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To stretch or to strengthen? Exercises for whiplash, neck pain and neck pain that involves headaches.

At a glance:
Exercises are a beneficial component of treatment for neck pain, including neck pain that involves headaches, or that is caused by whiplash. The type of exercise that should be used depends on the type of neck pain.

A combination of stretching and strengthening, when used alongside other treatments such as manipulation, seems to produce the best effects for mechanical neck pain (with or without headaches). Exercises that improve co-ordination and balance may be useful in whiplash and neck pain that involves headaches.

 
Perspectives:
Employee
Exercises are a beneficial treatment for neck pain, including pain that involves headaches or is caused by whiplash. Stretching and strengthening the neck, in conjunction with other treatments, reduces pain and improves function in the short and long term.

A strong and flexible neck is less likely to get injured again. A healthy neck – along with the rest of the body – can be achieved through regular exercise. The normal activities you do every day will also use your neck muscles, so you can improve your neck health simply by being as active as possible, and by doing specific neck exercises.

This is especially important to remember after a bout of pain or an injury. Although it is natural to be worried about causing more damage, most activities are safe and beneficial. Advice to stay active has been shown to be more effective than neck collars, rest or pain-killers in treating short-term neck problems. Feeling anxious and avoiding activities is likely to increase pain and delay recovery.

Set your mind at rest by asking your doctor which activities are best for you, and checking if any particular activities should be avoided. Be aware that in the past, doctors used to prescribe rest for neck pain, and some doctors might not be aware that more up-to-date treatment guidelines advise against it. You might like to take this article (or others from the site) in with you to discuss.
Employer
Neck exercises can help employees with neck pain to improve their symptoms and neck function. Recommending stretching breaks and providing opportunities for general physical exercise is likely to reduce the problems associated with neck pain – along with improving general health and reducing sick leave.

 
Treater
This review concluded that neck exercises can assist treatment of neck pain, including pain caused by whiplash or involving headaches. A combination of stretching and strengthening, along with manipulation and other therapy, seems to be most effective for mechanical pain. Proprioceptive
Proprioceptive
Describes the body sensing the position of a joint or limb through special nerves that are located in joints and muscles.
 exercises to improve coordination reduce symptoms of whiplash and neck pain with headaches.

Physical activity and return to normal activities is the first-line treatment for acute
acute
A condition develops quickly and is often of short duration. The opposite of acute is chronic, which refers to a long term problem continuing for months to years.
 neck pain. Patients are more likely to be compliant with instructions to be active if they understand the benefits and are reassured that it will not cause harm. Specific, personal advice is likely to be more successful than generalised, written information.
Insurer
Neck exercises, as part of an overall treatment for neck pain, are likely to reduce patient's pain and improve their function. Encouraging employers to provide opportunities for stretching breaks and general physical exercise is likely to improve the problems associated with neck pain, along with general health.

Staying active is the best prevention, as well as the best treatment, for acute neck pain (not to mention a host of other conditions). Exercise can seem difficult, especially at the beginning. Not all clients will feel they have the time, money, facilities or confidence. What can you do to help them?
Original Article, Authors & Publication Details:
T. Kay1, A. Gross, C. Goldsmith, P. L. Santaguida, J. Hoving, G. Bronfort (2005).

Exercises for mechanical neck disorders. Cochrane Database
database
Store of information (e.g. published research articles). Information can be retrieved by searching (e.g. for key words, authors, or titles).
 of Systematic Reviews(3): CD004250.

1Physiotherapy Services, CG 13b, Sunnybrook & Women's College Health Sciences Centre, 2075 Bayview Avenue, North York, ON, Canada, M3N 3M5.
 
Background, Study Objectives, How It Was Done:
Neck disorders are common. They cause pain, disruption of daily life and considerable cost to individuals and to society. Most people only experience minor difficulties, but 5% are significantly disabled.

Exercise therapy is often used to treat neck disorders. Previous research has shown that active therapies are more effective than passive ones. Advice to stay active has been shown to be more effective than neck collars, rest or pain-killers in treating short-term neck problems, and exercises reduce pain more than spinal manipulation.

This review of 31 randomised controlled trials
randomised controlled trial
A research study that groups participants into "treatment" and "control" groups. The treatment group is given an intervention
intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 while the control group is not. Outcomes for the groups are compared to see the difference made by the intervention. This ensures that the study results are valid and not influenced by another factor. Example: In a randomised controlled trial of treating back pain with anti-inflammatory tablets 60% of people improved over two weeks. However, if 60% of the control group who were given a placebo
placebo
A substance containing no active drug, administered as a control to a patient participating in a research study. Using a placebo helps researchers assess whether the treatment under study is actually responsible for any improvement or worsening of the problem.
 also improved over two weeks the results indicate the tablets did not help overall. It is important participants to be given the medication are chosen randomly. If there was a reason for putting those people in that group, such as worse pain, it might alter the results.
 investigated the effectiveness of neck exercises in treating:

Mechanical neck pain (pain that's influenced by movement or posture)

Neck pain that involves headaches

Neck pain that was caused by whiplash (with or without headaches).
 
Pain was classified as acute (lasting less than 4 weeks), subacute (lasting 4-12 weeks) or chronic
chronic
continuing a long time or recurring frequently
 (lasting 3 months or more).
Study Findings:
A combination of stretching and strengthening exercises:

There is strong evidence that stretching and strengthening exercises combined with mobilisation or manipulation therapy improve pain and function. This treatment was found to be effective for patients with medium or long-term mechanical neck pain and neck pain that involves headaches.

Also, stretching and strengthening exercises alone may improve pain for chronic mechanical pain and chronic pain that involves headaches.

The benefits of stretching and strengthening were seen in the short and long term.

Strengthening exercises alone:
Strength exercises involve resistance. They include isometric
Isometric
Isometric exercise or "isometrics" is a type of strength training in which the joint angle and muscle length do not change during contraction. Isometrics are done in a static position. The joint and muscle are either worked against an immovable force or are held in a static position while opposed by resistance.
 exercises, exercises using weights or machines and low-load endurance exercises. These exercises seem to be less effective when they are not combined with stretching. They may reduce pain and improve function for patients with chronic neck disorders that involve headaches. Exercises that focus on the neck might be more effective than those focusing on the shoulders or upper back.

Active range of motion exercises:
These exercises involve moving the neck without resistance, e.g. gentle movements and stretches. This kind of exercise may reduce pain in acute whiplash-related neck pain.

Eye-fixation and proprioception exercises:

This treatment aims to improve co-ordination and reflexes. When combined with other treatments, the exercises may improve pain and function for patients with whiplash related neck pain or neck pain that involves headaches. In whiplash patients, the exercises were useful for those whose pain has persisted for up to 12 weeks, and the benefits remained in the long-term.

Exercises at home:

Mobilisation combined with exercises done at home reduced pain more than resting early on. Individual instructions for home exercises seemed to be more effective than written information.

Side-effects:

In 5 of the 31 trials, some participants reported side-effects to doing their exercises. These symptoms were mild and did not last long. They included headaches, worsening of symptoms, pins and needles and dizziness.
 
Conclusions:
When it comes to neck pain, previous research has shown that activity is a much better treatment than rest. Neck exercises are a beneficial part of treatment for both acute and chronic neck pain, including neck pain that involves headaches or is caused by whiplash. Exercises can reduce pain and improve function. The specific type of exercise that should be chosen might depend on the neck condition.

Neck exercises for mechanical neck pain (with or without headaches) appear to be most effective when they include both stretching and strengthening exercises and are combined with other treatments. Proprioception exercises to improve co-ordination improve symptoms in whiplash-related disorders and neck pain that involves headaches.

Neck exercises sometimes produce side-effects, but these are minor and do not last long.
 
References:
PubMed Abstract

 
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