Exercises for Mechanical Neck Disorders

Clinical Question

How effective is exercise therapy for mechanical neck pain?

Evidence-Based Answer

There is some evidence that a variety of exercises help patients with mechanical neck pain. Evidence is strongest for a multimodal approach that includes exercise and mobilization or manipulation of the cervical spine, although this research has been criticized for having an imperfect control group.

Practice Pointers

Mechanical neck pain is caused by a variety of injuries and disease processes, including whiplash, myofascial neck pain, and degenerative cervical spine disease. Kay and colleagues reviewed the literature for randomized and quasi-randomized clinical trials on treatments for neck pain. Most studies (24) were of mechanical neck pain alone. The researchers also found one study of mechanical neck pain with some radicular signs, three studies of headache of cervical origin, and three involving a mixed group of patients with neck pain and neck disorder associated with headache or radicular symptoms. Studies were of fair quality. Although an earlier version of this systematic review was inconclusive, subsequent systematic reviews by other groups have found a benefit with exercise.

The authors found limited evidence of benefit for mechanical neck pain with a variety of types of exercise activity: active range-of-motion exercises without resistance, stretching and strengthening exercises, strengthening exercises alone, and eye-fixation exercises to improve proprioception. The strongest evidence, from four studies, was found for a multimodal approach that included exercise and mobilization or manipulation of the cervical spine (number needed to treat = 4 to 5).

The Philadelphia Panel, a panel of physicians and methodologic experts from the United States and Canada, developed an evidence-based guideline for the treatment of musculoskeletal disorders.¹ According to this guideline, there is good evidence (grade A for pain and function, grade B for patient global assessment) to include supervised exercise programs alone, including proprioceptive and traditional exercises, for the management of chronic neck pain (i.e., lasting longer than 12 weeks).¹ The Philadelphia Panel does not endorse manual therapy (i.e., cervical mobilization or manipulation) because the control group did not receive sham manual therapy.