
Jyväskylä, Finland
2Punkaharju Rehabilitation Center

A
Methods. A follow-up study of two neck muscle training Punkaharju, Finland
3Rheumatism Foundation Hospital
groups after a randomized controlled study was carried

G
Heinola, Finland

V
out. One-hundred and eighteen women included were

I
4Finnish Institute of Occupational Health
those who had performed neck strength and endurance
Helsinki, Finland
exercises in a previous randomised controlled trial. The

R R
primary outcome measures were neck pain measured by
the visual analogue scale and disability indices. Isometric

E
neck strength, range of motion (ROM) and pressure

Y
pain threshold (PPT) were measured and training fre- Since a 12-month exercise programme shows a long-
quency for the previous month elicited by a question- term effect, exercise may not need to be performed reg-

IN OP
naire.
Results. At the 3-year follow-up, neck pain and the dis-
ability indices showed no statistically discernible change
compared to the situation at the 12-month follow-up.
ularly for the remainder of the subject’s life.
KEY WORDS: Neck pain - Physical education and training -
Protocol compliance - Muscle, skeletal - Muscle stretching
exercises - Rehabilitation.

M C
Also, gains in neck strength, ROM and PPT achieved
during the training year were largely maintained.

N
However, adherence to the specific home training pro-
gram faltered considerably.
Conclusion. The improvements achieved through long-
term training were maintained at the 3-year follow-up.
Fundings.—Financed by the Social Insurance Institution, Helsinki,
Finland.
Acknowledgments.—The authors thank the staff of Punkaharju
Rehabilitation Center for their help in all the practical arrangements
for the study, especially physiotherapist L. Nyrhinen taking care of
the follow-up groups and performing the PPT measurements, and J.
Jalovaara for administering the other tests.
Submitted for publication on July 3, 2006.
Accepted for publication on February 2, 2007.
E-pub ahead of print on May 28, 2007.
Address reprint requests to: J. Ylinen, Jyväskylä Central Hospital,
Head of Department of Physical and Rehabilitation Medicine,
Keskussairaalantie 19, 40620 Jyväskylä, Finland.
E-mail: jari.ylinen@ksshp.fi
eck pain is one of the most common symptoms
leading sufferers to seek help from general prac-
titioners.1, 2 Neck pain-related medical examinations
and treatments have been estimated to account for
about 1% of the total costs of the health care system.3
Thus, there is interest in finding an effective method
of treatment, especially for chronic neck pain, which
incurs the major part of those costs.
Previous systematic meta-analytic reports have
found either lacking, limited, or conflicting evidence
for the effectiveness of passive physical therapies,
active training or multimodal rehabilitation in the
treatment of chronic neck pain.4-7 We have previ-
ously reported a randomized controlled study in
which a 2-week multimodal rehabilitation program
followed by 12 months’ home-based neck muscle

Vol. 43 - No. 2 EUROPA MEDICOPHYSICA 161

YLINEN NECK MUSCLE TRAINING IN THE TREATMENT OF CHRONIC NECK PAIN

347 patients referred from occupational health care physicians

167 did not meet eligibility criteria or were

excluded by low neck pain and disability index

CA 180 randomized

DI
60 strength group
(12 days institutional
rehabilitation)
60 endurance group
(12 days institutional
rehabilitation)
60 control group
(3 days)

E
M ®
Excluded:1 polymyalgia
rheumatica Withdrew:
Withdrew:1 personal 1 pregnancy
reasons

VA T
H
12-month follow-up 12-month follow-up 12-month follow-up
(n=60) (n=58) (n=59)

ER IG Withdrew: 1 personal reasons Withdrew: 1 personal reasons

IN YR
3-year follow-up
(n=59)
3-year follow-up
(n=57)

M P
Figure 1.—Participant flowchart.

CO
strength as well as endurance training led to a clin-
ically significant decrease in neck pain and disabil-
ity in women with chronic neck pain.8 Moreover,
the improved subjective outcomes were associated
with a significant increase in neck strength and range
of motion (ROM) and improved pressure pain thresh-
old (PPT).8, 9
Neck training studies suggest that positive effects
may be achieved after a training period from 5 to 12
weeks, but that these will have disappeared 12 months
later.10-13 Chronic neck pain also tends to be even
more persistent than low back pain.14 This gives rise
to doubts as to whether even long-term training can
be effective beyond the intervention period. Regular
check-ups and tests keep up the motivation to train,
but these require staff and financial resources. Thus,
from the health economics point of view, it is impor-
tant to know for how long it is necessary to support
patients’ training compliance.
The objective of the present study was to examine
the long-term effects of neck muscle training. The
primary aim was to evaluate the change in neck pain
and disability indices between the end of treatment
and a 3-year follow-up. The secondary aim was to

162 EUROPA MEDICOPHYSICA June 2007

NECK MUSCLE TRAINING IN THE TREATMENT OF CHRONIC NECK PAIN YLINEN

TABLE I.—Demographic and clinical data of the subjects at the TABLE II.—Differences of training programs between two trai-
baseline. ning groups. Training programs consisted of dynamic exercises,
if not stated otherwise.
Training groups
Training groups
Endurance (n=57) Strength (n=59) Exercises
Mean (SD) Mean (SD) Endurance Strength

Demographic Neck Load of the head 80% of

Age, years 46 (6) 45 (6) maximal strength
Height, cm
Weight, kg
BMI, kg/m2

CA 165 (6)
68 (10)
25 (3)
165 (5)
67 (11)
25 (3)
Flexion

Extension
Supine
20 repetitions
×3 sets
Prone
Sitting, isometric,
15 repetitions
×3 sets
Sitting, isometric,

I
Clinical
Duration of neck pain, years 9 (6) 8 (6) 20 repetitions 15 repetitions
×3 sets ×1 set

D
BMI: body mass index. Shoulders and upper extremities
Dumbbell shrugs Fixed load Individually

E
Presses 2×2 kg progressive load
examine whether the improved clinical measures Curls 20 repetitions 15 RM
would be sustained in the long-term and to evaluate bent-over rows ×3 sets ×1 set
Flyes

M ®
exercise compliance. Pullovers
Lower extremities
Materials and methods Squats Load of the body

A
Trunk 20 repetitions
Study design

V T
The study was a 3-year follow-up study of neck

H
muscle strength and endurance training lasting 12
Sit-ups
Back extension
Back extension
Training time
×3 sets

R
months (Figure 1). For ethical reasons the controls Muscle exercises 40 min 25 min

G
also had to receive rehabilitation and thus they com- Stretching exercises 20 min 20 min

E I
menced the same program as the neck strength train- Total 60 min 45 min
ing group immediately after the 12-month follow-

IN YR
up.15 Thus, the control group was lost and could not RM: repetition maximum.
be included at the 3-year follow-up.
Initially, the training groups had embarked on a
12-day period of institutional rehabilitation and fol- naires by post. The head researcher, biostatician and

M P
low-ups after 2, 6 and 12 months, in which the main tester were all independent of the rehabilitation insti-
aim was to teach and support them to perform the tution.
home training program properly. The original inten-

O
tion was to follow the training groups only up to the
Patients
12-month follow-up. Patients were urged to con-

C
tinue the training on their own after that and were
told that there would be no further follow-ups.
Patients were not informed about the 3-year follow-
up until a few months beforehand so that they could
arrange to travel to the rehabilitation center where
the tests were performed. Thus, the expectation of
follow-ups was no longer a motivation to continue
training.
Patients answered questionnaires and were invited
to the rehabilitation centre for 2 days of testing and a
feed-back meeting during one weekend. Those who
could not attend were asked to return the question-
Patients were recruited through their respective
occupational health care systems. On the basis of
anamnesis and a clinical examination physicians
referred suitable patients for the study. A questionnaire
on their current health and symptoms was mailed to
patients to confirm their status with to regard the
study criteria, neck pain and disability to enable a
further selection to be made. The inclusion criteria
were permanently employed female office workers of
working age with neck pain for over 6 months.
Exclusion criteria were specific diseases and trauma
causing chronic neck pain and other conditions pre-

Vol. 43 - No. 2 EUROPA MEDICOPHYSICA 163

YLINEN NECK MUSCLE TRAINING IN THE TREATMENT OF CHRONIC NECK PAIN

TABLE III.—Neck pain and disability indices at baseline, after the 12-month training intervention and at the 3-year follow-up.
Time P value †
Variables
Baseline Months 12 3 years 12 months vs 3 years vs
Median (IQR) Median (IQR) Median (IQR) baseline 12 months

Endurance (n=57)
Pain (VAS) 57 (42, 74) 15 (5, 25) 19 (6, 37) <0.001 0.72
Neck and shoulder pain and disability index 36 (28, 46) 9 (5, 16) 13 (4, 25) <0.001 0.85

Strength (n=59)
Pain (VAS)

CA
Vernon neck disability index 20 (16, 28)

58 (43, 72)
14 (6, 20)

9 (3, 21)
14 (6, 20)

14 (4, 39)
<0.001

<0.001
0.85

0.068

I
Neck and shoulder pain and disability index
Vernon neck disability index

D
35 (25, 45)
22 (16, 26)
6 (2, 20)
14 (6, 20)
12 (3, 27)
12 (4, 22)

†: Wilcoxon test and P value adjusted by using Hommel’s method; IQR: interquartile range; VAS: visual analogue scale.
<0.001
<0.001
0.072
0.79

E
venting physical loading. Finally 180 women under- between the midline and the lateral border of the

M ®
went a clinical examination by a specialist in physical
and rehabilitation medicine and were selected for the
original study. They were randomized into 2 training
groups and into a control group with 60 patients in
acromion, the levator scapulae muscle 2 cm above
the lower insertion located in the upper medial bor-
der of the scapulae and the suboccipital points 2 cm
lateral to the spinous processus of the axis, and on the

A T
each group. The training groups were invited to the
3-year follow-up. Table I describes their properties

V
sternum in the midline. The physiotherapist measur-
ing PPTs was the same as at the baseline and thus

H
at the baseline. she was not blinded to the groups.
Data of training frequency during the past month

ER
Outcome measures

IG
The primary outcome measures were neck pain
and disability, which were assessed on the visual ana-
was used to measure compliance. Sick leave during
the past year was collected by a questionnaire to com-
pare the 2 groups.

IN YR
logue scale (VAS), by a modified neck and shoulder
pain and disability index and by the Vernon neck dis-
ability index.16-18 On each scale the theoretical range
is from 0 to 100.
Description of interventions
Training regimens of both strength and endurance
training groups consisted of 3 training sessions per

M P
An isometric Neck Strength Measurement System week (Table II). The endurance training group exer-
(NSMS, Kuntoväline Ltd., Helsinki, Finland) was used cised the neck muscles by lifting the head up while
to test maximal neck strength in flexion, extension lying down. The strength training group performed

O
and rotation. The methodology followed the stan- isometric neck resistance training with an elastic rub-
dard testing method as described previously in the ber band (Theraband‚) in the sitting position. The

C
reliability study.19
A multidimensional neck ROM device (Kuntoväline
Ltd., Helsinki, Finland) was used to measure passive
ROM in flexion-extension, lateral flexion and rota-
tion.20 All the strength and ROM tests were performed
blind by the same experienced physiotherapist prior
to the intervention and follow-ups.
PPTs were assessed according to a previously
described technique, using a handheld electronic
pressure algometer (Force five, Wagner Instruments,
Greenwich, CT).9 Pain thresholds were measured on
the upper border of the trapezius muscle halfway
load was checked with a hand-held isometric strength
testing instrument (Force-Five). Both groups carried
out dynamic exercises for the shoulders, upper and
lower extremities and trunk. Training ended with
stretching exercises for the neck, shoulder and upper
limb muscles.
Ethics
The local ethics committee approved the study and
the participants gave their informed written consent
prior to inclusion in the study.

164 EUROPA MEDICOPHYSICA June 2007

NECK MUSCLE TRAINING IN THE TREATMENT OF CHRONIC NECK PAIN YLINEN

Statistical analysis 20

The results were expressed as mean or median, 15

Change from months 12 to months 36

standard deviation (SD) or interquartile range (IQR).
Repeated-measures analysis of variance with pairwise 10
comparison and Wilcoxon test were used within group
analysis of the primary outcomes between the 12- 5
month and 3-year follow-ups. Hommel’s adjustments

A
were used to correct significance levels for multiple
and post hoc testing. The effect of different treatments

C
on secondary outcomes was evaluated by analysis of
0

-5

DI
covariance (ANCOVA) with the baseline or 12 month
follow-up as covariates for normally distributed out-
comes and Mann-Whitney test if distributional assump-
tions for parametric method were not met. The nor-
-10

-15

E
mality of the variables was evaluated by the Shapiro- Pain NSPD index Vernon index
Wilk statistic. The α level was set at 0.05 for all tests.
Endurance Strength
Analyses were performed using Stata Statistical

M ®
Software version 8.0 (Stata Corp, College Station, Tex). Figure 2.—Median change with interquartile range of pain and dis-
ability indices in the endurance and strength training groups at the 3-
year follow-up compared to the levels after the home training inter-

A
vention at the 12-month follow-up. NSPD: neck and shoulder pain and

T
Results disability index.

RV
The questionnaire at the 3-year follow-up assess-

H
ment was answered and returned by 98% of the par-
ticipants. The participation rates for the physical assess-
compared to the baseline values and no statistically
discernible difference in the results was found between

G
ments were 77% in the strength training group and the 12-month and 3-year follow-ups (Table V). In the

E I
70% in the endurance training group. strength training group an even greater improvement
There had been a significant reduction in the neck in neck strength was observed at the 12-month follow-
pain and disability indices from baseline to the 12-

IN YR
month follow-up in both training groups and no sta-
tistically discernible change was noticed between the
12-month and 3-year follow-ups (Table III). Also, indi-
up, but this had not been maintained fully at the 3-year
follow-up. The changes were statistically significant in
all directions (P<0.001). The neck strength of the
strength training group was nevertheless significant-

M P
vidual variation in pain and disability remained small ly better in all the directions tested than at the base-
in both groups despite the long follow-up period, line (P<0.001). The neck strength of the strength train-
showing that the change had been rather stable (Figure ing group also remained significantly better in all the

O
2). No significant differences in pain and disability directions tested compared to that of the endurance
between the 2 training groups were found at the 3-year training group (P<0.001).

C
follow-up compared to the baseline and 12-month
follow-up.
The mean PPT in all the muscles tested was signif-
icantly higher in both training groups at the 12-month
follow-up compared to the baseline values, and the
changes remained the same or had even significant-
ly improved at most sites at the 3-year follow-up
(Table IV). There were no significant between-group
differences in the change in the PPT values.
The mean isometric neck strength in flexion, exten-
sion and rotation was significantly higher in the
endurance training group at the 12-month follow-up
The mean ROM in flexion-extension, lateral flexion
and rotation was significantly higher in both training
groups at the 12-month follow-up than baseline and
no significant change in the results for lateral flexion
and rotation were observed between the 12-month
and 3-year follow-ups (Table V). However, the ROM
was significantly reduced in the flexion-extension
direction in both training groups. There was no sta-
tistically discernible difference between 2 training
groups in ROM at the 3-year follow-up.
During the last month before the 3-year follow-up
specific neck exercises had been performed regular-

Vol. 43 - No. 2 EUROPA MEDICOPHYSICA 165

YLINEN NECK MUSCLE TRAINING IN THE TREATMENT OF CHRONIC NECK PAIN

TABLE IV.—Pain pressure thereshold measurement results (N/cm2) at baseline, after the 12-month training intervention and at the
3-year follow-up.
Time P value †
Variables
Baseline Months 12 3 years 12 months vs 3 years vs
Median (IQR) Median (IQR) Median (IQR) baseline 12 months

Endurance (n=41)
Sternum 34 (12) 37 (16) 47 (18) 0.274 <0.001
Trapezius middle:
right
left
Levator scapulae:

CA 31 (15)
32 (15)
48 (22)
48 (23)
52 (24)
55 (27)
<0.001
<0.001
0.207
0.011

I
right 49 (20) 73 (25) 84 (26) <0.001 0.001
left 51 (20) 76 (24) 85 (28) <0.001 0.005
Trapezius upper:

D
right 31 (14) 46 (17) 52 (19) <0.001 0.003
left 30 (13) 47 (18) 54 (20) <0.001 0.003

Strength (n=45)
Sternum
Trapezius middle:
E 32 (11) 37 (13) 43 (17) 0.008 0.004

M ®
right 28 (10) 45 (19) 49 (20) <0.001 0.151
left 29 (12) 45 (21) 51 (22) <0.001 0.016
Levator scapulae:
right 43 (13) 75 (25) 77 (27) <0.001 0.556

A
left 44 (15) 76 (26) 83 (26) <0.001 0.052
Trapezius upper:
right
left

V HT 28 (10)
27 (10)
49 (18)
49 (17)
53 (17)
53 (19)
<0.001
<0.001
0.132
0.037

R
†: repeated-measures analysis of variance with pairwise comparison; SD: standard deviation.

E IG
ly by 17% of women in the strength training group
and 25% in the endurance training group. Exercises for
There was no significant difference in pain and dis-
ability between the 2 training groups. The improve-

IN YR
shoulder muscles and upper extremities had been per-
formed by 27% and 32% and for trunk muscles by
37% and 33%. Stretching exercises had been performed
by 38% and 48%. About 40% of women in the strength
ments in pain and disability in both training groups
were not only statistically, but also clinically significant
compared to the baseline values.21 This suggests that

M P
the effects of the intervention had stabilized. The
training group and 35% in the endurance training improvement in the clinical measures was also main-
group reported, that they had done no exercises. tained, despite the fact that exercise compliance was

O
Three patients in the strength training group had found to be low.
been on sick leave up to 21 days and 4 in the endurance These findings differ from the results of previous
group an equal number of days due to neck pain dur-

C
ing the last year before the 3-year follow-up. Altogether
116 patients had been on sick leave for various other rea-
sons for a total of 1 650 days.
Discussion
The neck pain and disability indices, which had
significantly improved after the 1-year training inter-
vention, were found to be maintained at the 3-year fol-
low-up in both training groups.
randomized studies evaluating active training for
treatment of chronic neck pain, where no differ-
ence between the training and control group have
been found.4 However, some studies have shown
that active training may reduce neck pain at least in
the short-term. Levoska and Keinänen-Kiukaanniemi
compared passive physiotherapy and neck training
for 5 weeks.10 They found a significant reduction
in the occurrence of neck pain in the training group
after the intervention, but the effect was transitory
and, in most cases, pain had already returned by
the 3 and 12-month follow-ups. In the study by

166 EUROPA MEDICOPHYSICA June 2007

NECK MUSCLE TRAINING IN THE TREATMENT OF CHRONIC NECK PAIN YLINEN

TABLE V.—Maximal isometric neck strength and passive range of motion (ROM) at baseline, after the 12-month training interven-
tion and at the 3-year follow-up.
Time P value †
Variables
Baseline Months 12 3 years 12 months vs 3 years vs
Median (IQR) Median (IQR) Median (IQR) baseline 12 months

Endurance group (n=41)

Flexion, N 61 (20) 79 (23) 78 (17) < 0.001 0.989
Extension, N
Rotation, right, Nm
Rotation, left, Nm

CA 140 (31)
6.2 (1.5)
6.6 (1.5)
165 (29)
8.2 (1.8)
8,3 (1.7)
165 (22)
8.0 (1.5)
8.0 (1.5)
< 0.001
< 0.001
< 0.001
0.438
0.285
0.099

I
Strength group (n=45)
Flexion, N 49 (17) 105 (25) 89 (17) < 0.001 < 0.001
Extension, N 117 (42) 205 (28) 182 (26) < 0.001 < 0.001

Rotation, left, Nm

E D
Rotation, right, Nm

Endurance group (n=41)

Flexion-extension, °
5.7 (1.7)
6.2 (1.8)

129 (14)
11 (1.7)
10 (1.7)

137 (12)
9.4 (1.6)
9.2 (1.5)

132 (9)
< 0.001
< 0.001

< 0.001
< 0.001
< 0.001

0.001

M ®
Lateral flexion, ° 85 (10) 100 (13) 102 (17) < 0.001 0.162
Rotation, ° 161 (17) 167 (14) 167 (16) 0.001 0.797

Strength group (n=45)

A
Flexion – extension, ° 120 (16) 134 (10) 132 (9) < 0.001 0.045

Rotation

V HT
Lateral flexion, ° 82 (13)
157 (18)
100 (13)
170 (10)
99 (15)
167 (19)

†: repeated-measures analysis of variance with pairwise comparison; SD: standard deviation.

< 0.001
< 0.001
0.589
0.065

ER IG
Waling et al. neck pain decreased immediately after
a training period of 10 weeks, but no significant
stores essentially depend on protein metabolism.
Thus, most training studies seem to have been too

IN YR
differences were seen between training groups and
controls at the 8-month and 3-year follow-ups.11, 12
Taimela et al. found a significant reduction in neck
pain after a training period of 11 weeks.13 However,
short-term to produce notable physiological changes.
The present study establishes that a relatively small
training load is high enough to produce these changes,
as there was no significant difference between the

M P
there was no difference in pain between the train- strength and endurance training groups with regard to
ing group and controls at the 3 and 12-month fol- the primary outcomes.
low-ups. The conclusion that can be drawn from Although long-term training is commonly empha-

O
these previous studies is that the effects achieved sized in the rehabilitation of musculoskeletal disorders,
from short-term training for a few weeks or months aside from our study, the only long-term neck train-

C
do not produce long-lasting effects on chronic neck
pain.
Instead of short periods of rehabilitation, patients
should be motivated to continue training up to 12
months in order to gain long-term benefits. There are
sound training physiological grounds for doing this,
as short training periods lasting only a couple of
months, have been shown to lead to neural adapta-
tion only.22, 23 To influence the anabolic processes
leading to muscle hypertrophy, a longer-standing
training intervention is needed. Moreover, other impor-
tant processes like tissue regeneration and energy
ing intervention study to date is that by Viljanen et al.24
The training group performed dynamic muscle exer-
cises for the shoulders and upper extremities for 12
months. No significant changes were found in neck
pain and disability between the training and control
groups. Thus, the results appear to be contradictory
to those of our study.8 However, the study did not
include specific neck muscle exercises and Conley et
al. have shown that a strength training program that
does not include specific neck muscle exercises is
not effective in increasing neck muscle size and
strength.25

Vol. 43 - No. 2 EUROPA MEDICOPHYSICA 167

YLINEN NECK MUSCLE TRAINING IN THE TREATMENT OF CHRONIC NECK PAIN

PPT in the trapezius and levator scapulae mus-
cles, which had improved significantly in both train-
ing groups after the 1-year training intervention,
were found to have remained on the same level or
improved at the 3-year follow-up. While the change
was also found at the reference site on the sternum,
this may reflect a general rise in tolerance of pain
of neck exercise during the preceding month was
found to be low. Thus, habituation to the exercise
was not permanent. Due to the low training frequency
reported, the 3-year results are not thought to be the
result of regularly continued specific neck muscle
training, but rather to the earlier 12-month training
intervention. However, conclusions on training com-

A
rather than a muscle-training effect. Several previous pliance are not a straight-forward issue, as several
studies have found no significant change in PPT in patients reported that, although they did not perform
regular neck training, they were going to recommence

C
the trapezius and levator scapulae muscles after a
training intervention compared to the controls.9, 11, 13 it, if they felt neck symptoms. Thus, some patients

DI
These results suggest that a short training interven-
tion for only a couple of months is not sufficient to
raise PPT in hypersensitive tissues in patients with
chronic neck pain.
may have learned to manage their pain with inter-
mittent training.
Neck pain had been a major health problem
among the patients at entry into the study. However,

E
Subjects with chronic neck pain have proved to
have decreased neck strength compared to healthy
controls.26-28 Neck strength has also been shown to
at the 3-year follow-up only 6% of the patients had
been on sick leave owing to neck pain during the
previous year. These absences accounted for 2.5% of

M ®
correlate with improvement in neck pain and dis-
ability owing to it. 29 In the present study, neck
strength, which had improved in flexion by 28%,
the total number of sick leave days. This is in line
with our findings of low average neck pain and dis-
ability among patients who have participated in a

A T
rotation by 29% and extension by 16% at the 12-
month follow-up in the endurance training group,

V
remained on the same level at the 3-year follow-up.
one-year active rehabilitation program for chronic
neck pain. It would have been interesting to compare
these data with the data on sick leave before entry

H
In the strength training group the corresponding

R
parameters had improved by 110%, 76% and 69%

G
respectively, but were found to have declined by
to the study, but unfortunately this information was
not available.
Both strength and endurance training of the neck

E I
15%, 12% and 11% at the 3-year follow-up. Thus, muscles have been found to be effective treatments for
neck strength remained well above the baseline val- chronic neck pain in the randomized study, and the

IN YR
ues. Moreover, the neck strength values of the
endurance training group were on the same level
as the average for healthy women of the same age,
and in the strength training group these values were
results seem to be related to the specificity and inten-
sity of training as well as long-term training. The pre-
sent study suggests that a training period of 12-months
has long-term effects despite poor exercise compliance

M P
well above the average.30 thereafter. Thus, it seems that specific exercising of the
ROM had improved from 7% to 21% in the strength neck muscles does not need to be life-long to elimi-
training group and from 4% to 18% in the endurance nate symptoms of chronic neck pain.

O
training group at the 12-month follow-up and the
ROM had decreased only in the flexion-extension

C
direction at the 3-year follow-up. Thus, the improve-
ments achieved in ROM were largely maintained in
both groups.
A high-level of training compliance had been main-
tained during the 12-month intervention, as in both
training groups, according to their training diaries the
average training frequency was two times a week.
An intensive introduction at the beginning, keeping a
training diary and periodic follow-ups including
strength tests are assumed to be key factors in good
compliance. This was not maintained after the inter-
vention: at the 3-year follow-up the average frequency
Conclusions
In the present study, the decrease in pain and dis-
ability was found to remain at the 3-year follow-up.
Also, the functional improvements were sustained
despite the decline in training compliance after the first
year. Active neck muscle training can be recom-
mended for patients suffering from chronic nonspe-
cific neck pain, and the importance of maintaining
compliance up to one year should be emphasised,
but specific training is not necessarily a lifelong pro-
cedure to eradicate chronic neck pain.

168 EUROPA MEDICOPHYSICA June 2007

NECK MUSCLE TRAINING IN THE TREATMENT OF CHRONIC NECK PAIN
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