Do we need to target the neck specifically to improve neck pain, function, headaches, and dizziness? This recent trial did not look at tailored exercise vs. a control, rather, it looked at neck-specific exercise vs. a tailored, total body program. The study pulled from another trial's cohort of 144 individuals with cervical radiculopathy. Of the 88 that met the inclusion criteria for this trial, 59 had headache intensities of >10/100 and 73 had Dizziness Handicap Inventory scores of >12/100. These patients were randomly allocated to neck-specific exercise or tailored physical activity groups.
The intervention period for both groups was three months. The neck-specific group received continuous cognitive behavioral therapy while the tailored exercise group received it on the evaluation only. The neck-specific exercise group received a phased program that initially focused on isolated low-load sensorimotor exercises, progressing to endurance exercises as pain and exercise tolerance improved. The exercises were supervised by a PT and completed three times per week. The dosage was progressed individually within a standardized protocol.
The exercise program can be found here.
While the program is progressive and multiplanar, flexion, extension, and side bending are restricted to isometrics. The neck needs to be strengthened in all ranges of motion. Strength is specific to the range trained and hypertrophy is greater when training through a full range of motion or at least in the lengthened position of the muscle. The individual physical activity received a written exercise program that was intended to reduce pain and improve overall health. It included a tailored aerobic and/or resistance training program plus the general prescription of at least 30 minutes of physical activity at moderate intensity three times per week.
Both interventions were equally effective at reducing pain and dizziness. There were no significant differences between groups at any follow-up. Both interventions significantly improved headache pain at the 12-month follow-up (25 and 20-point reductions). Dizziness improved for both groups at 3 months (8 and 11 points) but only tailored physical activity led to significant 6-month changes (8 points). As many other studies have shown, when you limit the outcomes to symptoms, you will find little to no difference between interventions. Belief effects and time are powerful treatments for pain. Any form of exercise can improve resilience and facilitate progress. If you want to change strength, power, endurance, and muscle mass, the intensity and dosage need to be specific to the goals.