A randomized controlled trial on global postural re-education versus neck-specific exercise in women with chronic neck pain

Key points

1. 01GPR and neck-specific exercise produced equal reductions in pain (NPRS) and disability (NDI) with no between-group difference
2. 02Both groups improved cervical range of motion in all directions, with GPR showing slightly larger gains on average
3. 03Superficial cervical flexor muscle overactivity decreased similarly in both groups during the cranio-cervical flexion test
4. 04Neither intervention changed postural sway on any balance condition measured
5. 05All 50 participants completed the trial with no adverse events reported

How it was conducted

Design

Parallel-group, single-blinded randomized controlled trial

Participants

50 women aged 30-65 with chronic non-specific neck pain (duration at least 12 weeks, pain intensity >= 2 on NPRS)

Groups

GPR (N=25): global stretching postures with isometric contractions; Specific Exercise (SE, N=25): deep neck flexor motor control, axioscapular strengthening, and sensorimotor laser exercises

Dose

8 sessions of approximately 40 minutes, twice per week over 4 weeks, plus daily home exercises

Primary outcomes

Neck pain intensity (NPRS 0-10) and neck disability (Neck Disability Index, 0-50)

Secondary outcomes

Cervical range of motion (CROM device), postural sway (force platform), superficial neck flexor EMG during cranio-cervical flexion test (CCFT)

What they found

• Neck pain (NPRS) decreased significantly in both groups (main effect time: P<0.001, partial eta-squared=0.770); GPR reduced by 3.6 points and SE by 3.8 points on average; no between-group difference (P=0.534, partial eta-squared=0.001)
• Neck disability (NDI) decreased significantly in both groups (main effect time: P<0.001, partial eta-squared=0.306); both groups reduced by approximately 4.2-4.3 points; 11 participants per group improved by 5 or more points
• Cervical range of motion improved significantly in both groups for all directions (main effect time: P<0.001, 0.385<=partial eta-squared<=0.623); GPR increased ROM by 7.78 to 11.43 degrees and SE by 3.9 to 7.26 degrees; no between-group difference (P range 0.186-0.635)
• SCM and anterior scalene EMG amplitude decreased significantly in both groups across all CCFT stages (main effect time: P<0.0001, partial eta-squared=0.44 for SCM; P<0.0001, partial eta-squared=0.35 for anterior scalene); EMG amplitude decreased between 3.33% and 17.03% in GPR and between 4.38% and 14.97% in SE across CCFT stages
• A significant main group effect was detected for EMG amplitude (P<0.02, partial eta-squared<0.12), with the SE group showing higher absolute EMG amplitude than GPR across all CCFT stages
• Postural sway was unchanged by either intervention (main effect time: 0.064<P<0.201, 0.03<partial eta-squared<0.06 across all balance conditions)

Limitations

• No asymptomatic control group, so it is unclear whether participants had impaired balance at baseline or whether their balance was already normal
• Participants had only mild to moderate pain and disability, limiting generalizability to more severely affected patients
• Follow-up was limited to immediately post-intervention; long-term durability of effects is unknown
• Outcome measures captured only selected aspects of neuromuscular and sensorimotor control; other domains may differ between interventions

Why it matters

For patients

Women with chronic non-specific neck pain can expect similar short-term pain relief and improved neck movement whether they follow a GPR stretching program or a targeted neck exercise program.

For clinicians

Either GPR or neck-specific exercise can be selected based on patient preference, therapist expertise, or resource availability, as both produced clinically important changes in pain, disability, and cervical mobility after 4 weeks.

For readers

This trial is the first to directly compare GPR against an evidence-based neck-specific exercise program and to examine the effect of GPR on cervical flexor muscle coordination, providing useful comparative data for clinical decision-making.