Dott. Angaroni Martino [Alma Mater Studiorum, Bologna, Italy]
Prof. Romeo Antonio [Alma Mater Studiorum, Bologna, Italy]
Nonspecific neck pain is one of the most prevalent, disabling, and onerous musculoskeletal condition (1) so that it challenges both clinicians and sanitary systems. Exercise therapy is emerging among the multiplicity of treatment types, especially the motor control exercise for deep neck flexors, which are often defective and associated with neck pain (2). Nonetheless, the effectiveness compared to other treatments remains unclear.
The purpose of this work was to systematically review the scientific literature in order to evaluate the effectiveness of motor control exercise aimed at stabilizing neck muscles on pain intensity and disability in people suffering from idiopathic neck pain.
Six databases (Pubmed/MEDLINE, PEDro, CINAHL, Web of Science, Scopus, Sportdiscus) were searched from inception to April 2023. Only randomized controlled trials that studied use of therapeutic exercise in adults with nonspecific neck pain were included. Every type of comparison was admitted, also other categories of exercise. Then the selected studies were classified by exercise category. Two reviewers independently selected the studies; only one extracted the results. Data extraction was conducted only for neuromuscular training of deep neck flexors. The articles were qualitatively assessed based on the PEDro Scale.
Initially, 75 articles were included, of which 17 were about deep muscle training. The total number of subjects studied was 877, the majority of whom were female. Ten out of seventeen papers support the greater efficacy of craniocervical flexion compared to other treatments. Four studies found no significant differences from other rehabilitation programs. In only one study, exercise was less effective than manual therapy. Another study showed significant difference with the control group only for pain and not for disability. Nine studies were of moderate quality and eight were of good quality. The average at the PEDro scale was 6/10.
Consistent with other reviews (3), the results of this work support the use of therapeutic exercise aimed at the motor control of deep cervical flexor muscles, with or without biofeedback, to reduce pain intensity and disability in patients with nonspecific neck pain. Low-load craniocervical flexion exercise seems to be more effective than other types of intervention. Physioterapists should consider it within a multimodal-treatment approach. However, the superiority over some categories of exercise such as proprioceptive training or isotonic strengthening of superficial flexors remains uncertain. The review has several limitations: the small size of the total sample, the absence of high-quality studies, the presence of a single reviewer at some points of the process.
(1) Hoy D, March L, Woolf A, Blyth F, Brooks P, Smith E, et al. The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 1 luglio 2014;73(7):1309–15.
(2) Falla D, Farina D. Neuromuscular adaptation in experimental and clinical neck pain. J Electromyogr Kinesiol. 1 aprile 2008;18(2):255–61.
(3) Martin-Gomez C, Sestelo-Diaz R, Carrillo-Sanjuan V, Navarro-Santana MJ, Bardon-Romero J, Plaza-Manzano G. Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: A systematic review and meta-analysis. Musculoskelet Sci Pract. luglio 2019;42:52–9.
