Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis

Key points

1. 01Prevention here means stopping a first or recurrent episode in people who are currently free of neck pain, which is different from treating existing pain.
2. 02Pooled exercise programs reduced the odds of a new neck pain episode by about two-thirds (OR 0.32), equating to roughly a 53% relative risk reduction when re-expressed as risk ratio.
3. 03Ergonomic programs (workstation redesign, equipment changes) did not reduce neck pain risk (OR 1.00).
4. 04Evidence quality was moderate for exercise and low for ergonomics, and the exercise estimate comes from only two trials totaling 500 participants.
5. 05Exercise programs were long (9 and 12 months) and no trial reported beyond 12 months, so durability is unknown.

How it was conducted

Design

Systematic review and meta-analysis of RCTs (PROSPERO CRD42017055174), GRADE certainty rating

Search

Five databases to April 2018; 12,725 records screened, 5 trials included (3,852 participants), all in working-age office or nursing populations

Intervention

Exercise programs (neck stretching and endurance, or a generalised aerobic program) and ergonomic programs, versus no, sham, or minimal intervention

Outcomes

New episode of neck pain over follow-up (all 12 months or less), pooled as odds ratios

Analysis

Random-effects meta-analysis (Comprehensive Meta-analysis), risk of bias via PEDro scale (mean 6.2)

What they found

• Exercise programs (2 trials, 500 participants): OR 0.32 (95% CI 0.12 to 0.86), moderate-quality evidence, downgraded once for imprecision.
• Re-expressed as risk ratio, exercise reduced the risk of a new neck pain episode by 53% (RR 0.47, 95% CI 0.32 to 0.68).
• Ergonomic programs (3 trials, 3,352 participants): OR 1.00 (95% CI 0.74 to 1.35), low-quality evidence, no protective effect.
• Mean PEDro score 6.2 (SD 1.3), with blinding, concealed allocation, and adequate follow-up the weakest items.

Limitations

• Only five trials were eligible, and the exercise conclusion rests on just two of them.
• One of the two exercise trials added health information, stress management, and a workplace assessment, so the effect of exercise alone is uncertain.
• Almost all trials were in office workers, limiting generalisability to other populations.
• No outcomes extended beyond 12 months, so the long-term preventive effect is unknown.

Why it matters

For patients

Doing a regular neck or general exercise program when you are pain-free may meaningfully lower your chance of a future neck pain episode.

For clinicians

Offer exercise rather than ergonomic equipment changes for neck pain prevention, while noting the evidence is based on few trials and one mixed intervention.

For readers

Exercise looks promising for preventing new neck pain, but ergonomic workplace programs do not, and more long-term trials are needed.