Associations of neck muscle strength and cervical spine mobility with future neck pain and disability: a prospective 16-year study

Key points

1. 01All regression Beta coefficients for neck strength and mobility were below 0.1, indicating no meaningful association with future neck disability.
2. 0234% of responders reported no neck pain, 63% occasional pain, and only 3% chronic neck pain over 16 years.
3. 03Mean Neck Disability Index scores were 3.3 (no pain), 7.7 (occasional pain), and 19.6 (chronic pain) - the chronic group was significantly worse than the others.
4. 04No statistically significant between-group differences were found for extension strength (p=0.19), flexion strength (p=0.63), rotation strength (p=0.18), or any plane of cervical mobility.
5. 05Other factors such as psychosocial stress, sedentary behaviour, job strain, and BMI may be more relevant predictors of future neck pain than physical capacity measures.

How it was conducted

Design

Prospective cohort study with 16-year follow-up

Participants

220 healthy women aged 20-59 (mean age 40, SD 12 years) with no neck pain in the preceding 6 months at baseline

Baseline measurements

Maximal isometric neck muscle strength (flexion, extension, rotation) and passive cervical range of motion (sagittal, horizontal, frontal planes) measured 2000-2002

Follow-up outcome

Neck Disability Index (NDI, 0-100%) and self-reported neck pain category (none, occasional, chronic) via postal survey 16 years later

Analysis

Multiple linear regression adjusted for age and BMI; standardized Beta coefficients used to quantify associations

What they found

• Beta coefficients for all neck strength and PROM predictors remained below 0.1 (threshold for even a small effect) in the adjusted regression models.
• 149 of 220 subjects (68%) returned the 16-year follow-up questionnaire; 50 (34%) reported no pain, 94 (63%) occasional pain, 5 (3%) chronic pain.
• Mean NDI was 3.3 (SD 3.8) in the no pain group, 7.7 (SD 7.1) in the occasional pain group, and 19.6 (SD 22.0) in the chronic pain group.
• The chronic pain group had a significantly higher NDI than the no pain group (mean difference 16.3, 95% CI 8.4 to 24.2) and the occasional group (mean difference 11.9, 95% CI 4.2 to 19.7).
• Extension strength: 198 N (95% CI 190-205) in no pain group vs 190 N (95% CI 183-196) in pain group, p=0.19.
• Flexion strength: 74 N (95% CI 69-79) in no pain group vs 74 N (95% CI 70-78) in pain group, p=0.63.
• Rotation strength: 8.3 Nm (95% CI 7.7-8.9) in no pain group vs 7.8 Nm (95% CI 7.4-8.2) in pain group, p=0.18.
• Cervical mobility in sagittal, horizontal, and frontal planes did not differ significantly between groups (p=0.18, p=0.85, p=0.81 respectively).

Limitations

• The chronic neck pain group contained only 5 subjects, making it too small for subgroup regression analysis.
• The study included only women, limiting generalizability to men.
• No information was collected on exercise habits or other lifestyle changes during the 16-year follow-up period.
• The wide baseline age range (20-59 years) means participants were at different stages of life-course risk, and the effect of ageing on neck strength and pain could not be fully isolated.

Why it matters

For patients

Having normal or even below-average neck strength and flexibility at one point in life does not reliably predict whether you will develop neck pain decades later, so these measures alone are not useful warning signs.

For clinicians

Routine screening of asymptomatic patients for reduced neck muscle strength or cervical range of motion is not supported as a preventive strategy; broader assessment including psychosocial and work-related factors is warranted.

For readers

This long-term cohort study challenges the assumption that physical capacity of the neck determines future pain risk, pointing instead toward multifactorial models that include psychosocial and occupational contributors.