Welcome back to Spine IQ’s Back Blog! Last week we discussed how to incorporate walking programs to assist patients with low back pain in your practice. This week we will discuss how to incorporate exercise for patients with neck pain in your practice. Neck pain is often very difficult for patients to successfully manage and can severely interfere with activities of daily working and living. Clinical practice guidelines consistently recommend exercise as first-line treatment for neck pain, along with advice, reassurance and manual therapy combined with other treatments. (1) Exercise can be challenging for patients to incorporate into a regular routine for a number of reasons, including time constraints and low perceived-value by the patient. Education and discussion by you and/or your staff on the importance and value of exercise in reducing neck pain will be important to ensure compliance. Below is an easy to use and understand exercise program that has been tested in randomized controlled trials! (2,3) These can be given to your patient to guide them through a self-management program that can be done at home. Your staff can also be trained to help patients do this in your office or you can provide such guidance to your patients as a value-added service.
Intensity:
Option 1: These exercises should be incorporated using different resistance level Thera bands®. A guide to progress is to start with a band that allows the patient to complete 6 sets of 8 repetitions. Once the patient is able to do 6 sets of 12 repetitions, he or she can then progress to the next resistance level. Advice, reassurance and instruction delivered by you to the patient should include a reminder to contact your office if any they have any concerns after starting the program.
Option 2: Resistance exercises can be done to failure. The goal is to do as many repetitions as possible without pausing. In this option, the patient only has to do 1 set and this can usually be completed within 2 minutes. This is a time efficient, evidence based option for the busy patient. Patients should be encouraged to keep a record of the number of repetitions they complete each time as a way to track improvement and keep you informed regarding their progress.
Exercise options:
Lateral raise: Shoulder abduction can be performed unilaterally while standing on one end of the Thera band, the patient would raise the arm to shoulder height. Lateral raises can also be performed bilaterally while in the middle of the Thera band® with each end held in opposite hands. The patient would then perform shoulder abduction by raising both arms to shoulder height.
Shrugs: This exercise can be performed unilaterally by stepping on one end of the Thera band® and hold the other end in one hand. The patient would then perform a shrug by bringing shoulder towards the ear. Shrugs can also be performed bilaterally by standing in the middle of the Thera band® and holding each end in opposite hand. The patient then brings both shoulders towards the ear.
Chin tucks: The patient would wrap the Thera band® around their head at forehead level and hold one end of the Thera band in front of them at forehead level. The patient would then perform a chin tuck by bringing their chin towards their neck and retracting their head.
| Exercise | Dosage |
| Lateral raises | 5 times per week; intensity: 6 sets for 8-12 reps, once 6 sets for 12 reps can be completed then progress to higher resistance Thera band® OR 1 set of maximum reps that can be accomplished in 2 minutes |
| Shrugs | 5 times per week; intensity: 6 sets for 8-12 reps, once 6 sets for 12 reps can be completed then progress to higher resistance Thera band® OR 1 set of maximum reps that can be accomplished in 2 minutes |
| Chin tucks | 5 times per week; intensity: 6 sets for 8-12 reps, once 6 sets for 12 reps can be completed then progress to higher resistance Thera band® OR 1 set of maximum reps that can be accomplished in 2 minutes |
Conclusion:
This is a simple template that can be given as a home exercise program for self-management or be performed in office with supervision of you or any of your staff. Research has shown that doing as little as one exercise (lateral raises) for 1 set at max repetitions being performed in 2 minutes for 5 days a week (total: 10 minutes a week) is effective for reducing neck pain. Ideally, you will consider the patient preference and time constraints in order to help guide them to the best exercises and intensity for their neck pain. Exercise provides another opportunity for patient discussion during office visits. While being able to do a small amount of exercise is equally effective as more total exercises and time, it’s important to remember that these exercises count towards meeting physical activity recommendations of 150 minutes/week of moderate intensity exercise. Performing 3 exercises for 6 sets at 8-12 repetitions for 5 days a week will help the patient meet physical activity guidelines that bring secondary health benefits along with neck pain relief.
Stay tuned for next week when we dive into screening tools and outcome measures to consider incorporating in your practice!
References:
- Evidence‐based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines – Corp – 2021 – European Journal of Pain – Wiley Online Library [Internet]. [cited 2021 Jun 22]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1679
- Andersen LL, Saervoll CA, Mortensen OS, Poulsen OM, Hannerz H, Zebis MK. Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain. 2011 Feb;152(2):440–6.
- Zronek M, Sanker H, Newcomb J, Donaldson M. The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature. J Man Manip Ther. 2016 May;24(2):62–73.