Therapeutic Exercises for Non-Specific Neck Pain
For patients with non-specific neck pain without red flags, implement supervised cervical and scapulothoracic strengthening exercises 3 times per week for a minimum of 4 weeks, combined with range-of-motion exercises and cervical manipulation or mobilization 1-2 times per week. 1
Exercise Protocol
Strengthening Exercises
- Cervical extensor strengthening should be performed as part of the core exercise program, targeting the muscles that support neck posture 1
- Scapulothoracic stabilization exercises are essential components of the therapeutic regimen, addressing the shoulder girdle muscles that influence neck mechanics 1
- These exercises demonstrate the strongest evidence base among therapeutic modalities for neck pain 2
Range-of-Motion Exercises
- Extension movements should be emphasized during range-of-motion training as part of the comprehensive exercise program 1
- Active movement is preferred over passive stretching to maintain functional mobility 1
Treatment Frequency and Duration
- Perform exercises 3 times per week for a minimum of 4 weeks as the initial treatment course 1
- Combine with manual therapy (cervical manipulation or mobilization) 1-2 times per week for 4 weeks for optimal outcomes 1
- This multimodal approach of exercise plus manual therapy is recommended before considering medication 1
Supporting Evidence Quality
The recommendation for exercise therapy is supported by multiple high-quality guidelines. Exercise, mobilization, and manipulation have the greatest support in the literature for neck pain management 2. The Danish Health Authority guidelines, based on GRADE methodology, specifically suggest different types of supervised exercise and manual therapy, as well as combinations of exercise and manual therapy before medicine for non-specific neck pain 3.
Interventions to Avoid
- Do NOT use cervical traction, TENS, or laser therapy due to insufficient evidence of effectiveness 1, 2
- Thermal treatments (including therapeutic ultrasound) and electrical therapies have little evidence of effectiveness and no evidence for more than transient benefit 2
- Soft collars are generally ineffective for non-specific neck pain 2
Monitoring and Reassessment
- Reassess pain, disability, and range of motion at 4 weeks to determine treatment response 1
- Most acute neck pain resolves within 6 weeks, though approximately 50% may have residual or recurrent episodes up to 1 year 1, 4
- If symptoms persist beyond 3 months despite appropriate conservative management, consider MRI to evaluate for structural pathology 1
Critical Clinical Context
Approximately 75-90% of patients with cervical radiculopathy achieve symptomatic relief with nonoperative conservative therapy, emphasizing the effectiveness of this exercise-based approach 1. The key is consistent, supervised implementation rather than passive modalities that lack evidence.