Introduction
Methods
Eligibility criteria
Patients
Intervention
Comparator
Outcome
Database search
Overlap
Assessment of the methodological quality of the included reviews
Data extraction and synthesis
Assessment of the certainty of the evidence
Results
Search results
Study characteristics
Motor Control exercises (inclusive Pillar exercises) | |||
Authors (year) | Population Number of subjects, Chronic Neck Pain definition, pain duration, sex, age | Intervention Description, Training period | Control Description, Training period |
Ferro Moura Franco, et al. (2021) [42] | Number of subjects: 182 Definition: Chronic idiopathic neck pain Duration: ≥ 12 wks % Women: 73% Age: Mean 38 yrs | Description: Motor Control Exercises Training period: 4–12 wks. 2–3 sessions/wk. 20–40 min/session | Description: Muscle strengthening/muscle endurance training Training period: 4–12 wks |
Garzonio, et al. (2022) [21] | Number of subjects: 717 Definition: Chronic nonspecific neck pain Duration: ≥ 3 mo to 1 yr % Women: Between 40–100% Age: Mean 32 yrs | Description: Motor Control Exercises Training period: Varied from 4–12 wks; 1–7 times/wk | Description: Active exercises (e.g., aerobic, high load, conventional), other types of physical intervention (e.g., physical therapies, manual therapy, education, and pharmacological or surgical treatments, or passive treatment, e.g., placebo or waiting list, multimodal conventional treatments Training period: 4–12 wks, 1–7 times/wk |
Hanney, et al. (2010) [43] | Number of subjects: 132 Definition: Adults with neck pain Duration: > 3 mo % Women: NR (1 study only women) Age: 18–70 yrs | Description: Motor Control Exercises Training period: 1–7 wks, 1–2 sessions/wk. Home exercises 30 min/session | Description: Muscle strengthening/muscle endurance training or non-specific strengthening training Training period: 4–7 wks |
Martin-Gomez, et al. (2019) [44] | Number of subjects: 423 Definition: Adults with non-specific neck chronic neck pain Duration: ≥ 3 mo % Women: NR: (4 studies only women) Age: NR | Description: Motor Control Exercises through craniocervical flexion with pressure bio-feed-back unit Training period: 1–10 wks, 1–3 sessions/wk, 30–45 min/session | Description: Strengthening exercises neck flexors, proprioception exercises, active range of motion exercises, passive mobilization, wait and see Training period: NR |
Mueller et al. (2023) [45] | Number of subjects: 1166 Definition: Chronic non-specific neck pain or neck pain Duration: ≥ 12 wks % Women: 62% (18 studies), in 3 studies NR Age: Mean 36 yrs | Description: Motor control exercise aimed to increase the control and coordination of deep cervical musculature or increase the proprioceptive control of head and neck movements Training period: The intervention period ranged between 1 and 24 weeks. Training frequency ranged from 2 to 14 sessions per week with 5–50 min/session | Description: Strength training, home exercises/digital video instructions, postural corrections, and lectures on promoting general health Training period: Same as the intervention group |
Price, et al. (2020) [26] Motor Control Exercises | Number of subjects: 485 Definition: Non-specific neck pain Duration: > 3 mo % Women: NR (2 studies), range 40–100% (8 studies) Age: Mean (range) 38 (20–45) yrs | Description: Motor Control Exercises through craniocervical flexion with/without pressure biofeedback unit Training period: 1–12 wks, 1–7 sessions/wk | Description: Endurance training, pillar exercises active range of motion exercises, passive mobilization Training period: 1–12 weeks, 1–7 sessions/wk |
Price, et al. (2020) [26] Pillar Exercises | Number of subjects: 263 Definition: Non-specific neck pain Duration: > 3 mo % Women: one study only female, one study 89% Age: Mean (range) 38 (25–51) yrs | Description: Pillar Exercises are intended to develop the ability of the spine to maintain a neutral position. Cervical isometric flexion/ extension/ rotation/ lateral flexion using the hand as resistance/ pulley system/ resistance bands; Cervical isometric flexion against gravity in sitting Training period: 4–8 wks, 2–7 sessions/wk | Description: Education, Motor Control Exercises, usual care Training period: 6 wks, 3 sessions/wk |
Tsiringakis, et al. (2020) [46] | Number of subjects: 730 Definition: Chronic neck pain Duration: > 3 mo % Women: 42% (4 studies only women) Age: Mean 36 yrs | Description: Motor Control Exercises with pressure biofeedback unit Training period: 4–12 wks | Description: At least one of the control groups received no further intervention, a placebo intervention or another passive or active intervention without a pressure feedback device Training period: 4–12 wks |
Villanueva-Ruiz, et al. (2022) [47] | Number of subjects: 468 Definition: Nonspecific neck pain Duration: ≥ 3 mo % Women: 63% Age: Mean 36 yrs | Description: Specific neck exercises (CFF) targeting deep cervical flexors and extensors with slow and controlled CCF using biofeedback unit Training period: ≥ 4 wks ≥ 6 mo, 30–45 min/session | Description: Alternative exercise intervention used strengthening, and/or endurance exercises as a sole exercise intervention Training period: ≥ 4 wks < 6 mo |
Pilates | |||
Authors (year) | Population Number of subjects, Chronic Neck Pain definition, pain duration, sex, age | Intervention Description, Training period | Control Description, Training period |
Martini et al. (2022) [23] | Number of subjects: 224 Definition: Neck pain with or without radicular symptoms Duration: 3 studies > 3mo, 1 study NR % Women: 82% Age: Range 23–61 yrs | Description: Different interventions based on the Pilates method using a Pilates mat and/or Pilates devices. One study reported supervised exercises and the other N.R Training period: 1–3 sessions/wk, for 8–12 wks | Description: Yoga, isometric exercises, motor control exercises and standard pharmacological treatment Training period: No intervention at all up to 8–10 weeks |
Resistance training | |||
Authors (year) | Population Number of subjects, Chronic Neck Pain definition, pain duration, sex, age | Intervention Description, Training period | Control Description, Training period |
Bertozzi, et al. (2013) [48] | Number of subjects: 1063 Definition: Chronic non-specific neck pain incl. trapezius myalgia Duration: > 3 mo % Women: 90% Age: Mean (Range) 39 (29–45) yrs | Description: Therapeutic exercise performed at home or the gym, including warm-ups, isometric and dynamic strengthening, coordination, stretching, deep neck muscle activation, and postural exercise, targeting muscles of the neck, shoulder, and upper extremities Training period: 1–28 sessions/wk for 10–60 min, for 2–52 wks (12–156 sessions in total) | Description: No intervention, partially including education or counseling, stretching, with medication as usual Training period: No intervention at all up to 3 sessions/wk for 52 wks |
Cheng, et al. (2015) [49] | Number of subjects: 876 Definition: Chronic non-specific neck pain incl. upper-trapezius pain Duration: > 3 mo % Women: NR Age: Mean 37.9—45.6 yrs | Description: Exercise training for muscle strength and endurance for neck and shoulder including elastic bands and dumbbells, combined with traction and whole-body exercises, partially including relaxation and coordination Training period: 2–3 sessions/wk for 45–60 min, for 10–12 wks (short-term) and 1 yr (long-term) | Description: Not engaging in any exercise intervention, partially including stretching, education, and stress management Training period: No intervention at all or 1–3 sessions/wk for 20–120 min, for 10 wks—1 yr |
Louw, et al. (2017) [50] | Number of subjects: 2075 Definition: Neck pain Duration: 3 mo (6 studies) to 6 mo (2 studies) % Woman: 77% Age: Mean 34.2 to 49 yrs | Description: Different types of progressive dynamic resistance exercises for neck and shoulder muscles Training period: 3–9 sessions/wk for 7–30 min, for 10 wks to 12 mo | Description: Health promotion activities (ergonomics, stress management, information to maintain regular physical activities, stretching, aerobic exercise) or no exercise Training period: NR |
Mueller et al. (2023) [45] | Number of subjects: 1958 Definition: Chronic non-specific neck pain or neck pain Duration: > 3 mo (20 studies) NR (1 study), non-traumatic (1 study), and NP intensity ≥ 3 (0–9 scale) last month (1 study) % Woman: 80% (20 studies). In 3 studies NR Age: Mean 36.4 (SD 7.1) yrs and in 1 study NR | Description: Exercises that aim to increase the strength, power, or endurance of the cervical- and scapula musculature Training period: 1–7 sessions/wk for 7–60 min (in 6 studies NR), for 4 to 12 wks (17 studies), 14 sessions twice/day for 10–20 min for 6 wks (1 study), 14 sessions for 10–25 min during 6 wks (2 studies), every day for 25–30 min for 12 wks (1 study), session/wk NR (2 studies) | Description: Different activities (ergonomics, information to maintain regular physical activities, home exercises with digital video instructions) waiting list, exercise and spinal manipulation, craniocervical flexion training, deep cervical flexion training, scapula training, neck- and scapula stabilization training or not described Training period: Same as for the intervention group |
Ouellet, et al. (2021) [51] | Number of subjects: 209 Definition: Persistent or chronic neck pain Duration: > 30 days (2 studies), > 12 wks (2 studies), > 6 mo (1 study) % Women: In 3 studies only women (27%) in 2 not reported Age: Mean age between 41–52 yrs (4 studies) and 76 yrs (1 study) | Description: Region-specific exercises: Specific supervised strength training for neck and shoulders (1 study) Strengthening of neck and Core, Proprioceptive exercises, Dynamic mobilization (1 study) Specific resisted exercises aimed at the neck/shoulder region (1 study) Standardized program including active movements, strengthening, and flexibility exercises (1 study) Training period: 10–12 wks | Description: General exercises: Aerobic; Monark bicycle ergometer (1 study), Tai Chi (1 study), Aerobic; Supervised walking program (1 study), Qigong (1 study) Training period: 10–12 wks |
Seo, et al. (2020) [52] | Number of subjects: 122 Definition: Chronic pain in the cervical and shoulder region Duration: 3–6 mo % Women: NR Age: NR | Description: Scapular stabilization exercises are most often implemented as strengthening exercises targeting the trapezius and serratus anterior muscles. The exercise types were varied substantially Training period: 3–7 sessions/wk for 20–30 min, for 4–10 wks (12–42 sessions in total) | Description: NR Training period: NR |
Price, et al. (2020) [26] Resistance Training (2 studies) | Number of subjects: 186 Definition: Non-specific neck pain excluding specific pathologies Duration: ≥ 3 mo % Women: NR Age: 18–70 yrs | Description: Upper limb Resistance Exercises (ULRE) such as triceps and shoulder press, biceps curls, pullovers, overhead and chest press, punches, rotations Training period: 3 sessions/wk with 2 or 3 sets of 12 repetitions, for 6–10 wks | Description: No treatment or education and stress reduction Training period: 1 session/wk for 10 wks |
Yang, et al. (2022) [53] | Number of subjects: 1891 Definition: Chronic Duration: ≥ 3 mo % Women: NR Age: mean age ranged between 16–58 yrs | Description: Isometric training refers to increasing muscle tension to fight against a fixed resistance exercise Training period: 2–8 wks; 6–24 sessions | Description: non-isometric exercises or no training intervention: neuroregulations, exercise therapy, lectures, conventional therapy, TCM therapy Training period: 2–8 wks; 6–24 sessions |
Traditional Chinese exercises with a focus on Qigong and Tai Chi | |||
Authors (year) | Population Number of subjects, Chronic Neck Pain definition, pain duration, sex, age | Intervention Description, Training period | Control Definition, Training period |
Bai, et al. (2015) [54] | Number of subjects: 161 Definition: Recurrent neck pain > 6 mo (1 study). The minimum of neck pain between 6 mo and 5 yrs (1 study) Duration: Mean 3.17 yrs, (1 Study), mean 19 (SD 14.9) yrs (1 study) % Women: 87.7%—95% Age: Mean 45.6 (SD 10.17) (1 study), mean 76 (SD 8) (1 study) yrs | Description: Neiyanggong Qigong (1 study) and Dantian Qigong (1 study) including neck exercises, shoulder exercises and moving (closing) exercises, and breathing exercises Training period: 18–24 sessions over 6 mo (1–2 sessions/wk), 45–90 min/session. Supervised 0–3 mo, 3–6 mo self-training | Description: Exercise therapy included warming-up with a softball, main exercises with theraband, mainly neck exercises, and closing exercise and active cervical rotations, strength and flexibility exercises Training period: Exercise therapy was supervised 18–24 sessions over 6 mo, 2–3 sessions/wk, 45 min/session. Self-training between month 3 and 6 (1 study) The waitlist group received no intervention but was offered treatment of their choice after 6 months (1 study) |
Ferro Moura Franco, et al. (2020) [42] | Number of subjects: 355 Definition: Chronic idiopathic neck pain Duration: range 3 mo to > 10 yrs % Women: 81% Age: Mean (SD) 54 (9.2) yrs | Description: All sessions supervised. Tai Chi based on Yang style (1 study). Qigong, including different methods; Dantian method (1 study), Neiyanggong method (1 study) and Biyun Medical Qigong (1 study). All with different combinations of body postures, movement, breathing, meditation, relaxation and sometimes self-massage Training period: 12–26 wks, 1–2 sessions/wk (12–24 sessions in total), 45–90 min/session | Definition: All sessions supervised, some combined with home exercise. Exercise therapy for neck pain, individually tailored programs combining e.g. mobility, proprioceptive exercises, stretching, strengthening exercises and endurance training Training period: 12–26 wks, 1–2 sessions/wk (12–24 sessions in total), 45–75 min/session |
Girard, et al. (2019) [55] | Number of subjects: 362 Definition: Chronic neck pain Duration: > 3 mo % Women: 84% Age: Mean (SD) 55.3 (6.3) yrs | Description: Qigong, including different methods; Dantian method (1 study), Nestudyiyanggong method (1 study) and Biyun Medical Qigong (1 study). All with different combinations of body postures, movement, breathing, meditation, relaxation and sometimes self-massage Training period: 12–24 wks, 1–2 sessions/wk (12–24 sessions in total), 45–90 min/session | Definition: Standardized exercise therapy for computer and workplace-related neck pain and individually tailored exercise programs combining e.g. mobility, stretching, strengthening exercises and endurance training Watilist control Training period: 12–24 wks, 1–2 sessions/wk (12–24 sessions in total), 45–90 min/session |
Gross, et al. (2016) [32] | Number of subjects: 239 Definition: Chronic mechanical neck disorders Duration: NR % Woman: NR Age: only reported in elderly adults | Description: Qigong: Neck and shoulder exercises including relaxation of mind and body, conscious breathing and movement exercises of the hip, legs, shoulders, arms and head. home exercise with a manual. ROM, use of softball, strengthening using a theraband; flexibility exercise Training period: 18–24 sessions, 45–90 min/session | Description: No intervention /waitlist control |
Kong et al. (2022) (57) | Number of subjects: 468 Definition: Neck pain Duration: NR % Women: NR Age: Mean 54.8 yrs | Description: Traditional Chinese mind and body exercises. Qigong with body postures, deep meditation, purposeful breathing, relaxation and self-massage (1 study), Tai Chi with relaxing music and breathing exercises (2 studies). Traditional Chinese exercises, fitness Qigong (1 study) and Five-animal exercises (1 study) Training period: 10–24 wks., 1–6 sessions/wk (12–60 sessions in total), 45–90 min/session | Description: Exercise therapy (3 studies). Passive treatment; Tuina (1 study), Traction (1 study) Waitlist control (3 studies) Training period: 12–24 wks, 1–2 sessions/wk (10–24 sessions in total), 45–75 min/session Treatment period (passive): 10-wks, 3–4 sessions/wk (30–40 sessions in total), 20–60 min/session |
Xie, et al. (2021) [56] | Number of subjects: 605 Definition: Neck pain (4 study chronic neck pain) Duration: NR % Women: 70.5% Age: Mean (SD) 51.7 (12.7) yrs | Description: Traditional Chinese mind and body exercises. Qigong with body postures, deep meditation, purposeful breathing, relaxation and self-massage (3 trials), Tai Chi with relaxing music and breathing exercises (1 trial) and the 12-words-for-life-nurturing exercise (1 trial) with massaging acupoints or a part of the body, deep breathing, and regulating body postures Training period: 3–6 mo, 1–2 sessions/wk (12–24 sessions in total), 45–90 min/session | Description: Exercise therapy. Modern rehabilitation treatments, including cervical manipulation, mobility, stretching, strengthening exercises, endurance training, other modern exercise therapy or minimal intervention Training period: 12–26 wks, 1–2 sessions/wk (10–24 sessions in total), 45–75 min/session |
Yuan, et al. (2015) [57] | Number of subjects: 362 Definition: chronic neck pain Duration: > 3 mo % Women: 84% Age: Mean (SD) 55.3 (6.3) yrs | Description: Qigong, including different methods; Dantian method (1 study), Nestudyiyanggong method (1 study) and Biyun Medical Qigong (1 study). All with different combinations of body postures, movement, breathing, meditation, relaxation and sometimes self-massage | Description: Standardized exercise therapy for computer and workplace-related neck pain and individually tailored exercise programs combining e.g. mobility, stretching, strengthening exercises and endurance training Waitlist control |
De Zoete, et al. (2020) [58] | Qigong (2 studies) Number of subjects: 239 Definition: Chronic idiopathic neck pain (neck pain lasting longer than 12 wks) Duration: NR % Women: 82% Age: Mean 44 yrs (1 study) and 76 yrs (1 study) Tai-Chi (1 study) Number of subjects: 114 Definition: NR Duration: NR % Women: 80% Age: mean 49.4 yrs | Qigong: Description: soft, whole-body movements with a focus on relaxation, posture and breathing Training dose: 12 wks; 2 sessions/wk; 45–60 min/session Tai-Chi: Description: soft, whole-body movements with a focus on relaxation, posture and breathing Training period: 12 wks | Qigong Description: Neck-specific exercises and waiting list control Training dose: 12 wks Tai-Chi Description: Waiting list control, neck-specific exercises Training period: 12 wks |
Yoga | |||
Authors (year) | Population Number of subjects, Chronic Neck Pain definition, pain duration, sex, age | Intervention Description, Training period | Control Description, Training period |
Cramer, et al. (2017) [59] | Number of subjects: 188 Definition: Chronic non-specific neck pain/disability defined as more than 12 wks Duration: NR % Women: 82.4% Age: Mean (SD) 45.8 (12.3) yrs | Description: Studies on yoga interventions including at least one of the following: Physical activity, breath control, meditation, and/or lifestyle advice (based on yoga theory and/or traditional yoga practices) No restrictions were made regarding yoga tradition, length, frequency, or duration of the program. Studies on multimodal interventions that include yoga among others were excluded Iyengar yoga (physical postures) (2 studies), Yogic mind sound resonance technique (meditation) (1 study) Training period: between 10 days to 9 wks (median length: 9 wks). Iyengar yoga for 9 wks 1 session/wk 90 min/session (2 studies). Yogic mind sound resonance technique for 10 days 20 min/session daily + physiotherapy 10 days 30 min/session daily (1 study) | Description: Usual care, self-care information, supine rest + physiotherapy Training period: From 10 days to 9 wks Usual care, self-care information 9 weeks (2 studies), Supine rest 10 days, 20 min daily + physiotherapy 10 days, 30 min daily (1 study) |
Kim, et al. (2016) [60] | Number of subjects: 184 Definition: Chronic non-specific neck pain defined as a duration longer than 3 mo Neck pain intensity at least 40 mm on a 100-mm visual analog scale (VAS) or ≥ 3/10 on the numeric pain rating scale (NRS) Duration: NR % Women: 85.9% Age: Means ranged between 47.8 and 55.6 yrs | Description: Iyengar program (poses to lengthen and strengthen muscles in the neck and shoulders and to improve stability, flexibility, alignment, and mobility in muscles, joints, and tendons) (2 studies) Yoga program (comprised of regulated breathing and poses to improve alignment, strength, flexibility, and relaxation) (1 study) Training period: In Iyengar yoga, participants practiced 90 min/day, 1/wk for 9 wks (2 studies). Yoga for 60 min/day, 5 days/wk for 3 mo (1 study) | Description: Exercise 10–15 min/day self-care manual Training. period: wks (2 studies), no control group (1 study) |
Li, et al. (2019) [22] | Number of subjects: 686 Definition: Persistent neck pain or severe discomfort in the neck > 3 mo Duration: NR % Women: NR Age: 18–55 with means (SD) between 20.8 (1.2) and 55.6 (9.0) yrs | Description: Yoga intervention, including both exercise-based and meditation-based Training period: Program length ranging from 10 days to 12 wks | Description: other therapies except yoga (e.g., exercise, Pilates, usual care, etc.) Training period: 4–15 wks, 1–3 sessions/wk (12–45 sessions in total), 45–60 min/session |
De Zoete, et al. (2020) [58] | Number of subjects: 188 Definition: Idiopathic neck pain Duration: NR % Women: 84% Age: 18–60 with means between 39.7 and 47.9 yrs | Description: NR Training period: 6–9 wks | Description: Self-care manual including neck-specific exercises (2 studies) Standard physiotherapy (including isometric neck exercises, and electrophysical elements) (1 study) |
Type of exercise | Description | References |
---|---|---|
Motor Control Exercises, including pillar exercises | Motor control exercises are defined as training of the deep neck muscles mostly using a craniocervical flexion hold without a bio-pressure feedback device Pillar exercises are defined as exercises intended to develop the ability of the spine to maintain a neutral position while giving resistance via pulleys, elastic bands, or by giving manual resistance to the head [26] | |
Pilates | Pilates exercises follow the traditional Pilates principles, such as centering, concentration, control, precision, flow, and breathing | [23] |
Resistance training | Resistance training is any exercise that causes the muscle to contract against an external resistance to improve strength, power, endurance, and/or hypertrophy. The external resistance can be dumbbells, resistance bands, or the own body weight | |
Traditional Chinese exercises with a focus on Qigong and Tai-Chi | Traditional Chinese exercises include Traditional Chinese Mind and Body Exercise (TCMBE) which is a rehabilitation modality that has been used for neck pain by rehabilitation professionals. TCMBE was developed in China and includes several practices, such as Qigong, Tai-chi, and the 12-words-for-life-nurturing exercise. TCMBE has a variety of subsets, each of which has a unique action, and those subsets have common characteristics that integrate with holistic body concepts emphasizing the integration of body posture, breathing patterns, and mind adjustments to achieve beneficial effects on both mental and physical well-being | |
Yoga | Yoga combines physical postures (asana), breathing techniques (pranayama), and meditation (dyana) to promote physical and mental well-being. There are a variety of different yoga styles focusing on these above-mentioned areas in a particular way |
Quality of the included SRs
Authors | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | Flaws (n) | Weakness (n) | Quality |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Bai et al. (2015) [54] | Y | N | Y | PY | Y | Y | N | PY | Y | N | Y | N | Y | N | Y | Y | 2 Partial | 6 | Low |
Bertozzi, et al. (2013) [48] | Y | N | N | PY | Y | Y | N | Y | Y | N | N | N | Y | Y | Y | N | 1 Partial | 6 | Low |
Cheng, et al. (2015) [49] | Y | N | N | N | N | N | N | PY | Y | N | N | N | N | N | N | N | 3 1 Partial | 10 | Critically Low |
Cramer, et al. (2017) [59] | Y | Y | Y | PY | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | 1 Partial | 1 | High |
Ferro Moura Franco, et al. (2020) [42] | Y | Y | Y | Y | Y | Y | N | Y | Y | N | Y | Y | Y | Y | Y | Y | 0 | 2 | High |
Garzonio, et al. (2022) [21] | Y | Y | Y | Y | Y | Y | PY | Y | Y | N | Y | Y | Y | Y | Y | N | 0 | 2 1 Partial | Moderate |
Girard, et al. (2019) [55] | Y | N | Y | PY | Y | N | N | PY | PY | N | N | N | N | N | N | Y | 1 3 Partial | 8 | Critically low |
Gross, et al. (2016) [32] | Y | Y | Y | Y | Y | Y | Y | PY | Y | N | Y | N | Y | Y | Y | N | 1 Partial | 3 | Moderate |
Haney, et al. (2010) [43] | PY | N | Y | Y | Y | N | N | Y | Y | N | N | N | N | Y | - | N | 1 1 Partial | 7 | Low |
Kim, et al. (2016) [60] | Y | PY | N | PY | N | N | N | PY | Y | N | N | N | Y | N | N | N | 2 2 Partial | 8 | Critically low |
Kong et al. (2022) [61] | Y | Y | Y | Y | Y | Y | N | PY | Y | N | N | N | N | N | Y | Y | 1 Partial | 6 | Low |
Li, et al. (2019) [22] | Y | Y | N | PY | Y | Y | N | PY | Y | N | Y | N | Y | Y | N | Y | 2 Partial | 5 low | Low |
Louw, et al. (2017) [50] | Y | N | N | Y | Y | Y | N | Y | Y | N | Y | N | PY | Y | N | Y | 0 | 6 1 Partial | Low |
Mueller et al. (2023) [45] | Y | Y | N | Y | Y | Y | PY | Y | Y | N | Y | Y | N | N | Y | Y | 0 | 1 Partial | Moderate |
Martinez-Gomez, et al. (2019) [44] | Y | Y | Y | Y | Y | Y | PY | Y | Y | N | Y | N | N | Y | Y | Y | 0 | 3 1 Partial | Moderate |
Martini et al. (2022) [23] | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | 0 | 0 | High |
Ouellet, et al. (2021) [51] | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | N | 0 | 2 | High |
Price, et al. (2020) [26] | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | N | Y | 0 | 2 | High |
Seo, et al. (2020) [52] | N | N | N | N | Y | N | N | N | Y | N | N | N | N | N | N | Y | 4 | 9 | Critically Low |
Tsiringakis, et al. (2020) [46] | Y | N | Y | Y | Y | Y | PY | Y | Y | N | Y | N | Y | Y | Y | Y | 0 | 3 1 Partial | Moderate |
Villanueva- Ruiz, et al. (2022) [47] | Y | Y | Y | PY | Y | Y | N | Y | Y | N | Y | Y | Y | Y | Y | Y | 1 Partial | 2 | Moderate |
Xie, et al. (2021) [56] | Y | Y | Y | PY | Y | Y | N | PY | Y | N | Y | N | Y | Y | N | Y | 2 Partial | 4 | Low |
Yang, et al. (2022) [53] | Y | N | N | N | Y | Y | N | PY | Y | N | Y | Y | Y | Y | Y | Y | 1 | 4 | Low |
Yuan, et al. (2015) [57] | Y | N | Y | Y | Y | Y | N | Y | Y | N | Y | N | Y | Y | Y | Y | 0 | 3 | Moderate |
de Zoete, et al. (2020) [58] | Y | PY | Y | PY | Y | Y | N | N | Y | N | N | N | Y | N | N | Y | 1 1 Partial | 5 | Critically low |
Summary results for exercises in chronic neck pain
NON-EXERCISING COMPARISON GROUP | |||||||||||||
Type of exercise | Outcome | Effects based on narrative analyses1 | Effects based on meta-synthesis SMD (95%CI) (number of studies2) | Study design3 | GRADE FACTORS4 | Certainty of evidence5 | |||||||
Timeframe | Downgrading factors | Upgrading factors | |||||||||||
a) | b) | c) | d) | e) | f) | g) | |||||||
Motor Control Exercises | PAIN | Short-term | positive | positive effect -1.69 (-2.73; -0.64) (2 studies) | + + + + | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + + + + |
Intermediate/long-term | varying | N/A | 0 | - | 0 | 0 | 0 | 0 | 0 | + + + | |||
DISABILITY | Short-term | positive | positive effect -2.26 (-3.38; -1.39) (2 studies) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + + + + | ||
Intermediate/long-term | positive | N/A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + + + + | |||
Resistance training | PAIN | Short-term | positive | positive effect -0.75 (-1.41; -0.09) (2 studies) | + + + + | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + |
Intermediate/long-term | positive | no effect -0.19 (-0.48; 0.09) (2 studies) | - | - | 0 | 0 | 0 | 0 | 0 | + + | |||
DISABILITY | Short-term | no | no effect -0.91 (-2.22; 0.39) (2 studies) | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | ||
Intermediate/long-term | no | positive effect -0.19, 95%CI -0.33 to -0.05 (2 studies) | - | - | 0 | 0 | 0 | 0 | 0 | + + | |||
Traditional Chinese Exercises | PAIN | Short-term | positive | positive effect -0.63 (-0.95; -0.32) (4 studies) | + + + + | - | - | 0 | 0 | 0 | 0 | 0 | + + |
Intermediate/long-term | positive | positive effect -0.54 (-0.74; -0.35) (4 studies) | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | |||
DISABILITY | Short-term | positive | positive effect -0.39 (-0.65; -0.13) (2 studies) | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | ||
Intermediate/long-term | positive | positive effect -0.45 (-0.76; -0.14) (3 studies) | - | - | 0 | 0 | 0 | 0 | 0 | + + | |||
Yoga | PAIN | Short-term | positive | positive effect -1.32 (-1.84; -0.80) (2 studies) | + + + + | - | - | 0 | 0 | 0 | 0 | 0 | + + |
Intermediate/long-term | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
DISABILITY | Short-term | positive | positive effect -1.00 (-1.47; -0.54) (2 studies) | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | ||
Intermediate/long-term | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
EXERCISING COMPARISON GROUP | |||||||||||||
Type of exercise | Outcome | Effects based on narrative analyses1 | Effects based on meta-synthesis SMD (95%CI) (number of studies2) | Study design3 | GRADE FACTORS4 | certainty of evidence5 | |||||||
Downgrading factors | Upgrading factors | ||||||||||||
a) | b) | c) | d) | e) | f) | g) | |||||||
Motor Control Exercises | PAIN | Short-term | Varying | positive effect -0.25 (-0.38; -0.13) (6 studies) | + + + + | 0 | - | 0 | 0 | 0 | 0 | 0 | + + + |
Intermediate/long-term | Varying | N/A | 0 | - | 0 | 0 | 0 | 0 | 0 | + + + | |||
DISABILITY | Short-term | Varying | positive effect -0.36 (-0.52; -0.20) (4 studies) | 0 | - | 0 | 0 | 0 | 0 | 0 | + + + | ||
Intermediate/long-term | Varying | N/A | 0 | - | 0 | 0 | 0 | 0 | 0 | + + + | |||
Resistance training | PAIN | Short-term | Varying | no effect -0.48 (-1.11; 0.15) (2 studies) | + + + + | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + |
Intermediate/long-term | Positive | N/A | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | |||
DISABILITY | Short-term | No | N/A | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | ||
Intermediate/long-term | No | N/A | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | |||
Traditional Chinese Exercises | PAIN | Short-term | Varying | no effect 0.08 (-0.09; 0.26) (3 studies) | + + + + | - | - | 0 | 0 | 0 | 0 | 0 | + + |
Intermediate/long-term | No | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | ||||
DISABILITY | Short-term | No | no effect -0.05 (-0.26; 0.35) (2 studies) | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | ||
Intermediate/long-term | No | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | ||||
Yoga | PAIN | Short-term | Varying | N/A | + + + + | - | 0 | - | 0 | 0 | 0 | 0 | + + |
Intermediate/long-term | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
DISABILITY | Short-term | Varying | N/A | - | 0 | 0 | 0 | 0 | 0 | 0 | + + + | ||
Intermediate/long-term | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Results for various exercise types
MCE and pillar exercises
Motor Control Exercises (incl. Pillar exercises) | |||||
Author (year) Study quality | Number of included studies (number of included studies in a meta-analysis) | Outcome measures Follow up time | Results pain | Results disability | Original review of authors’ conclusions |
Ferro Moura Franco, et al. (2020) [42] AMSTAR-2 High | SR (MA) N = 6 (3) | Pain: NPRS, VAS Disability: NR Follow-up: Short-term 6 wks -4 mo | MCE = strength training Short-term WMD = -3.16 (95% CI -13.78; 7.47) (3 studies) | NR | No difference between MCE and strengthening exercises. The exercises can be performed in supervised sessions with 30- to 60-min duration, 2–3 sessions/wk for a period of up to 10 wks |
Garzonio, et al. (2022) [21] AMSTAR-2 Moderate | SR (MA) N = 16 (9) | Pain: NRS, VAS Disability: NR Follow-up: Short-term > 5 min. to ≤ 12 wks | MCE ≥ GE (active exercises) Short-term SMD = -0.31 (95% CI -0.67; 0.04) (9 studies) MCE = Strength training SMD = -0.10 (95% CI -0.37; 0.17) (4 studies) MCE = Other exercises SMD = -0.41 (95% CI -1.15; 0.32) (5 studies) | NR | Future studies with high methodological quality are necessary to reach firm conclusions |
Hanney, et al. (2010) [43] AMSTAR-2 Low | SR (MA) N = 2 (0) | Pain: NR Disability: NDI Follow-up: Short-term: 6–7 wks Intermediate term: 6 mo | NR | MCE = strength/endurance training/GE Short/intermediate term (2 studies) | Little evidence that motor control exercises are more beneficial in either the short-term or the long-term in comparison to a more general exercise program |
Martin-Gomez, et al. (2019) [44] AMSTAR-2 Moderate | SR (MA) N = 10 (10) | Pain: NRS, VAS Disability: NDI Follow-up: Short term 0–10 wks | MCE = strength/endurance training Short term SMD = -0.25 (95% CI – 0.50; 0.01) (5 studies) MCE = mobilization Short term SMD = -1.21 (95% CI -2.57; 0.15) (2 studies) MCE > all controls Short term SMD = -0.58, (95% CI -0.97; -0.20) (7 studies) | MCE = strength/ endurance training Short term SMD = -0.23 (95% CI -0.49; 0.02) (5 studies) MCE = mobilization Short term SMD = -1.44 (95% CI -3.58; 0.71) (2 studies) MCE > all controls Short term SMD = -0.44 (95% CI -0.81; -0.08) (8 studies) | Cranio-cervical flexion (MCE) compared with other treatments shows statistically significant results regarding the diminution of pain and disability in non-specific chronic neck pain GRADE very low to low certainty of effect for pain and disability |
Mueller, et al. (2023) [45] AMSTAR-2 Moderate | SR (MA) N = 21 (21) | Pain: NRS, NPSS, VAS Disability: NDI Follow-up: Short term 2–12 wks after baseline | MCE > control, minimal intervention Short term SMD = -2.29 (95%CI -3.82; -0.75) (8 studies) MCE = other exercise Short term SMD = -0.09 (95%CI -0.61; 0.44) (12 studies) | MCE > control, minimal intervention Short term SMD = -2.42 (95%CI -3.38; -1.47) (8 studies) MCE > other exercise Short term SMD = -0.70 (95%CI -1.23; -0.17) (10 studies) | Compared to true control, effects on pain and disability were significantly larger for MCE. Higher frequencies and longer duration of MCE sessions had a significant effect on pain |
Price, et al. (2020) [26] Motor Control Exercises AMSTAR-2 High | SR (MA) N = 10 (0) | Pain: VAS Disability NDI Follow up: Immediate ≤ 24 h Short-term > 24 h to ≤ 3 mo Intermediate term 3–12 mo | MCE > MT Immediate (1 study) MCE > no treatment, usual care, Short-term (2 studies) MCE = general active range of movement Short-term (2 studies) MCE = other exercises and proprioceptive training Short-term (4 studies) MCE < combinations of MC, segmental exercise Short-term (1 study) MCE < Pillar exercises performed with therapist’s resistance Short-term (1 study) MCE = usual care Intermediate (1 study) MCE < pillar exercises Intermediate (1 study) | MCE = proprioceptive training Immediate (1 study) MCE > no treatment, usual care, general active range of movement, pillar exercise Short-term (5 studies) MCE = other exercises and proprioceptive training Short-term (4 studies) MCE < Pillar exercises performed with therapist’s resistance Short-term (1 study) MCE = usual care Intermediate (1 study) MCE < pillar exercises Intermediate (1 study) | Based on very low-level evidence, MCE are not effectively reducing immediate pain Based on moderate-level evidence, MCE are not effectively reducing short-term pain or disability Based on low-level evidence, MCE are not effective in reducing intermediate-term pain or disability When MCE were used alone the effectiveness was unclear, however, benefits are maximized, when combined with other exercises |
Price, et al. (2020) [26] Pillar exercises AMSTAR-2 High | SR (MA) N = 5 (0) | Pain: VAS (at rest, maximum, during activities) Disability: NDI Follow-up Short/intermediate term 1 wks to 3 mo | Pillar > education Regardless of exercise dosage Short-term (1 study) Pillar < other exercises Short-term (4 studies) Pillar > education Regardless of exercise dosage Intermediate (1 study) Pillar > other exercises Intermediate (1 study) | Pillar > education Regardless of exercise dosage Short-term (1 study) Pillar < other exercises Short-term (4 studies) Pillar > education regardless of exercise dosage Intermediate (1 study) Pillar > other exercises Intermediate (1 study) | Based on moderate-level evidence (GRADE) Pillar exercises are not effective in reducing short-term pain or disability compared to other exercises. Pillar exercises based on one study are effective in short-term pain and disability compared to education |
Tsiringakis, et al. (2020) [46] AMSTAR-2 Moderate | SR (MA) N = 15 (10) | Pain: NRS, NPRS, VAS Disability: NDI Follow-up: Short-term 4–12 wks | MCE > GE Short-term Hedges´g = 0.32 (95% CI 0.04; 0.60) (9 studies) | MCE > GE Short-term Hedges´g = 0.40 (95% CI 0.12; 0.68) (10 studies) | Motor control training (with PBU) is an effective intervention for improving pain intensity and disability in patients with neck pain and is preferable to strength-endurance training of cervical muscles |
Villanueva-Ruiz, et al. (2022) [47] AMSTAR-2 Moderate | SR (MA) N = 12 (11) | Pain: NRS, VAS Disability: NDI Follow-up: Short-term 4–12 wks Intermediate term 18–26 wks | MCE > GE Short-intermediate term SMD = -0.41 (95% CI -0.76; -0.06) (11 studies) MCE = GE Intermediate SMD = -1.30 (95% CI -3.35; 0.75) (3 studies) | MCE > GE Short-intermediate term SMD = -0.41 (95% CI -0.78; -0.04) (11 studies) MCE = GE Intermediate SMD = -1.81 (95% CI -4.29; 0.67) (3 studies) | Evidence suggests specific neck exercises are more effective than other forms of exercise, although evidence is overall of low quality |
Pilates | |||||
Author (year) Study quality | Number of included studies (number of included studies in a meta-analysis) | Outcome measures Follow up time | Results pain | Results disability | Original review authors’ conclusions |
Martini (2022) [23] AMSTAR-2 High | SR (MA) N = 5 (5) | Pain: VAS Disability: NDI Follow-up: Short-term: End of intervention (6–12 weeks) Intermediate term: 6 mo | Pilates = Other treatments/exercises Short-term (5 studies) SMD = 9.29 (95% CI -25.84; 7.26) Pilates > pharmacological treatment Intermediate term (1 study) SMD = 3.11 (95% CI 2.05; 0.17) | Pilates = Other treatments/exercises Short-term (5 studies) SMD = 3.20 (95% CI -7.70; 1.30) Pilates > pharmacological treatment Intermediate term (1 study) SMD = 11.21 (95% CI 5.58; 16.74) | Based on low-certainty evidence, the Pilates method does not appear to be better than other treatments or exercises for pain and disability in the short-term for patients with neck pain |
Resistance training | |||||
Author (year) Study quality | Number of included studies (number of included studies in a meta-analysis) | Outcome measures Follow up time | Results pain | Results disability | Original review authors’ conclusions |
Bertozzi, et al. (2013) [48] AMSTAR-2 Low | SR (MA) N = 9 (7) | Pain: VAS, NRS, Self-reported pain Disability: Instrument measuring the impact of chronic NP on everyday life, beyond work or leisure-time activities Follow-up: Short-term: < 1 mo Intermediate term: 1–6 mo Long-term: > 6 mo | Resistance training > No intervention/education Short-term Hedges’ g = -0.53 (95%CI -0.86; -0.20) (6 studies, 9 comparisons) Intermediate term Hedges’ g = -0.45 (95%CI -0.82; -0.07) (5 studies, 7 comparisons) Resistance training = No intervention/education Long-term follow-up Hedges’g = -0.04 (95%CI -0.28; 0.20) (1 study) | Intervention = No intervention/education Short-term Hedges’ g = -0.39 (95%CI -0.86; 0.07) (4 studies) Intermediate term (3 studies) Hedges’ g = -0.46 (95%CI -1.00; 0.08) Intervention = No intervention/education Long-term follow-up Hedges’ g = -0.14 (95%CI -0.38; 0.11) (1 study) | Consistent with other reviews, the results support the use of therapeutic exercises in the management of chronic non-specific neck pain. A significant overall effect size was found supporting therapeutic exercises for their effect on pain in both the short and intermediate terms |
Cheng, et al. (2015) [49] AMSTAR-2 Crit. Low | SR (MA) N = 6 (0) | Pain: VAS, Pressure pain threshold, NRS, Pain Frequency Disability: NDI, Health-Related Quality of Life, Fear avoidance beliefs Follow-up: Short-term: 10 wks Long-term: 1 yr | Resistance training > Stretching, education, and stress management Short-term (2 studies) Long-term (1 study) Resistance training = Control Long-term (2 studies) | Resistance training > Stretching, education, and stress management Long-term (1 study) | Long-term exercise has long-term benefits for patients with nonspecific neck pain |
Louw, et al. (2017) [50] AMSTAR-2 Low | SR (MA) N = 8 (2) | Pain: intensity scale (0–9) or VAS (0–100) Disability: NDI Post-intervention: Short-term: 10–20 wks Long-term: at 12 mo | Resistance training > Education/stretching Short-term (2 studies). NR Long-term SMD = -0.33 (95%CI -0.53; -0.13) (2 studies) | Intervention = Education/stretching NR Long-term SMD = -0.18 (95%CI -0.38; 0.02) (2 studies) | The overall effect shows that strengthening exercise can have a significant effect on pain reduction for up to 12 mo after the intervention is completed |
Mueller, et al. (2023) [45] AMSTAR-2 Moderate | SR (MA) N = 23 (23) | Pain: NPRS (0–10), NRS or VAS (0–100) Disability: NDI, NPAD, NPNPQ, Neck disability scale (0–10) Follow-up: Short-term: 4–12 wks (1 study 24 wks) | Resistance training > real control/minimal intervention Short-term SMD = -1.27 (95%CI -2.26; -0.28) (5 studies) Resistance training = other exercise Short-term SMD = -0.31 (95%CI -1.05; 0.44) (16 studies) | Resistance training > real control/minimal intervention Short-term SMD = -1.76 (95%CI -3.16; -0.37) (5 studies) Resistance training = real control/minimal intervention Short-term SMD = 0.40 (95%CI -0.18; 0.98) (14 studies) | Resistance and motor control exercises were effective for reducing neck pain (very low– to moderate-certainty evidence). Higher frequencies and longer duration of sessions had a significant effect on pain for motor control exercise |
Seo et al. (2020) [52] AMSTAR-2 Crit low | SR (MA) N = 4 (0) | Pain: VAS, Self-rated pain intensity Disability: NDI Follow-up: Short-term: Post-intervention | Resistance training > Control (NR) Short-term (2 studies) | Intervention = Control (NR) Short-term (1 study) | Scapular stabilization exercises could be considered an effective intervention for patients with nonspecific neck pain. Scapular stabilization may improve neck pain and function, but the evidence of this in the reviewed articles was insufficient |
Ouellet, et al. (2021) [51] AMSTAR-2 High | SR (MA) N = 4 (4) | Pain: VAS Disability: NDI Follow-up: Short term: 6–13 wks Intermediate: 4–9 mo | Short-term Region-specific exercises = General exercises MD = -0.86 (95% CI -2.20; 0.48) (4 studies) Region-specific exercises = Aerobic exercises MD = -1.16 (95%CI -3.83; 1.52) (2 studies) Intermediate Region-specific exercises > Tai chi, Dantian Qigong exercise (2 trials) Region-specific exercises > Aerobic exercise (1 study) Region-specific exercises > Aerobic exercise (1 study) | Short term Region-specific exercises = Tai chi, Strength training + proprioceptive exercise group, Dantian Qigong exercises (2 studies) Intermediate Region-specific exercises = Tai chi, Strength training + proprioceptive exercise group, Dantian qigong exercises (2 studies) | The difference in treatment effect remains uncertain between region-specific and general exercises. Based on very low to low-quality evidence, there appear to be no differences between both types of exercise approaches for pain reduction or disability for adults with spinal disorders |
Price, et al. (2020) [26] Resistance Exercises AMSTAR-2 High | SR (MA) N = 2 (0) | Pain: VAS (at rest, maximum, during activities) Follow-up Short/intermediate term 1 wks to 3 mo Follow-ups Short-term Intermediate | ULRE > No treatment Short-term (1 study) ULRE > education/stress reductionShort-term (1 study; 3 outcomes) ULRE < education/stress reductionIntermediate (1 study) ULRE > Other exercise Short-term (1 study) ULRE = Other exercise Short-term (1 study) ULRE > Body awareness trainingShort-term (1 study; 2 outcomes) ULRE = Body awareness trainingShort-term (1 study) Intermediate (1 study; 2 outcomes) | NR | Based on low-level evidence (GRADE) ULRE are effective in reducing pain in the short term but not in the intermediate or long term |
Yang, et al. (2022) [53] AMSTAR-2 Low | SR (MA) N = 18 (18) | Pain: VAS Disability: NDI | Isometric exercises > controls Short-term WMD = -0.81 (95%CI -0.88; -0.73) (16 studies) | Isometric exercises < controls WMD = -5.55 (95%CI -4.57; -6.53) (10 studies) | Isometric training can reduce the degree of neck pain and improve neck dysfunction. An intervention frequency of more than 20 times had more significant improvement effects on the degree of neck pain, compared to an intervention frequency of less than 20 times. In addition, the effect of isometric training on VAS and NDI indices with an intervention period of more than 8 weeks was more significant compared to a training period of less than 8 weeks |
Traditional Chinese Exercises | |||||
Author (year) Study quality | Number of included studies (number of included studies in a meta-analysis) | Outcome measures Follow up time | Results pain | Results disability | Original review authors' conclusions |
Bai, et al. (2015) [54] AMSTAR-2 Low | SR (MA) N = 2 (2) | Pain VAS Follow-up: Short-term: After treatment (3 mo.) Intermediate term: 6 mo. after study-start | TCE > Waiting list control Short-term SMD: -1.17 (95% CI: -2.44; 0.1) (2 studies) Intermediate-term TCE > Waiting list control SMD: -1.00 (95% CI: -1.94, -0.06) (2 studies) | NR | Significant difference for internal Qigon for chronic neck pain compared to waiting list controls at 3 and 6 months |
Ferro Moura Franco, et al. (2020) [42] AMSTAR-2 High | SR (MA) N = 4 (3) | Pain VAS Follow-up Short-term: post-intervention 3 mo | TCMBE < Exercise therapy short-term MD = 6.46 (95%CI 0.75; 12.17) (3 studies) | NR | Combined exercise was better than meditative therapies (Tai Chi and Qigong). Focused and intense exercises for a short period of time can be prescribed for patients with nociceptive pain predominance |
Girard, et al. (2019) [55] AMSTAR-2 Critically low | SR (MA) N = 3 (0) | Pain: VAS Disability: NDI, NPDS Follow-up 3 mo and at 6 mo | Short term Qigong = Waiting list controls (1 study) Qigong = Exercise therapy (2 studies) Intermediate term Qigong > Waiting list controls (1 study) Qigong = Exercise therapy (1 study) | Short term Qigong = Waiting list controls (1 study) Qigong = Exercise therapy (2 studies) Intermediate term Qigong > Waiting list controls (1 study) Qigong = Exercise therapy (1 study) | The findings of this systematic review indicate that qigong might have a beneficial effect in some individuals with neck pain, although not necessarily more effective than therapeutic exercise |
Gross, et al. (2016) [32] AMSTAR-2 Moderate | SR (MA) N = 2 (2) | Pain: VAS Disability: NPDI and NDI Follow-up: Short-term 12 wks Intermediate 24 wks | Qigong > Waiting list controls Short-term Pooled MD = -13.28 (95%CI -20.98; -5.58) (2 studies) Qigong > Waiting list controls Intermediate Pooled MD = -7.82 (95%CI -14.57; -1.07) (2 studies) | Qigong > Waiting list controls Short-term Pooled MD = -0.36 (95%CI -0.68; -0.03) (2 studies) Qigong = Waiting list controls Intermediate Pooled MD = -0.28 (95%CI -0.68; 0.11) (2 studies) | Moderate quality evidence: Two trials show that Qigong exercises (Dantian Qigong) may improve pain and function slightly when compared with waiting list controls at short-term follow-up |
Kong et al. (2022) [61] AMSTAR-2 Low | SR (MA) N = 4 (3) | Pain: VAS Disability: NDI Follow-up: Short term 3 mo Intermediate term | TCE > Waiting list controls Short term (3 studies)a SMD = 0.81 (95%CI -1.13; -0.50) TCE = Other exercises Short term (3 studies)a SMD = -0.07 (95%CI -0.33; 0.18) TCE > other treatments Intermediate term (3 studies) a SMD = -0.69 (95%CI -0.39; -0.99) | TCE > other treatments Short term (2 studies) SMD = 0.74 (95%CI 0.40; 1.08) | The evidence supporting the effects of TCEs alone in improving pain and disability in patients with neck pain was limited due to the small sample size. The follow-up effects of TCEs were still insufficient |
Xie, et al. (2021) [56] AMSTAR-2 Low | SR (MA) N = 5 (5) | Pain: VAS Disability: NDI, NPDS Follow-up: Short term 3 mo | TCMBE = Exercise therapy Short-term MD = 1.88 (95%CI -7.70; 11.46) (5 studies) | TCMBE = Exercise therapy Short-term NDI MD = 0.15 (95%CI -6.37; 6.66) (3 studies) Short-term NPDS MD = 1.31 (95%CI -4.10; 6.71) (2 studies) | Based on the meta-analysis, there is insufficient evidence to support the clinical use of TCMBE in improving pain intensity and enhancing functional mobility in individuals with neck pain |
Yuan, et al. (2015) [57] AMSTAR-2 Moderate | SR (MA) N = 3 (2) | Pain: VAS Disability: NDI, NPDS Follow-up Short term 3 mo Intermediate 3–12 mo | Qigong > Waiting list controls Short-term WMD = -15.27 (95%CI -22.49; -8.05) (2 studies) Qigong > Waiting list controls Intermediate term WMD = -10.18 (95%CI -16.63; -3.73) (2 studies) Qigong = Exercise therapy Short term WMD = 1.88 (95%CI -5.77; 9.54) (2 studies) Qigong = Exercise therapy Intermediate term WMD = -1.00 (95%CI -6.21; 8.21) (2 studies) | Qigong > Waiting list controls Short-term WMD = -7.67 (95%CI -12.45; -2.88) (2 studies) Qigong = Waiting list controls (2 studies) Intermediate term WMD = 0.43 (95%CI -4.43; 5.28) (2 studies) Qigong = Exercise therapy Short term WMD = 1.29 (95%CI -4.32; 6.91) (2 studies) Qigong = Exercise therapy Intermediate term WMD = 0.02 (95%CI -5.25; 5.28) (2 studies) | Two small studies showed that qigong may be superior compared with waiting list controls for chronic neck pain sufferers (moderate evidence), but no differences were found compared with other exercises |
de Zoete, et al. (2020) [58] AMSTAR-2 Critically Low | SR (MA) Qigong N = 2 (0) Tai-Chi N = 1 (0) | Qigong Pain: NR Disability: NR Follow-up: Up to 6 mo Tai-Chi Pain: NR Disability: NR Follow-up: 6 mo post-intervention (1 study) | Qigong = Waiting list controls (1 study) Qigong = Neck-specific exercise (2 studies) Tai-Chi > Waiting list controls (1 study) Tai-Chi > Neck-specific exercise (1 study) | Qigong NR Tai Chi NR | No specific conclusions were drawn concerning TCE, however, the authors concluded that all their included studies showed positive effects on neck pain intensity and disability and that general physical exercise showed equal or superior improvements in neck pain intensity and neck disability compared to usual care alternatives |
Yoga | |||||
Author (year) Study quality | Number of included studies (number of included studies in a meta-analysis) | Outcome measures Follow up time | Results pain | Results disability | Original review authors' conclusions |
Cramer, et al., (2017) [59] AMSTAR-2 High | SR (MA) N = 3 (3) | Pain: NRS, VAS Disability: NDI Follow-up: Short-term: NR | YOGA > Usual care Short-term SMD = -1.28 (95%CI -1.81; -0.75) (3 studies) | YOGA > Usual care Short-term SMD = -0.97 (95%CI -1.44; -0.50) (3 studies) | Yoga has short-term effects on chronic neck pain, its related disability, quality of life, and mood suggesting that yoga might be a good treatment option Meta-analysis of these trials found robust evidence for large short-term effects of (Iyengar) yoga on neck pain intensity, pain-related disability in patients with chronic non-specific neck pain |
Kim, et al. (2016) [60] AMSTAR-2 Critically low | SR (MA) N = 3 (0) | Pain: NRS, VAS Disability: NDI Follow-up: Short term 6 wks | YOGA > Home Exercise Short-term (3 studies) | YOGA > Home Exercise Short-term (3 studies) | Significant decreases in chronic neck pain intensity and functional disability for the yoga group were found in all of the trials. These findings support the practice of yoga as an evidence-based treatment for chronic neck pain. Evidence from the three RCTs shows that yoga may be beneficial for chronic neck pain |
Li, et al. (2019) [22] AMSTAR-2 Low | SR (MA) N = 10 (10) | Pain: CPGS NRS SF-MPQ VAS Disability: NDI NDS NPDS NPQ Follow-up: Short-term: post-intervention—6 wks Intermediate: 6 mo., Long-term: 12 mo | YOGA > Other therapies (e.g., exercise, Pilates, usual care) Short-term (10 studies) SMD = -1.13 (95%CI -1.60; -0.66) Subgroup analyses YOGA = PILATES Short-term SMD = -0.18 (95%CI -0.76; 0.39) (3 studies) YOGA > EXERCISE Short-term SMD = -1.26 (95%CI -1.83; -0.68) (9 studies) YOGA = CAM Short-term SMD = -2.40 (95%CI -5.26; 0.46) (2 studies) | YOGA > Other therapies (e.g., exercise, Pilates, usual care) Short-term SMD = -0.92 (95%CI -1.38; -0.47) (8 studies) Subgroup analyses YOGA = PILATES Short-term SMD = -0.27 (95%CI -0.88; 0.35) (3 studies) YOGA > EXERCISE Short-term SMD = -0.97 (95%CI -1.55; -0.38) (7 studies) YOGA = CAM Short-term SMD = -2.31 (95%CI -5.35; 0.73) (2 studies) Long-term NR | It was difficult to make a comprehensive summary of all the evidence due to the different sessions and duration of the yoga interventions, and the different outcome measurement tools in the study, we draw a very cautious conclusion that yoga can relieve neck pain intensity, improve pain-related function disability, increase CROM. This suggests that yoga might be an important alternative in the treatment of CNNP |
De Zoete, et al. (2020) [58] AMSTAR-2 Critically low | SR (MA) N = 3 (0) | Pain: 100 mm VAS Disability: NR Follow-up: Short-term: Post-intervention | Yoga > self-care (2 studies) One study reported only within-group analyses | Yoga > self-care (2 studies) One study reported only within-group analyses | No specific conclusions were made about yoga, but the authors concluded that general physical exercises may be more effective than interventions lacking such exercises (i.e. only neck-specific exercises) |