Exercise therapy for office workers with nonspecific neck pain: a systematic review.
From: J Manipulative Physiol Ther. 2011 Jan;34(1):62-71.
Normal neck function underpins successful performance of activities of daily living. In the general population, neck pain and dysfunction are common, affecting up to 67% of the general population at some time during their life.
Neck pain may arise from any of the innervated structures in the neck, such as intervertebral discs, muscles, ligaments, zygapophyseal joints, dura or nerve roots. However in the majority of cases, the pathophysiological mechanisms underlying neck pain are unclear. Such “nonspecific” neck problems are costly in terms of disability and work loss. Estimates indicate that the economic consequences of treating disabling chronic neck pain are significant.
Physical risk factors (such as prolonged sitting and neck flexion) have been identified as predictive of neck pain in the study of a mixed population of workers from various industry, health and professional settings.
We know that sitting at work for more than 95% of the working time seems to be a risk factor for neck pain and there is a trend for a positive relation between neck flexion and neck pain. There is an increased risk of neck pain
for people who are working with the neck flexed more than 20° for a major part of their working day. A low endurance time of the neck muscles seems to play an important part in the development of neck pain due to neck flexion at work.
Exercise interventions are deemed essential for the effective management of patients with neck pain. Patients with chronic neck pain demonstrate reduced motion and altered patterns of muscle control in the cervical flexor and upper trapezius muscles during specific tasks.
The purpose of this study in JMPT was to evaluate the effectiveness of various types of exercise for prevention and cure of nonspecific neck pain in office workers.
Publications between 1980 and April 2010 were systematically searched in various databases (PubMed, CINAHL Plus with full text, The Cochrane Library, Science Direct, PEDro, ProQuest, PsycNet, and Scopus). The following key words were used: neck pain, cervical pain, exercise, strengthening, stretching, endurance, office workers, visual display unit, visual display terminal, and computer users. A hand search of relevant journals was also carried out. Relevant randomized controlled trials were retrieved and assessed for methodological quality by 2 independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results.
Nine randomized controlled trials were included in this review, of which 6 were rated as high-quality studies. No exercise type was identified as being effective in the prevention of nonspecific neck pain in office workers. Strong evidence was found for the effectiveness of muscle strengthening and endurance exercises in treating neck pain. Moderate evidence supported the use of muscle endurance exercise in reducing disability attributed to neck pain.
Literature investigating the efficacy of exercise in office workers with nonspecific neck pain was heterogeneous. Within the limitations, for treatment of neck pain, either muscle strengthening or endurance exercise is recommended, whereas for reduction of pain-related disability, muscle endurance exercise is suggested. Further research is needed before any firm conclusions regarding the most effective exercise programs for office workers can be reached.
Prevention of neck pain should focus on the reduction of time spent working in a sitting position and the promotion of more dynamic working postures. Evidence of altered coordination between the deep and superficial neck muscles, greater neck muscle fatigue under sustained low loads, and deficits in kinaesthetic sense have been identified in symptomatic individuals. There is evidence to indicate that addressing these muscle control problems, with specific gentle exercise strategies, results in a reduction in neck pain and associated symptoms.