Ejercicio específico versus no específico para la musculatura extensora cervical en mujeres con dolor cervical crónico idiopáticoun ensayo clínico controlado aleatorizado

Abstract

Background: Structural and functional impairments of the cervical extensor muscles have been demonstrated in people with neck pain. A global exercise approach targeting all neck extensor muscles has shown positive effects in this population. However, to date, the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors. Objectives: To compare the effects on pain and disability of a specific lower deep neck extensors (EEIPC) versus a general neck extensor (EGC) exercise program in women with chronic idiopathic neck pain. Methods: Forty-three women with chronic idiopathic neck pain were randomly allocated to either a six-week EEIPC or a EGC exercise program. As primary outcome, neck disability was measured with the Neck Disability Index (NDI). Secondarily, pain intensity (VAS), cervical ROM, pressure pain thresholds (PPTs), cervical and thoracic posture and self-perceived benefit of treatment (GROC) were also measured. Every outcome was measured at baseline and immediately after treatment, except NDI, which was also measured at 6-months follow-up. The GROC was only assessed post-intervention. Results: Both interventions (EEIPC and EGC) resulted in a significant reduction in cervical disability immediately after the intervention (within-group mean difference (MD) = -6.09; 95% confidence interval (CI): -7.75, -4.42 and -4.73; 95% CI: -6.57, -2.91 respectively) and at 6-month follow-up (-4.47; 95% CI: -6.41, -2.53 and -4.74; 95% CI: -6.50, -2.97), but with no significant difference between the two groups. Pain intensity improved significantly after the intervention, with no significant differences between the two groups (within-group MD = -20.87 mm; 95% CI: -28.55, -13.19 and -18.00 mm; 95% CI: (-26.24, -9.76) for the EEIPC and EGC groups, respectively). Cervical ROM improved in all directions in both groups, with no significant differences between groups. A slightly greater increase in both local and remote PPTs was observed in the specific exercise group (EEIPC), with no statistically significant between-group differences. Posture measurements showed no significant effect with either exercise programme, except for the relaxed cervical angle where a main effect of time was observed between groups. GROC improved after both interventions with no significant difference between groups. Conclusions: A six-week exercise programme specifically targeting the lower deep extensors of the neck produces comparable results in terms of pain, disability, ROM and cervical posture and pain-to-pressure thresholds to those of a general exercise programme for the neck extensors over the medium term in women with idiopathic chronic neck pain.