The Efficacy of Neck Strengthening Exercises in Reducing Neck Pain in Office Workers
This section outlines the background of the research problem and the research questions. This section is important in developing a proper understanding of the need for the study and its contribution to office ergonomics in research and practice.
Office work is often characterised by repetitive work that can cause physical strain. Employees working on computers, machines such as printers and any other form or repetitive work are prone to different forms of injuries. Neck injuries are a common form of injury in the workplace. With increase in the time that office workers spend on their computers and going through paperwork, the frequency of neck injuries has increased (Ylinen, Takala, Nykänen et al, 2003).
Office workers spend up to ten hours in positions that risk their neck and back muscles. This strain is largely a result of tight deadlines and the highly competitive nature of the job market. Other non-professional factors such as playing games on office computers also contribute to the large periods of exposure to potential neck injuries (Sjogrena, Nissinenc, Salme, Markku, Vanharantae, & Esko, 2005). Workers that have neck pains may be forced to take sick leaves as they seek professional help. Since employers loose in such leaves, they tend to prefer timely return by their employees.
Timely management of neck pain or any other form of workplace injury is a shared goal between the employees and the employer especially in cases where the employees compensation is tied to the time they dedicate to their professional obligations. Insurers are also affected by neck pains. The frequency of occurrence of neck pains and the time taken by a client to recover affects the overall reimbursement (Falla, Jull, Russell, Vincenzino, & Hodges, 2007). Minimising the frequency of neck pains among clients and the pain management period is thus of importance to insurers.
Neck pains not only affect the time employees input in their work but may also have long-term effects that may affect productivity. In general, safer and healthful work environments are critical for optimal service delivery by employees (Tsauo, Lee, Hsu, Chen, & Chen, 2004). However, neck injuries due to ergonomic or other factors such as accidents may affect the quality of work. Employees in pain lack the physical and mental capability required to deliver services that meet the set expectations. In a service setting as an example, employees that are in pain have been shown to be more irate than employees that are not in pain. Another modality via which neck pains may affect productivity is high employee turnover. In workplaces where employees are prone to injuries, there is a high risk of employees leaving for safer or healthier workplaces (Leaver, 2010). Increased employee turnover reduces the chance of an organisation learning since such organisations have few employees that are experienced in the internal dynamics of the organisations.
High employee turnover has also been shown to impede innovation and collaboration within organisations (Skillgate, Bohman, Holm, Vingård, & Alfredsson, 2010). Neck pains may also result in reduced staff morale. Employees that are always absent due to workplace injuries and are aware of the risks of injury resulting from their professional obligations are more likely to display reduced initiative. This in the long term reduces their overall input into the productivity of their employers.
Work related muscoskeletal disorders (WMSDs) accounts for over 40% of all office workers compensation claims. This form of injury is responsible for loss of over 70000 workdays per year (Leaver, 2010). WMSDs develop over time and therefore the severity of any condition in this class may worsen with time (Green, 2008). This implies that the cost of managing problems such as neck pain in office workers increase with time and the employees will take longer times to return to work. The management of neck pains in an office setting can be reactive or proactive. Reactive strategies generally target managing the symptoms and pain once they occur. Proactive strategies generally target the conformance with ergonomics principles to avoid the risk of workplace injuries.
In addition, early reporting of symptoms by the employees is also important in reducing the risk of aggravating the resultant injury (Naz, & Yildirim, 2010). In some instance, simple changes in the work practices, workstation or even the nature of the job may reduce neck pain symptoms (Macaulay, Cameron, & Vaughan, 2007). However, such corrective strategies apply for few cases and are limited by employees’ willingness to report neck pains.
Physical conditioning programs that entail activities such as work hardening, work conditioning and exercise programs are often used with the aim of reducing the return to work time and improving the achievement of higher work functions. Such programs simulate or duplicate the office environment though in a safer and supervised environment (Ylinen, Takala, Nykanen, Hakkinen, Malkia, Pohjolainen, Karppi, Kautiainen, & Airaksinen, 2003). In so doing, the programs help injured workers develop relevant job performance skills and their physical conditioning. The strategies used in exercising target improvement in endurance, cardiovascular fitness, endurance levels, neck strength and overall employee fitness.
It is noteworthy that such programs differ from others such as patient care management, physiotherapy and pain clinics than generally target the reduction of pain symptoms and intensity. Clearly, the efficacy of the strategy used to either prevent or manage neck pains is of importance to the employees, their employers and insurers. Neck strengthening exercises are part of physical conditioning exercises and are often used to prevent and manage the symptoms associated with neck pain.
Past studies have evaluated the efficacy of work oriented neck pain management programs and even exercise therapy. However, these studies have either targeted the use of neck strengthening as a preventive measure or as a curative strategy. In addition, the perspectives adopted by the existing studies vary in that some focus on return to work whereas others focus on work as the key outcome (Viljanen, Malmivaara, Uitti, Rinne, Palmroos, & Laippala, 2003).
The research question is what is the efficacy of neck strengthening exercises in reducing neck pain among office workers? The focus of the research is thus on neck strengthening exercises among office workers. The effect of the exercise of neck pain is in reference to both the curative and the preventive aspects of management. Thus, the study encompasses both the curative and preventive aspects of neck strengthening exercises.
This section outlines the method that was used in addressing the research question. This section covers the search strategies, the inclusion criteria, quality assessment, data extraction and data analysis. It is noteworthy that a qualitative content analysis approach was adopted in addressing the research question. Under this approach, the study focuses primarily on the collection of secondary data from authentic and high quality sources. This approach is facilitated by the availability of and access to high quality studies focussing on the effects of neck exercises on various aspects relating to neck pain (Denzin, & Lincoln, 2011).
Locating and accessing high quality studies or information in the subject area is critical to the successful implementation of the adopted research design. Whereas the adopted research design allows the researcher to access and use rich data in addressing the research question, its success is affected by the search strategy used (Boeije, 2009). The focus of the search was online databases that focus on workplace and health issues. Electronic databases including PubMed, CINAHL, Academic search premier, ProQuest, Business source complete, MasterFILE Premier and Emerald were searched with the earliest inclusion date being January 2007.
The five-year period is set to ensure that the information used in the study is relevant to the current state of neck strengthening exercise. In searching the stated databases, the following keywords neck pain, office workers, neck exercises along with Boolean operators such as computer, laptops, workstations, office, Video display terminals, VDU were used. Furthermore, the search involved the use of the order (sort) by relevance utility offered by electronic databases. The focus of the search in most cases was on the first two pages returned by the search query. In addition, the abstract preview tool offered by the databases was used in scheming through the returned articles to determine their relevance.
It is not enough to access a wide array of data and studies on neck pain and neck strengthening exercises among office workers. The quality of the studies included in the research is critical to the overall validity and reliability of the findings presented by this paper. Due to this realisation, an inclusion criterion was formulated and implemented to ensure that the studies used were of high quality. The first inclusion criterion is only peer-reviewed papers were to be used in the study. Peer reviewing is a mechanism that helps in determining the authenticity of the information presented and the methods used by a study. Thus, peer reviewed articles offer greater levels of guarantee that the information presented by a paper is accurate and the methods used are valid. By focusing on peer-reviewed articles, the risk of transferring researcher biases from the studies into the research paper is minimised.
The second inclusion criterion is the papers to be used had to be journal articles. Journal articles are generally recent than books and contain focused content. The focus on journal articles thus ensures improved access to information that is highly relevant and attuned to the research question. In addition, this ensures that the studies and therefore data used are highly relevant to the research question. The third inclusion criteria is the studies used had to be relevant. To meet this criterion, two strategies were employed. First, the studies used had to be published within the last five years. Secondly, the abstract of the papers were schemed to determine their actual relevance to the research question. The last inclusion criterion is only studies published in English were to be included. This is a practical consideration aimed at facilitating the data extraction process since the researcher is well versed with the English language.
The quality assessment strategy applied in the study is a general preference for specific type of studies. First, studies that were controlled or randomised were given greater precedence to studies that lacked control measures and randomisation. Another important quality assessment strategy is that there was greater preference for primary research studies as opposed to secondary research studies and reviews. Lastly, studies that had large sample sizes were preferred to studies that had smaller sample sizes. Large sample size in this respect is defined as a sample equal to or greater than 30. These measures are aimed at ensuring that the level of bias carried into the research paper from the secondary data is kept at a minimum.
The data extraction focused mainly on the results and discussion sections of the articles used. Extraction involved determination of the relevance of the data or information presented to the research questions. The data extraction procedure was thus highly researcher dependent since the researcher has to read and determine the relevance of data items to the research question. In addition, the data extraction was guided by the need to support several themes relating to the research question. This is in line with the thematic (grounded theory) approach used in data analysis. Coding data items with respect to the themes that they supported also helped ease the data extraction process.
Data analysis involved the use of qualitative data analysis procedures specifically grounded theory. Under this approach, a theory or hypothesis is developed inductively from empirical data and findings. It is noteworthy that grounded theory is case rather than variable based thus the extensive use of themes and coding of data according to themes (Boeije, 2009). Axial and selective coding techniques were used in creating and relating themes. The main motivation for using grounded theory is its support for qualitative data analysis and use of rich data collected from different sources. However, the technique is limited by the fact that it is highly researcher dependent. The researcher is involved in determining the themes and the data to include which leaves room for subjective inclusion of data and therefore biases.
1363 papers were identified in the study. However, only 314 papers met inclusion criteria. After quality assessment, twenty articles that met the inclusion criteria were identified for review. All the papers reviewed focus on the effect of exercise of neck pain. However, the nature of the exercise differs and the background of the sample differs. Since the papers that were included met both the inclusion and the quality assessment criteria, it is expected that the papers were of high quality. This is supported by the fact that 80% of the studies reviewed had sample sizes over 30. In addition, 60% of the studies used randomisation whereas 65% of the studies had control groups. Ten studies used both control groups and randomisation. Furthermore, all the papers reviewed in the study are primary research papers. From this, it is evident that the search strategy and the quality assessment technique resulted in primary studies that are of high quality even though some were lacking with respect to randomisation and use of control groups.
In most studies, the results are contrasted across gender and the nature of the condition (Peolsson, & Kjellman, 2007). In most cases, neck pain is categorised as acute, chronic and non-specific (Peolsson, & Kjellman, 2007). In addition, the mean age of the participants when given ranged between 22 and 50 years. This range is within the expected age of the average office worker. Whereas some studies highlight the specific exercise that was used (as treatment), others generalise. Some studies consider confounding factors such as the specific nature of work done, the total number of hours per day or week in the working environment and prior back or neck surgery. Other aspects that are compared by the existing studies are medical versus self-exercise and prior and post intervention effect of exercise.
There is a statistically significant difference in the neck muscle strength gain after exercising regimen after 2, 6 and 12-month follow-ups (Ylinen, Hakjinen, Nykanen, Kautiainen, & Takala, 2007). The muscle strength gain is also shown to be a result of training and does not obstruct intensive training. It is also notable that the most gain or change in muscle strength is observed within the first two months of exercising (Andersen, Kjær, Søgaard, Hansen, Kryger, & Sjøgaard, 2008). There are concerns on employee ability to train if they have chronic neck pain. Though there is convergence by the studies that people with chronic neck pain can train effectively, gains in such cases can take up to 12 months (Andersen, Saervoll, Mortensen, Poulsen, Hannerz, & Zebis, 2011). Another issue that is brought out in the papers is the unclear implication of statistical significance on clinical gains. Statistically significant changes in muscle strength do not necessary imply clinical significance (Peolsson, & Kjellman, 2007).
The findings also assert that muscle neck exercises result in more clinically meaningful reduction in person with acute rather than chronic neck pain (Peolsson, & Kjellman, 2007). Primary sources of acute neck pain tend to be located in the nerves, intervertebral disks and ligaments whereas the aetiology of neck pain includes degeneration, stretch and contusion (Blangsted, Søgaard, Hansen, Hannerz, & Sjøgaard, 2008). The spontaneous recovery reported in people suffering from acute neck pain after neck strengthening exercises leads to the suggestion that nonspecific neck pain may be neuromuscular (Blangsted, Søgaard, Hansen, Hannerz, & Sjøgaard, 2008).
After neck training exercises, the means of all strength measures were found to lowly correlate significantly with change in pain and disability measures (Martel, Dugas, Dubois, & Descarreaux, 2011). The low correlation is attributed to the possible existence of multiple effects of muscle neck training beyond improved muscle strength measures (Martel, Dugas, Dubois, & Descarreaux, 2011). Another possible explanation offered is that increase of neck strength beyond the levels required for pain relief and performance of ordinary activity.
The training method used is influential on the neck strength gain measures (Martel, Dugas, Dubois, & Descarreaux, 2011). Training that emphasise on flexor and extensor muscles and the ration of these training regimens influence the rate of gain of neck muscle strength. The implication is that proper loading of muscles is critical to effective rehabilitation in persons recovering from neck pain.
There are concerns on the effects of the intensity of training on the treatment of neck pain. Most studies have findings showing that low intensity training of neck muscles that is often characterised by focus on shoulder and arm muscles may not be effective in the treatment of neck pain (Andersen, Kjær, Andersen, Hansen, Zebis, Hansen, & Sjøgaard, 2008). This is supported by studies asserting that the weight of the head may not be sufficient for neck training. However, other study findings reveal that the head weight is a sufficient load for women (Salo, Häkkinen, Kautiainen, & Ylinen, 2010).
This brings about the important role played by gender in determining the efficacy of the exercises. Another area of interest by the existing studies is the effect of intensive gym exercises focusing on the upper extremities on the strength and size of neck muscles. The findings reveal that though such exercises are likely to elicit isometric contractions of cervical muscles, they have no effect on the generalised neck muscle hypertrophy (Cleland, Mintken, Carpenter, Fritz, Glynn, Whitman, Childs, & Hancock, 2010). This shows that specific targeted muscle training for prolonged periods are required to induce neck muscle hypertrophy. This is supported by findings showing considerable neck strength improvements in persons undergoing training regimens that focused mainly on neck rotation (Martel, Dugas, Dubois, & Descarreaux, 2011).
However, the strengthening exercises for the shoulders and upper body such as press-ups have been shown to reduce pain arising from the trapezius muscles and improve the functionality of this muscle and therefore the neck (Häkkinen, Kautiainen, Hannonen, & Ylinen, 2008). Thus, though such exercises do not affect the size or strength of the muscles, they have a bearing on neck pain. It is noteworthy that the effect of such training is diminished within 5 weeks and the symptoms of neck pain may recur within 3 months (Ask, Strand, & Skouen, 2009). This implies that such exercises can be used as short term rather than long-term remedies to neck pain.
Even though no study has explored the effect of exercise on the onset of neck pain, there is evidence suggesting that repeated exercising of neck muscles reduces the likelihood of recurring symptoms. In a study comparing postural, dynamic neck muscle training, and home regimen training, it was shown that pain was reduced by up to 50% in both cases.
However, at the 12-month follow up, differences between the two groups that were reported after the 3-month intervention period were no longer significant (Bronfort, Evans, Anderson, Svendsen, Bracha, & Grimm, 2012). Studies in which training is continued regularly over 12-month period report significant differences between the two groups (Andersen, Andersen, Mortensen, Zebis, & Sjøgaard, 2011). The implication is that the long term outcomes of neck exercising on neck pain symptoms reduction is dependent on the continued engagement in the neck muscle training exercises.
The frequency of training is also influential on the effect of training on neck pain in the long term. In studies where subjects report training only once a week during the follow up year, muscle training is found to have no effect on the intensity of pain or neck disability (Olivier, du Toit, du Randt, & Venter, 2010). However, active training or training on average twice in a week results in reduced intensity of pain and reduced disability of the neck within the year (Voerman, Sandsjö, Vollenbroek-Hutten, Larsman, Kadefors, & Hermens, 2007; Peolsson, & Kjellman, 2007). The findings show that compliance with training instructions and effective continued engagement in neck training exercises may reduce the risk of neck pain.
The focus of the study is the efficacy of neck strengthening exercises in reducing neck pain among office workers. The mean age of the sample profiled in the reviewed studies falls within the expected age of the average office worker. Few studies focusing on the effects of neck exercises on neck pain target office workers. The focus in most studies is a specific gender or an occupation rather than office workers in general. The findings support the notion that specific targeted neck training exercises may increase muscle strength, reduce neck disability and reduce neck pain. Furthermore, there is evidence suggesting that non-neck exercise such as exercises targeting the upper body and the shoulder region may also result in reduced neck pain in the short term. Gains from such training can however not be sustained for over three months.
In the presence of increased risk of neck pain for instance within an office, the neck exercises can result in reduce pain through a number of mechanisms. First, such exercises increase the muscle strength and reduce neck disability. These aspects have been linked to neck pain. In addition, the neck exercises may increase the flexibility (hypertrophy) of the neck muscles thereby reducing the likelihood of injury and therefore pain. Furthermore, the exercises have a direct effect in reducing neck pain.
The efficacy of the neck strengthening exercises in reducing neck pain is however subject to a number of factors. First, the effect is not instantaneous since in almost all studies the reduced pain and reduced neck disability is significant after a three month period for acute neck pain. In patients with chronic neck pain, the exercises may be taken for periods of up to 12 months for realisation of significant reduction in neck pain. Another factor is that the neck strengthening exercises have differing effect depending on the training regimen.
Training that does not involve additional resistance on the head (use the head weight only) may not have the desired effect for males. Thus, the neck training exercise should be gender specific and developed with a clear understanding of the office workers’ needs. Lastly, the neck-training regimen should be constantly followed. Training should be done at a recommended frequency (2-3 times a week) for its efficacy in reducing pain to be realised in the long term. Thus, neck-strengthening exercises minimises neck pains and reduces the likelihood of recurring neck pains.
The overall finding from the study has multiple implications on the client in the workplace. First, since the neck training exercise reduce the risk of recurrent (redeveloping) neck symptoms, office workers should adopt and strictly follow neck-training regimens to reduce the risk of developing neck pain symptoms. The regimens should be developed in collaboration with a physical therapists or an expert in ergonomics. It is upon the office worker to ensure that the formulated regimens are strictly adhered to for favourable results. Another implication is office workers that use neck exercises in dealing with neck pains should not expect instantaneous results. It may take at least three months for the pains to subside. This in effect implies that neck exercises are an effective long term rather than short-term strategy for dealing with neck pain.
Avoiding neck pain through preventive strategies such as the implementation of ergonomics principles and neck-strengthening exercises is thus a better option for the office worker. Lastly, office workers should endeavour to ensure that they are in good physical and mental condition to reduce the frequency and intensity of neck pain.
There is evidence suggesting that nonspecific neck pain is largely neuromuscular and that upper body and shoulder training reduces neck pain. These suggest that office workers that maintain their neurological and muscular (physical) health are likely to avoid and deal with the neck pain. Neurological health is linked to healthy eating and good mental and emotional health that can be attained through avoiding stressors.
The research paper sought to determine the efficacy of neck strengthening exercises in reducing neck pain among office workers. The findings show that neck-strengthening exercises can reduce the likelihood of developing neck pain and reduce the intensity of the neck pain. However, the efficacy of the neck strengthening exercises is limited to acute neck pain and can only be realised after a significant period. In chronic neck pain cases, significant pain reduction from the neck strengthening exercises can be attained after one year. The neck training exercises must be specific to the needs of the client and should be done consistently. The findings imply that office workers should consider neck strengthening exercises as part of strategies aimed at preventing and dealing with neck pain.