Exercises for mechanical neck disorders

Abstract

Background: Neck pain is common, disabling and costly. Exercise is one treatment approach.

Objectives: To assess the effectiveness of exercises to improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain.

Search methods: We searched MEDLINE, MANTIS, ClinicalTrials.gov and three other computerized databases up to between January and May 2014 plus additional sources (reference checking, citation searching, contact with authors).

Selection criteria: We included randomized controlled trials (RCTs) comparing single therapeutic exercise with a control for adults suffering from neck pain with or without cervicogenic headache or radiculopathy.

Data collection and analysis: Two review authors independently conducted trial selection, data extraction, 'Risk of bias' assessment and clinical relevance. The quality of the evidence was assessed using GRADE. Meta-analyses were performed for relative risk and standardized mean differences (SMD) with 95% confidence intervals (CIs) after judging clinical and statistical heterogeneity.

Main results: Twenty-seven trials (2485 analyzed /3005 randomized participants) met our inclusion criteria.For acute neck pain only, no evidence was found.For chronic neck pain, moderate quality evidence supports 1) cervico-scapulothoracic and upper extremity strength training to improve pain of a moderate to large amount immediately post treatment [pooled SMD (SMDp) -0.71 (95% CI: -1.33 to -0.10)] and at short-term follow-up; 2) scapulothoracic and upper extremity endurance training for slight beneficial effect on pain at immediate post treatment and short-term follow-up; 3) combined cervical, shoulder and scapulothoracic strengthening and stretching exercises varied from a small to large magnitude of beneficial effect on pain at immediate post treatment [SMDp -0.33 (95% CI: -0.55 to -0.10)] and up to long-term follow-up and a medium magnitude of effect improving function at both immediate post treatment and at short-term follow-up [SMDp -0.45 (95%CI: -0.72 to -0.18)]; 4) cervico-scapulothoracic strengthening/stabilization exercises to improve pain and function at intermediate term [SMDp -14.90 (95% CI:-22.40 to -7.39)]; 5) Mindfulness exercises (Qigong) minimally improved function but not global perceived effect at short term. Low evidence suggests 1) breathing exercises; 2) general fitness training; 3) stretching alone; and 4) feedback exercises combined with pattern synchronization may not change pain or function at immediate post treatment to short-term follow-up. Very low evidence suggests neuromuscular eye-neck co-ordination/proprioceptive exercises may improve pain and function at short-term follow-up.For chronic cervicogenic headache, moderate quality evidence supports static-dynamic cervico-scapulothoracic strengthening/endurance exercises including pressure biofeedback immediate post treatment and probably improves pain, function and global perceived effect at long-term follow-up. Low grade evidence supports sustained natural apophyseal glides (SNAG) exercises.For acute radiculopathy, low quality evidence suggests a small benefit for pain reduction at immediate post treatment with cervical stretch/strengthening/stabilization exercises.

Authors' conclusions: No high quality evidence was found, indicating that there is still uncertainty about the effectiveness of exercise for neck pain. Using specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy may be beneficial. Research showed the use of strengthening and endurance exercises for the cervico-scapulothoracic and shoulder may be beneficial in reducing pain and improving function. However, when only stretching exercises were used no beneficial effects may be expected. Future research should explore optimal dosage.

Conflict of interest statement

Dr. Gert Bronfort is the first author of one of the trials included in this systematic review. He was not involved in the selection of studies, quality assessment, or data extraction for the study for which he was author.

Figures

1

Study flow diagram (PRISMA).

2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

3

Funnel plot of comparison: 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, outcome: 7.2 Pain Intensity: 10 to 20 weeks of treatment.

4

Forest plot of comparison: 1 Chronic MND: Breathing Patterns vs CONTROL, outcome: 1.1 Pain Intensity (Borg 0 to 10): 10 weeks of treatment vs Control.

5

Forest plot of comparison: 2 Acute to Chronic MND: General Fitness Training vs CONTROL, outcome: 2.2 Pain Intensity (VAS): 10 weeks of treatment + 10 weeks follow‐up.

6

Forest plot of comparison: 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM, outcome: 4.3 Pain Intensity (VAS): 8 weeks of treatment + 12 months follow‐up.

7

Forest plot of comparison for (sub)Acute/Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, outcome: Pain Intensity: 10 to 20 weeks of treatment.

8

Forest plot of comparison for Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, outcome: Pain Intensity (VAS): 24 weeks of treatment.

9

Forest plot of comparison for chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION in the outcome Function at intermediate term follow‐up.

1.1. Analysis

Comparison 1 Chronic MND: Breathing Patterns vs CONTROL, Outcome 1 Pain Intensity (Borg 0 to 10): 10 weeks of treatment vs Control.

1.2. Analysis

Comparison 1 Chronic MND: Breathing Patterns vs CONTROL, Outcome 2 Function (NDI 0 to 100): 10 weeks of treatment vs Control.

1.3. Analysis

Comparison 1 Chronic MND: Breathing Patterns vs CONTROL, Outcome 3 SF‐36 (physical function): 10 weeks of treatment vs Control.

2.1. Analysis

Comparison 2 Acute to Chronic MND: General Fitness Training vs CONTROL, Outcome 1 Pain Intensity (VAS): 10 weeks of treatment.

2.2. Analysis

Comparison 2 Acute to Chronic MND: General Fitness Training vs CONTROL, Outcome 2 Pain Intensity (VAS): 10 weeks of treatment + 10 weeks follow‐up.

4.1. Analysis

Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM, Outcome 1 Pain Intensity (VAS): 8 weeks of treatment.

4.2. Analysis

Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM, Outcome 2 Pain Intensity (VAS): 8 weeks of treatment + 6 month follow‐up.

4.3. Analysis

Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM, Outcome 3 Pain Intensity (VAS): 8 weeks of treatment + 12 months follow‐up.

4.4. Analysis

Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM, Outcome 4 Function (NDI): 8 weeks of treatment.

4.5. Analysis

Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM, Outcome 5 Function (NDI): 8 weeks of treatment + 6 month follow‐up.

4.6. Analysis

Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM, Outcome 6 Function (NDI): 8 weeks of treatment + 12 month follow‐up.

5.1. Analysis

Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION OR WAIT LIST, Outcome 1 Pain Intensity (VAS): 6 weeks of treatment.

5.2. Analysis

Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION OR WAIT LIST, Outcome 2 Pain Intensity (VAS): 6 weeks of treatment + 6 weeks follow‐up.

5.3. Analysis

Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION OR WAIT LIST, Outcome 3 Function (NPQ): 6 weeks of treatment.

5.4. Analysis

Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION OR WAIT LIST, Outcome 4 Function (NPQ): 6 weeks of treatment + 6 weeks follow‐up.

5.6. Analysis

Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION OR WAIT LIST, Outcome 6 Quality of Life (SF‐36): 6 weeks of treatment + 6 w follow‐up.

6.1. Analysis

Comparison 6 Chronic MND: Pattern synchronization (sitting posture) vs CONTROL, Outcome 1 Pain intensity (VAS) 2 weeks of treatment.

6.2. Analysis

Comparison 6 Chronic MND: Pattern synchronization (sitting posture) vs CONTROL, Outcome 2 Function (NDI): 2 weeks of treatment.

7.1. Analysis

Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 1 Pain Intensity (NPS): 4 weeks of treatment.

7.2. Analysis

Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 2 Pain Intensity: 10 to 20 weeks of treatment.

7.3. Analysis

Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 3 Pain Intensity: 20 weeks of treatment.

7.4. Analysis

Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 4 Pain Intensity (VAS): 10 weeks of treatment + 10 weeks follow‐up.

7.5. Analysis

Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 5 Function: 4 weeks of treatment.

7.6. Analysis

Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 6 Function: 20 weeks of treatment.

7.7. Analysis

Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 7 Function: 12 to 20 weeks of treatment/follow‐up.

8.1. Analysis

Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 1 Pain Intensity (VAS): 8 weeks of treatment.

8.2. Analysis

Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 2 Pain Intensity (VAS): 8 weeks of treatment + 6 month follow‐up.

8.3. Analysis

Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 3 Pain Intensity (VAS): 8 weeks of treatment + 12 month follow‐up.

8.4. Analysis

Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 4 Function (NDI): 8 weeks of treatment.

8.5. Analysis

Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 5 Function (NDI): 8 weeks of treatment + 6 month follow‐up.

8.6. Analysis

Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 6 Function (NDI): 8 weeks treatment + 12 month follow‐up.

9.1. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 1 Pain Intensity: Immediate Post Treatment (

9.2. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 2 Pain Intensity: 11 w of treatment + 3 month follow‐up.

9.3. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 3 Pain Intensity: Treatment + IT follow‐up (11 weeks of treatment + 6 month follow‐up.

9.4. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 4 Pain Intensity: Treatment + LT follow‐up.

9.5. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 5 Function: Immediate Post treatment.

9.6. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 6 Function: Treatment + ST follow‐up.

9.7. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 7 Function: Treatment + IT follow‐up.

9.8. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 8 Function: Treatment + LT follow‐up.

9.9. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 9 Quality of Life: Immediate Post Treatment.

9.10. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 10 Quality of Life: Treatment + ST follow‐up.

9.11. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 11 Quality of Life: Treatment + IT follow‐up.

9.12. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 12 Quality of Life: Treatment + LT follow‐up.

9.13. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 13 Patient Satisfaction: Immediate Post Treatment.

9.14. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 14 Patient Satisfaction: Treatment + ST follow‐up.

9.15. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 15 Patient Satisfaction: Treatment + IT follow‐up.

9.16. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 16 Patient Satisfaction: Treatment + LT follow‐up.

9.17. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 17 Global Perceived Effect: Immediate Post Treatment.

9.18. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 18 Global Perceived Effect: Treatment + ST follow‐up.

9.19. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 19 Global Perceived Effect: Treatment + IT follow‐up.

9.20. Analysis

Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/‐UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME INTERVENTION, Outcome 20 Global Perceived Effect: Treatment + LT follow‐up.

10.1. Analysis

Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 1 Pain Intensity (VAS): 12 weeks of treatment.

10.2. Analysis

Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 2 Pain Intensity (VAS): 24 weeks of treatment.

10.3. Analysis

Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 3 Function: 12 weeks of treatment.

10.4. Analysis

Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 4 Function: 24 weeks of treatment.

10.5. Analysis

Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 5 Global Perceived Effect (General Health Perception): 12 weeks of treatment.

10.6. Analysis

Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 6 Global Perceived Effect (General Health Perception): 12 weeks of treatment + 12 weeks follow‐up.

10.7. Analysis

Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 7 Quality of Life (SF‐36): 12 weeks of treatment.

10.8. Analysis

Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 8 Quality of Life (SF‐36): 24 weeks of treatment.

11.1. Analysis

Comparison 11 Chronic MND: Cervical/Scapulothoracic/UE Stretch + UE Endurance Training vs NO INTERVENTION or WAIT LIST, Outcome 1 Pain Intensity (VAS): 12 weeks of treatment.

11.2. Analysis

Comparison 11 Chronic MND: Cervical/Scapulothoracic/UE Stretch + UE Endurance Training vs NO INTERVENTION or WAIT LIST, Outcome 2 Pain Intensity (VAS): 12 weeks of treatment + 3 month follow‐up.

11.3. Analysis

Comparison 11 Chronic MND: Cervical/Scapulothoracic/UE Stretch + UE Endurance Training vs NO INTERVENTION or WAIT LIST, Outcome 3 Pain Intensity (VAS): 12 weeks of treatment + 9 month follow‐up.

11.4. Analysis

Comparison 11 Chronic MND: Cervical/Scapulothoracic/UE Stretch + UE Endurance Training vs NO INTERVENTION or WAIT LIST, Outcome 4 Function (Neck Disability 0‐80): 12 weeks of treatment.

11.5. Analysis

Comparison 11 Chronic MND: Cervical/Scapulothoracic/UE Stretch + UE Endurance Training vs NO INTERVENTION or WAIT LIST, Outcome 5 Function (Neck Disability 0‐80): 12 weeks of treatment + 3 month follow‐up.

11.6. Analysis

Comparison 11 Chronic MND: Cervical/Scapulothoracic/UE Stretch + UE Endurance Training vs NO INTERVENTION or WAIT LIST, Outcome 6 Function (Neck Disability 0‐80): 12 weeks of treatment + 9 month follow‐up.

12.1. Analysis

Comparison 12 Acute to Chronic MND: Pattern synchronization + cervical/scapulothoracic strengthening + scapulothoracic endurance vs NO INTERVENTION, Outcome 1 Pain Intensity (VAS 0 to 10): 24 weeks of treatment.

13.1. Analysis

Comparison 13 Chronic MND: Cervical/Scapulothoracic Strengthening + Cervical/Scapulothoracic Endurance Training, Outcome 1 Pain Prevelance during previous week: 6 weeks of treatment + 46 weeks follow‐up.

14.1. Analysis

Comparison 14 Acute to Chronic MND: Scapulothoracic/UE Endurance Training vs CONTROL, Outcome 1 Pain Intensity (VAS): 10 weeks treatment.

15.1. Analysis

Comparison 15 Chronic MND: Neuromuscular Education (eye neck coordination/proprioception) + ANOTHER INTERVENTION VS THAT SAME INTERVENTION, Outcome 1 Pain Intensity (VAS): 8 weeks treatment + 10 weeks follow‐up.

15.2. Analysis

Comparison 15 Chronic MND: Neuromuscular Education (eye neck coordination/proprioception) + ANOTHER INTERVENTION VS THAT SAME INTERVENTION, Outcome 2 Function (pt's assessment of functional improvement): 8 weeks treatment + 10 weeks follow‐up.

16.1. Analysis

Comparison 16 Chronic MND:Trunk/Extremity Stretch + Pattern/Synchronization: Balance and Coordination + Cardiovascular/Aerobic vs NO TREATMENT, Outcome 1 Pain Intensity (VAS): 10 weeks of treatment.

17.1. Analysis

Comparison 17 Chronic MND:General Endurance Training + Dynamic/Static Lowback/pelvic Stabilization + General Stretching + Neuromuscular/body Mechanics Movement Training vs NO INTERVENTION OR WAIT LIST, Outcome 1 Pain Intensity (VAS): 16 weeks treatment + 6 weeks follow‐up.

18.1. Analysis

Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 1 Pain Intensity (VAS): 12 weeks of treatment.

18.2. Analysis

Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 2 Pain Intensity (VAS): 24 weeks of treatment.

18.3. Analysis

Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 3 Function: 12 weeks of treatment.

18.4. Analysis

Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 4 Function: 24 weeks of treatment.

18.5. Analysis

Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 5 Global Perceived Effect (General Health Perception): 12 weeks of treatment.

18.6. Analysis

Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 6 Global Perceived Effect (General Health Perception): 12 weeks of treatment + 12 weeks Follow‐up.

18.7. Analysis

Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 7 Quality of Life (SF‐36 physical component): 12 weeks of treatment.

18.8. Analysis

Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 8 Quality of Life: 24 weeks of treatment.

19.1. Analysis

Comparison 19 Subacute to chronic WAD: Trunk/Extremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/Extremity Endurance Training + Pattern/Synchronization: Coordination + Cardiovascular/Aerobic + Cognitive (CBT) + ANOTHER TREATMENT vs THAT SAME OTHER TREATMENT, Outcome 1 Pain Intensity: (0‐10 box scale): 6 weeks of treatment.

19.2. Analysis

Comparison 19 Subacute to chronic WAD: Trunk/Extremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/Extremity Endurance Training + Pattern/Synchronization: Coordination + Cardiovascular/Aerobic + Cognitive (CBT) + ANOTHER TREATMENT vs THAT SAME OTHER TREATMENT, Outcome 2 Pain Intensity (0‐10 box scale): 6 weeks treatment + 12 month follow‐up.

19.3. Analysis

Comparison 19 Subacute to chronic WAD: Trunk/Extremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/Extremity Endurance Training + Pattern/Synchronization: Coordination + Cardiovascular/Aerobic + Cognitive (CBT) + ANOTHER TREATMENT vs THAT SAME OTHER TREATMENT, Outcome 3 Function (NDI): 6 weeks of treatment.

19.4. Analysis

Comparison 19 Subacute to chronic WAD: Trunk/Extremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/Extremity Endurance Training + Pattern/Synchronization: Coordination + Cardiovascular/Aerobic + Cognitive (CBT) + ANOTHER TREATMENT vs THAT SAME OTHER TREATMENT, Outcome 4 Function (NDI): 6 weeks of treatment + 12 month follow‐up.

19.5. Analysis

Comparison 19 Subacute to chronic WAD: Trunk/Extremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/Extremity Endurance Training + Pattern/Synchronization: Coordination + Cardiovascular/Aerobic + Cognitive (CBT) + ANOTHER TREATMENT vs THAT SAME OTHER TREATMENT, Outcome 5 Global Perceived Effect (‐5 to 5 scale): 6 weeks of treatment.

19.6. Analysis

Comparison 19 Subacute to chronic WAD: Trunk/Extremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/Extremity Endurance Training + Pattern/Synchronization: Coordination + Cardiovascular/Aerobic + Cognitive (CBT) + ANOTHER TREATMENT vs THAT SAME OTHER TREATMENT, Outcome 6 Global Perceived Effect (‐5 to 5 scale): 6 weeks of treatment + 12 month follow‐up.

19.7. Analysis

Comparison 19 Subacute to chronic WAD: Trunk/Extremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/Extremity Endurance Training + Pattern/Synchronization: Coordination + Cardiovascular/Aerobic + Cognitive (CBT) + ANOTHER TREATMENT vs THAT SAME OTHER TREATMENT, Outcome 7 Quality of Life (SF‐36): 6 weeks of treatment.

19.8. Analysis

Comparison 19 Subacute to chronic WAD: Trunk/Extremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/Extremity Endurance Training + Pattern/Synchronization: Coordination + Cardiovascular/Aerobic + Cognitive (CBT) + ANOTHER TREATMENT vs THAT SAME OTHER TREATMENT, Outcome 8 Quality of Life (SF‐36): 6 weeks of treatment + 12 month follow‐up.

20.1. Analysis

Comparison 20 Acute to Subacute CGH: Cervical Stretch/ROM vs SHAM, Outcome 1 Pain Intensity (Headache Questionnaire): Treatment + 4 weeks follow‐up.

20.2. Analysis

Comparison 20 Acute to Subacute CGH: Cervical Stretch/ROM vs SHAM, Outcome 2 Pain Intensity (Headache Questionnaire): Treatment + 12 month follow‐up.

21.1. Analysis

Comparison 21 Chronic CGH: Cervical/Scapulothoracic Strengthening with Endurance Training + Craniocervical Pressure Biofeedback + Dynamic Cervical Stabilization vs NO INTERVENTION or WAIT LIST, Outcome 1 Headache Intensity (VAS 0‐10): 6 weeks of treatment.

21.2. Analysis

Comparison 21 Chronic CGH: Cervical/Scapulothoracic Strengthening with Endurance Training + Craniocervical Pressure Biofeedback + Dynamic Cervical Stabilization vs NO INTERVENTION or WAIT LIST, Outcome 2 Headache Intensity (VAS 0‐10): 6 weeks treatment + 12 month follow‐up.

21.3. Analysis

Comparison 21 Chronic CGH: Cervical/Scapulothoracic Strengthening with Endurance Training + Craniocervical Pressure Biofeedback + Dynamic Cervical Stabilization vs NO INTERVENTION or WAIT LIST, Outcome 3 Function (NPNPQ 0‐36): 6 weeks treatment.

21.4. Analysis

Comparison 21 Chronic CGH: Cervical/Scapulothoracic Strengthening with Endurance Training + Craniocervical Pressure Biofeedback + Dynamic Cervical Stabilization vs NO INTERVENTION or WAIT LIST, Outcome 4 Function (NPNPQ 0‐36): 6 weeks treatment + 12 month follow‐up.

21.5. Analysis

Comparison 21 Chronic CGH: Cervical/Scapulothoracic Strengthening with Endurance Training + Craniocervical Pressure Biofeedback + Dynamic Cervical Stabilization vs NO INTERVENTION or WAIT LIST, Outcome 5 Global Perceived Effect (VAS): 6 weeks treatment.

21.6. Analysis

Comparison 21 Chronic CGH: Cervical/Scapulothoracic Strengthening with Endurance Training + Craniocervical Pressure Biofeedback + Dynamic Cervical Stabilization vs NO INTERVENTION or WAIT LIST, Outcome 6 Global Perceived Effect (VAS): 6 weeks treatment + 12 month follow‐up.

22.1. Analysis

Comparison 22 Acute Radiculopathy (NDR): Cervical Stretch/ROM + Cervical/Scapulothoracic/UE Strengthening + Static/Dynamic Cervical Stabilization vs WAIT LIST, Outcome 1 Pain Intensity (VAS): 6 weeks treatment.

22.2. Analysis

Comparison 22 Acute Radiculopathy (NDR): Cervical Stretch/ROM + Cervical/Scapulothoracic/UE Strengthening + Static/Dynamic Cervical Stabilization vs WAIT LIST, Outcome 2 Pain Intensity (VAS): 6 weeks treatment + 6 month follow‐up.

22.3. Analysis

Comparison 22 Acute Radiculopathy (NDR): Cervical Stretch/ROM + Cervical/Scapulothoracic/UE Strengthening + Static/Dynamic Cervical Stabilization vs WAIT LIST, Outcome 3 Function (NDI): 6 weeks treatment.

22.4. Analysis

Comparison 22 Acute Radiculopathy (NDR): Cervical Stretch/ROM + Cervical/Scapulothoracic/UE Strengthening + Static/Dynamic Cervical Stabilization vs WAIT LIST, Outcome 4 Function (NDI): 6 weeks treatment + 6 month follow‐up.

22.5. Analysis

Comparison 22 Acute Radiculopathy (NDR): Cervical Stretch/ROM + Cervical/Scapulothoracic/UE Strengthening + Static/Dynamic Cervical Stabilization vs WAIT LIST, Outcome 5 Satisfaction (5 point scale): 6 weeks treatment.

23.1. Analysis

Comparison 23 Chronic MND: Patterns synchronization + Feedforward/feedback: vestibular rehabilitation (balance on unstable surfaces and walking with head movements and eyes closed) vs NO INTERVENTION, Outcome 1 Pain Intensity (VAS) 6 weeks vs Control.

23.2. Analysis

Comparison 23 Chronic MND: Patterns synchronization + Feedforward/feedback: vestibular rehabilitation (balance on unstable surfaces and walking with head movements and eyes closed) vs NO INTERVENTION, Outcome 2 Pain Intensity (VAS) 3 months vs control.

24.1. Analysis

Comparison 24 Chronic MND: Patterns synchronization + Feedforward/feedback: exercises for coordinating the neck, eyes and upper limbs vs NO INTERVENTION, Outcome 1 Pain intensity (VAS) 4 weeks vs Control.