• Jari Ylinen, Riku Nikander, Matti Nykänen, Hannu Kautiainen, and Arja Häkkinen.
• Department of Physical Medicine and Rehabilitation, Central Hospital of Central Finland, Jyväskylä, Finland. jari.ylinen@ksshp.fi
• J Rehabil Med. 2010 Apr 1;42(4):344-9.

ObjectiveTo compare the efficacy of three 12-month training programmes on headache and upper extremity pain in patients with chronic neck pain.MethodsA total of 180 female office workers, with chronic, non-specific neck pain were randomly assigned to 3 groups. The strength group performed isometric, dynamic and stretching exercises. The endurance group performed dynamic muscle and stretching exercises. The control group performed stretching exercises. Pain was assessed with a visual analogue scale. Each group was divided into 3 subgroups according to headache intensity.ResultsAt the 12-month follow-up headache had decreased by 69% in the strength group, 58% in the endurance group and 37% in the control group compared with baseline. Neck pain diminished most in the strength group with the most severe headache (p < 0.001). In the dose analysis, one metabolic equivalent per hour of training per week accounted for a 0.6-mm decrease in headache on the visual analogue scale. Upper extremity pain decreased by 58% in the strength group, 70% in the endurance group and 21% in the control group.ConclusionAll of the training methods decreased headache. However, stretching, which is often recommended for patients, was less effective alone than when combined with muscle endurance and strength training. Care must be taken in recommending the type of training to be undertaken by patients with severe cervicogenic headache.

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