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Benefits of strengthening not limited to back pain
While strengthening and endurance exercises have been shown to benefit workers with back pain, there has been a lack of medical literature addressing other areas of the body. Now, a new study published in the May 21, 2003, issue of JAMA indicates they may also benefit individuals with neck pain.
The study, titled "Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women," followed a total of 180 female office workers recruited from occupational health care systems in southern and eastern Finland.
"This is the first study I’ve seen that talks about strengthening and endurance for the neck," says Brad Friedland, DO, MPH, a specialist in occupational medicine practicing in Grand Rapids, MI. "I’ve become convinced that exercise strengthening and endurance are important not just for the back, but for the shoulder girdle and neck, and extreme areas where a lot of people are weak."
The women were randomly assigned to either two training groups or to a control group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Then both groups also did dynamic exercises for the shoulders and upper extremities with dumbbells, and were advised to do aerobic and stretching exercises three times a week.
At a 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group. Maximal isometric neck strength had improved by 110%, rotation by 75%, and extension by 69% in the strength-training group. The improvements in the endurance-training group were 28%, 29%, and 15%, respectively; and in the control group, 10%, 10% and 7%. Range of motion improvement also was statistically significant in both training groups.
Broader implications seen
While Friedland recognizes the study was done with a very specific group of employees, he sees broader implications for the findings. "This was a study of women office workers, but I think it’s applicable to other types of workers as well," he asserts.
And what about men? "There might be a more pronounced effect [in women], because until recently women had not done much strength training," he replies. "My sense is you would see similar benefits with a male population. So many jobs are automated that there is very little physical labor with most jobs today."
The problem, he says, stems not so much from repetitive motion, but from maintaining the same position and posture for a long period of time. "Anyone with a sedentary job is particularly at risk [for developing neck pain]," he says. "These workers need something to counteract that. Getting up and stretching periodically is helpful, but you need something more to build strength, to counter the fact that you are not otherwise using your body very much."
Friedland notes that self-care also played a role in the study’s results. "There was a home program component," he observes. "There will always be a dropout rate [with self-care] and some noncompliance, but I am very much in favor of people taking charge of their own lives."
Workers want that, too, he asserts. "I think most people want to learn the tools and use them themselves," he says. "The tools in the study are things people could do."
In his own practice, Friedland says he coaches patients to perform certain activities, and rarely sends them to a physical therapist. "How much would they spend on PT [physical therapy]? And will it solve the problem?" he poses. "Instead, I figure, why not show them how to do some things themselves?"
Friedland says this approach works for most people who do not have major physical problems. "But before this, I had not found a neck program. All I had seen before was isometrics," he says. "This program makes sense. They do it twice a week, and all they need are 2-kg dumbbells."
The program is a significant departure from the way neck pain is currently treated, says Friedland. "Typically, today, they send the patient to physical therapy and give them meds, and hope they get better," he observes. "If they don’t, there’s not much they can do for them."
To date, he says, the only exercise-related focus has been on stretching. "But you need to get people strong," he insists. "Neck pain seems to have been underappreciated in a world where cumulative trauma and ergonomics are dominant," he continues. "It’s a pretty common problem, but people often put up with it for a long time unless there’s a significant disc problem or something of that nature. They may be told they have arthritis, and they have to live with it.’ I just don’t think that’s true."
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