Background Clinical guidelines make vague recommendations as to exercise training (ET) type and dosage to manage chronic non-specific neck pain (CNSNP). Objective To synthesise evidence on the effectiveness of different ET programmes to reduce CNSNP and associated disability, and whether dosage affects outcomes. Methods A systematic review and data synthesis was conducted according to a published registered protocol (PROSPERO CRD42018096187). A sensitive topic-based search was conducted of CINAHL, MEDLINE, EMBASE, PEDro, grey literature sources and key journals from inception to 6 th January 2020 for randomised controlled trials, investigating ET for CNSNP or disability. Two reviewers independently completed eligibility screening, data extraction, risk of bias assessment (Cochrane Risk of Bias Tool) and rated the overall strength of evidence using Grading of Recommendations Assessment, Development and Evaluation. Data was tabulated for narrative synthesis and grouped by intervention, outcome and time point to compare across studies. Results Twenty-six trials from 3990 citations (n = 2288 participants) investigated fifteen ET programmes. High RoB and low sample sizes reduced evidence quality. Clinical heterogeneity prevented meta-analyses. A range of ET programmes reduce pain/disability in the short term (low to moderate evidence). Pillar exercises reduce pain/disability in the intermediate term (low level evidence). Moderate to very large pain reduction is found with ET packages

BackgroundResearch investigating Whiplash Associated Disorder (WAD) has largely focused on the cervical spine yet symptoms can be widespread. Thoracic spine pain prevalence is reported ~66%; perhaps unsurprising given the forceful stretch/eccentric loading of posterior structures of the spine, and the thoracic spine’s contribution to neck mobility/function. Approximately 50% WAD patients develop chronic pain and disability resulting in high levels of societal and healthcare costs. It is time to look beyond the cervical spine to fully understand anatomical dysfunction in WAD and provide new directions for clinical practice and research.PurposeTo evaluate the scope and nature of dysfunction in the thoracic region in patients with WAD.MethodsA systematic review and data synthesis was conducted according to a pre-defined, registered (PROSPERO, CRD42015026983) and published protocol. All forms of observational study were included. A sensitive topic-based search strategy was designed from inception to 1/06/16. Databases, grey literature and registers were searched using a study population terms and key words derived from scoping search. Two reviewers independently searched information sources, assessed studies for inclusion, extracted data and assessed risk of bias. A third reviewer checked for consistency and clarity. Extracted data included summary data: sample size and characteristics, outcomes, and timescales to reflect disorder state. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were tabulated to allow enabling a semi-qualitative comparison and grouped by outcome across studies. Strength of the overall body of evidence was assessed using a modified GRADE.ResultsThirty eight studies (n>50,000) which were conducted across a range of countries were included. Few authors responded to requests for further data (5 of 9 contacted). Results were reported in the context of overall quality and were presented for measures of pain or dysfunction and presented, where possible, according to WAD severity and time point post injury. Key findings include: 1) high prevalence of thoracic pain (>60%); higher for those with more severe presentations and in the acute stage, 2) low prevalence of chest pain (<22%), 3) evidence of thoracic outlet syndrome, with some association to and involvement of the brachial plexus, 4) muscle dysfunction in the form of heightened activity of the sternocleidomastoid or delayed onset of action of the serratus anterior, 5) high prevalence of myofascial pain and trigger points in the scalene muscles, sternocleidomastoid and mid/lower fibres of trapezius muscle (48–65%), and 6) inconclusive evidence of altered thoracic posture or mobility.ConclusionsConsiderable evidence supports thoracic pain and dysfunction in patients with WAD, involving primarily nerves and muscles. Notwithstanding the low/very low level of evidence from this review, our findings do support a more extensive clinical evaluation of patients presenting with WAD. Additional high quality research is required to further c...

IntroductionThe prevalence of neck pain is increasing rapidly with a high percentage of patients going on to experience recurrent or chronic symptoms. The resulting pain and disability are commonly managed using a variety of treatments including exercise. Resistance training exercise aimed at the neck and shoulders is advocated to treat chronic non-specific neck pain (CNSNP), however the dosage of prescribed exercise varies considerably between studies. The aim of this study is to evaluate the effectiveness of resistance training in CNSNP and to determine an optimal dosage that should be prescribed in clinical practice.Methods and analysisA systematic review with qualitative synthesis and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, PEDro, Zetoc, Index to Chiropractic Literature ChiroAcces, PubMed, grey literature sources and key journals will be searched. Randomised clinical trials investigating resistance training exercise in adults with CNSNP using outcome measures of pain and/or disability will be eligible for inclusion. Two reviewers will independently screen for eligibility, extract data and assess risk of bias (Cochrane risk of bias tool) with a third reviewer mediating in cases of disagreement. Data will be synthesised qualitatively to investigate intervention effectiveness and to determine the effect of exercise dosage on pain and disability. Meta-analysis using a random-effects model will be conducted where sufficient clinical homogeneity exists. The strength of the overall body of evidence will be assessed and reported using Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis study raises no ethical issues. Results will inform exercise prescription to improve management of CNSNP. Results will be published in a peer-reviewed journal and presented at conferences.PROSPERO registration numberCRD42018096187.

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