How much exercise is enough to reduce neck pain in the workplace?
A randomized controlled trial investigated the dose-response relationship of specific training to reduce chronic neck pain and disability in the workplace environment. Female office workers with neck pain were randomized into 3 groups. The specific strength training group (SST, n=60) used an elastic rubber band to train the neck flexor muscles for a single set of 15 reps in each direction. The general fitness training group (GFT, n=58) exercised the neck flexor muscles by lifting the head from a supine position for 3 sets of 20 reps. Both groups performed dynamic exercises for the shoulders and upper body, trunk and leg exercises against body weight, a 20-min stretching session, relaxation and aerobic training, behavioural support to reduce fear of pain and increase motivation, and lectures in exercise and ergonomics. The control group (n=59) was advised to perform aerobic exercises and received instruction in home stretching. The initial program was delivered over a 12-day rehabilitation period by a trained physiotherapist. Participants continued with exercises at home disability. Based on the levels of activity, which were converted to metabolic equivalents (MET), the authors developed a recommendation for reduction
in pain and disability with increased exercise, summarized as:
“The training program was ineffective when performed 2x/week at a total load of less than 5 MET-h/wk. However, the same training was effective if it was performed 3x/week, for 8.75 MET-h/wk.”
Exercise interventions are effective for treatment of neck pain:
-For chronic neck pain, there is level 1a+ evidence (strongest) for a positive effect of all forms of exercise including strengthening, proprioceptive, individualized home, and multimodal combining physical agents (defined by the authors as ‘a comprehensive, multi-professional programme with a combination of treatment modalities, education, strengthening exercises and fitness training’) except range-of-motion.
-For acute neck pain, there is level 1a+ evidence for benefits of range-of-motion exercises, individualized home exercises, and multimodal interventions combining physical agents.
Physiotherapists work with the patient, the employer and other health care providers to facilitate successful return to work
Physiotherapists are experts in the assessment, diagnosis and treatment of musculoskeletal disorders; musculoskeletal complaints are second only to respiratory disorders as a cause of short-term sickness absence in developed countries. Whereas most patients return to work within one week and 90% return within 2 months, the longer a person is on sick leave the less likely he or she is to return to work. After 6 months off work, less than 50% of people will return to work, and after 2 years absence, there is little chance of return to work. These statistics represent a significant economic burden both directly (lost wages and productivity) and indirectly (costs of health care, short- and long-term disability).
There is alarming correlation between the number of hours spent seated in a day and the reported incidence of neck and lowback pain
Specific to the office setting, neck and low back pain are among the most common musculoskeletal disorders. Poor posture has been identified as a primary causative factor in musculoskeletal disorders and despite wide acceptance of this notion it remains largely poorly treated with exercise intervention alone. Posture is acquired over a period of time. It is the repetition of a series of joint movements resulting in set muscle firing patterns. Much like how a professional athlete acquires the ability to swing a golf club or tennis racquet well through repetition, posture (good or bad) is acquired similarly. Unlike golf or tennis however, sitting is a passive activity where we unknowingly become skilled at doing poorly. Unfortunately correcting posture must be an active process. This is a daunting task that physiotherapists can assist in employing short-term measures such as taping and bracing in order to make exercise intervention a possibility. Office workers may sit upwards of 5-6 hours/day while exercising just 30-60min/day. That is to say, office workers practice sitting (poorly) up to 5-6 hours/day while practicing just 30-60min/day to offset the abnormal muscle firing patterns that are developing while sitting. Though the sitting nature of a seated office worker will not likely change, physiotherapists can employ short-term measures to slow down the development of sitting-induced abnormal muscle firing patterns. Exercise interventions could then have an opportunity at reversing and restoring normal muscle firing patterns.
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