Qigong, Exercise Therapy Effective for Long-Term, Nonspecific Neck Pain
From: Spine. 2007;32:2415-2422.
In the Western world, two thirds of the population have neck pain during their lifetime, which is a significant source of disability and healthcare costs. Physiotherapy for neck pain may include massage, nonspecific strengthening exercises, manipulative therapy, transcutaneous electric nerve stimulation, and heat therapy. Exercise therapy incorporates mobilizing exercises, stretching, and strength and endurance training to improve functional capacity, decrease pain, and educate patients on pain mechanisms.
Qigong is a Chinese therapy involving slow movements, breathing exercises, and meditation aimed at maintain or restoring balance and harmony of mind and body. The efficacy of qigong in neck pain has not been scientifically tested. The objective of this study was to compare the effectiveness of qigong and exercise therapy in patients with long-term neck pain.
Qigong and exercise for neck pain notes
- Improvement in neck pain was significant (> 50%) in both groups (qigong or exercise therapy) immediately after treatment, and this was maintained at 6- and 12-month follow-ups in 5 of 8 outcome variables.
- No apparent between-group differences at any time point were detected on any outcome measure with qigong vs exercise therapy.
Qigong and exercise for neck pain highlights
- Between 2001 and 2004, 122 patients with long-term, nonspecific neck pain were randomized to receive qigong (n = 60) or exercise therapy (n = 62).
- During a period of 3 months, patients received a maximum of 12 treatments, 1 to 2 times per week, each lasting approximately 1 hour.
- Inclusion criteria were 18 to 65 years of age; nonspecific, long-term (> 3 months) neck pain; and average neck pain the week before screening of 20 mm or more on a visual analog scale (0 = no pain to 100 = unbearable pain).
- Exclusion criteria were chronic tension-type headache, migraine, traumatic neck injury, neurologic findings, rheumatic diseases, fibromyalgia or other severe physical diseases, and treatment with antidepressive and anti-inflammatory drugs.
- Mean age was 44 years; 70% were women. At baseline, both treatment groups had similar clinical and demographic characteristics.
- Qigong was conducted in groups of 10 to 15 participants. Each session started with information about the philosophy of medical qigong, followed by 14 selected qigong exercises (general warming up, soft movements for the whole body, specific slow-movement sequences combined with breathing techniques, and deep concentration [meditation]).
- Each patient’s exercise therapy was individually adjusted, with resistance of 30% to 70% of maximum voluntary capacity. Each exercise was performed for 1 to 3 sets of 10 to 30 repetitions, with the amount of resistance and number of repetitions started at a pain-free level and gradually increased. Exercises included warming up on an ergometer-bicycle for 10 minutes, followed by active cervical, shoulder, and thoracic movements, then different exercises to maintain and increase circulation, endurance, and strength.
- Frequency and intensity of neck pain, neck disability, grip strength, and cervical range of motion were assessed before and immediately after treatment and at 6 and 12 months after the treatment period was completed. Outcome measures were characterized either as improved or as unchanged/deteriorated.
- Improvement was significant (> 50%) in both groups immediately after treatment, and this was maintained at 6- and 12-month follow-ups in 5 of 8 outcome variables: average neck pain in the most recent week, current neck pain (except for immediately after treatment), neck pain diary, neck disability, and cervical range of motion in rotation.
- No statistical improvement of more than 50% was observed in pain frequency, grip strength, and cervical range of motion in flexion-extension.
- No apparent between-group differences at any time point were detected on any outcome measure with qigong vs exercise therapy (neck pain frequency, average neck pain in the most recent week, current neck pain, neck pain diary, neck disability, grip strength, and cervical range of motion in flexion-extension).
- Limitations of the study include underpowered study design caused by too few patients in the intent-to-treat analysis or by dichotomization of data, lack of a precise diagnosis contributing to a misclassification bias, lack of a nontreated control group, and lack of blinding.
- Based on these findings, the investigators concluded that treatments including supervised qigong or exercise therapy resulting in reduced pain and disability could be recommended for patients with long-term, nonspecific neck pain and that patients should be given a choice of treatment approaches encouraging self-management.