Meeus M.1,2, Aguilar-Rodríguez M.3, Voogt L.4, Lluch E.3, Struyf F.5, Dueñas L.3
1University of Antwerp, Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium, 2Ghent University, Rehabilitation Sciences and Physiotherapy, Ghent, Belgium, 3University of Valencia, Valencia, Spain, 4University College Rotterdam, Rotterdam, Netherlands, 5University of Antwerp, Antwerp, Belgium
Background: Specific shoulder and neck exercises are often part of programs for pain relief in patients with neck and shoulder pain, although they may sometimes cause immediate pain exacerbations imposing barriers for compliance to exercise programs. More generic aerobic exercise might provoke less local pain increases. Nevertheless, there is a lack of consistent evidence supporting superiority of one approach over another.
Purpose: The current review aims to provide aN overview of the existing literature reporting pain relief, following specific and non-specific or generic exercise treatment in chronic shoulder-neck pain patients.
Methods: A systematic review of randomized controlled trials was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Using specific keywords related to exercise and chronic neck or shoulder pain, the electronic databases PubMed, EmBase and Web of Science were searched. The search was supplemented by hand searching. Risk of bias across studies was assessed with Cochrane Collaborations tool for assessing risk of bias and quality of evidence was determined applying the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. The latter and data collection were performed by two independent researchers. In case of persisting disagreements after a consensus meeting, a third opinion was given by a third researcher.
Results: A total of 11 eligible studies were identified with a predominant considerable risk of bias. Clusters were made based on the timing of the effects (acute response to a single bout of exercise and short and long-term effect of training) and based on exercise modes. Only 1 study investigated the acute effect of single bouts of exercise on pain and found that generic exercise caused an immediate pain reduction, compared to specific resistance exercises causing a pain increase. All other studies compared the training effects on pain on short and long term follow-up. The majority of these studies compares specific strengthening exercises with generic aerobic exercise or body-mind exercises. One study compared specific stretching with generic stretching. For the effects of training there are no differences between specific and general interventions for short-term effects regarding pain in 7 of 11 studies. The remaining 4 studies are conflicting (2 favor specific and 2 favor generic exercises).
Conclusion(s): Based on the acute effects generic exercise seems better tolerable for patients with chronic neck or shoulder pain, but regarding the training effects, both specific and generic exercises seem to reduced pain. Due to the relatively high risk of bias across the included studies, future studies with randomized designs are needed to confirm the current findings. Also the working mechanisms behind the effects and the exact definition and dosage of the exercise therapy modalities need to be further elaborated.
Implications: Based on the present finding it seems beneficial to combine generic and specific exercises for patients with chronic neck and shoulder pain, with more emphasis on the generic exercises in the beginning of the training period.
Funding acknowledgements: NA
Topic: Pain & pain management
Ethics approval: NA
All authors, affiliations and abstracts have been published as submitted.
