Overview of reviews for effectiveness of exercise-based interventions for neck pain

Background and purpose: At least one in three adults experience persistent neck pain. Exercise is a common intervention; however, variability in exercise types, dosage, and outcomes makes it difficult to compare effectiveness and guide clinical decisions. This umbrella review provides an overview of exercise interventions for neck pain and compares and contrast findings across systematic reviews. Materials and methods: Following PRISMA guidelines, a search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases identified systematic reviews published between July 2016 and June 2024. Eligible reviews examined exercise as the primary intervention for individuals with neck pain. Five reviewers extracted data on study characteristics, exercise types, outcomes (e.g., pain, disability, range of motion), and methodological quality using AMSTAR 2. Results: Fifty-two systematic reviews met inclusion criteria and were grouped into four domains: (1) deep neck flexor (DNF) endurance training (n=11), (2) upper quarter strengthening (n=11), (3) fitness-based interventions (e.g., yoga, Pilates, tai chi) (n=17), and (4) other exercises (n=13). DNF training showed moderate evidence for short- to intermediate-term improvements in pain, disability, and range of motion, especially with biofeedback or cognitive strategies. Upper quarter strengthening reduced pain and disability, though optimal dosing remains unclear. Fitness-based interventions improved pain, function, and quality of life, with no clear superiority. Other exercises showed variable efficacy due to inconsistent methods and reporting. Overall, results supported exercise despite variability. Conclusion: Exercise is beneficial for neck pain management, but no single approach is superior. Tailored programs based on patient preferences, functional goals, and adherence are recommended. Registration: PROSPERO: CRD42022326257.

Duke Scholars

Author Derek James Clewley Orthopaedic Surgery, Physical Therapy