Blomgren Johannes, Strandell Erika, Jull Gwendolen, Vikman Irene, Röijezon Ulrik
Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia.
BMC Musculoskelet Disord. 2018 Nov 28;19(1):415. doi: 10.1186/s12891-018-2324-z.
BACKGROUND: Neck pain is a major health issue with high rates of recurrence. It presents with a variety of altered sensorimotor functions. Exercise is a cornerstone of rehabilitation and many training methods are used. Exercise is evaluated in most randomized controlled trials on its pain relieving effects. No review has assessed the effect of exercise on the altered physiological functions or determined if there are differential effects of particular training methods. This review investigated the effects of deep cervical flexor (DCF) training, a training method commonly used for patients with neck pain, and compared it to other training methods or no training on outcomes of cervical neuromuscular function, muscle size, kinematics and kinetics. METHODS: Web of Science, Scopus, CINAHL, PubMed were searched from inception until January 2018. Twelve randomized controlled trials were included that compared DCF training as sole intervention to other training or no interventions in persons with neck pain. The Cochrane Risk of Bias tool was used to assess the method quality. All outcome measures were analysed descriptively and meta-analyses were performed for measures evaluated in three or more studies. RESULTS: DCF training was compared to cervical endurance, strength, proprioception and mobility training, muscle stretching, and no intervention control groups. Physiological outcome measures included neuromuscular co-ordination (craniocervical flexion test), functional tasks, muscle fatigability, muscle size, kinematics (joint position sense, posture and range of motion) and kinetics (strength, endurance and contraction accuracy). Strong evidence was found for effectiveness of DCF training on neuromuscular coordination, but it had no or small effects on strength and endurance at higher loads. DCF training improved head and cervical posture, while evidence was limited or contradictory for other measures. CONCLUSIONS: DCF training can successfully address impaired neuromuscular coordination, but not cervical flexor strength and endurance at higher contraction intensities. A multimodal training regime is proposed when the aim is to specifically address various impaired physiological functions associated with neck pain.
背景：颈部疼痛是一个复发率很高的主要健康问题。它表现为各种感觉运动功能的改变。运动是康复的基石，人们使用了多种训练方法。在大多数随机对照试验中，运动都是根据其止痛效果进行评估的。尚无综述评估运动对改变的生理功能的影响，也未确定特定训练方法是否有不同效果。本综述研究了颈深屈肌（DCF）训练（一种常用于颈部疼痛患者的训练方法）的效果，并将其与其他训练方法或不进行训练对颈椎神经肌肉功能、肌肉大小、运动学和动力学结果的影响进行了比较。 方法：检索了Web of Science、Scopus、CINAHL、PubMed数据库，检索时间从建库至2018年1月。纳入了12项随机对照试验，这些试验比较了将DCF训练作为唯一干预措施与其他训练或不干预对颈部疼痛患者的影响。使用Cochrane偏倚风险工具评估方法质量。对所有结局指标进行描述性分析，并对三项或更多研究中评估的指标进行荟萃分析。 结果：将DCF训练与颈部耐力、力量、本体感觉和活动度训练、肌肉拉伸以及无干预对照组进行了比较。生理结局指标包括神经肌肉协调性（颅颈屈曲试验）、功能任务、肌肉易疲劳性、肌肉大小、运动学（关节位置觉、姿势和活动范围）和动力学（力量、耐力和收缩准确性）。有强有力的证据表明DCF训练对神经肌肉协调性有效，但对较高负荷下的力量和耐力没有影响或影响较小。DCF训练改善了头部和颈部姿势，而其他指标的证据有限或相互矛盾。 结论：DCF训练可以成功解决神经肌肉协调性受损的问题，但不能解决较高收缩强度下的颈屈肌力量和耐力问题。当目标是专门解决与颈部疼痛相关的各种受损生理功能时，建议采用多模式训练方案。
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