Effectiveness of a standardised exercise programme for recurrent neck and low back pain: a multicentre, randomised, two-arm, parallel group trial across 34 fitness clubs in Finland

Abstract

Background: Neck and low back pain (LBP) are common in office workers. Exercise trials to reduce neck and LBP conducted in sport sector are lacking. We investigated the effectiveness of the standardised Fustra20Neck&Back exercise program for reducing pain and increasing fitness in office workers with recurrent non-specific neck and/or LBP.

Method: Volunteers were recruited through newspaper and Facebook. The design is a multi-centre randomised, two-arm, parallel group trial across 34 fitness clubs in Finland. Eligibility was determined by structured telephone interview. Instructors were specially educated professionals. Neuromuscular exercise was individually guided twice weekly for 10 weeks. Webropol survey, and objective measurements of fitness, physical activity, and sedentary behavior were conducted at baseline, and at 3 and 12 months. Mean differences between study groups (Exercise vs Control) were analysed using a general linear mixed model according to the intention-to-treat principle.

Results: At least moderate intensity pain (≥40 mm) in both the neck and back was detected in 44% of participants at baseline. Exercise compliance was excellent: 92% participated 15-20 times out of 20 possible. Intensity and frequency of neck pain, and strain in neck/shoulders decreased significantly in the Exercise group compared with the Control group. No differences in LBP and strain were detected. Neck/shoulder and trunk flexibility improved, as did quality of life in terms of pain and physical functioning.

Conclusions: The Fustra20Neck&Back exercise program was effective for reducing neck/shoulder pain and strain, but not LBP. Evidence-based exercise programs of sports clubs have potential to prevent persistent, disabling musculoskeletal problems.

Keywords: neuromuscular; physical fitness; public health; sports & exercise medicine; sports rehabilitation programs.

Figure 1

Study protocol and the flow of participants at different stages of the study.

Figure 2

Changes in intensity and frequency of pain and work-induced local musculoskeletal strain between baseline, 3-month and 12-month follow-up. (A) Intensity of neck pain and (B) intensity of low back pain; lower number indicates positive outcome and ≥15mm change indicates minimal important change. (C) Frequency of neck pain and (D) frequency of low back pain; proportion with daily or almost daily pain, lower number indicates positive outcome. (E) Local strain in neck and shoulders and (F) local strain in upper and lower back; Numeric Rating Scale (0–6), sum score of two locations (0–12), smaller number indicates positive outcome.

Figure 3

Changes in physical fitness between baseline, 3-month and 12-month follow-up: (A) Mobility limitations in neck-shoulder area; % with severe limitations, lower number indicates positive change. (B) Flexibility in trunk side-bending; average of right and left side (cm), higher number indicates positive change. (C) Upper-body strength and trunk stability; number of modified push-ups in 40 s, higher number indicates positive change. (D) Lower extremity endurance; endurance time in static squat position, higher number indicates positive change. (E) Cardiorespiratory fitness measured with 6 min walk test; distance walked, higher number indicates positive change. (F) Static balance in one-leg stand; time managed to stand still, higher number indicates positive change.

Figure 4

Changes in quality of life between baseline, 3-month and 12-month follow-up: (A) pain, (B) physical functioning, (C) general health, (D) role limitations due to physical health, (E) energy and (F) emotional well-being; higher number indicates positive change.