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Aktives Nackenmuskeltraining in der Behandlung chronischer Nackenschmerzen bei Frauen

Eine randomisierte kontrollierte Studie

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Zusammenfassung

Aktives körperliches Training ist eine weitverbreitete Therapie für Patienten mit chronischen Nackenschmerzen; bisher konnte dessen Wirksamkeit jedoch noch nicht in randomisierten Studien nachgewiesen werden. Ziel dieser Studie war es, die Wirksamkeit von intensivem isometrischem Nackenmuskeltraining und leichterem Ausdauertraining zu evaluieren. Wir führten eine Untersucher-verblindete randomisierte kontrollierte Studie von Februar 2000 bis März 2002 durch. Die Teilnehmer wurden von betriebsärztlichen Einrichtungen in Süd- und Ostfinnland rekrutiert, wobei 180weibliche Büroangestellte zwischen 25 und 53 Jahren mit chronischen unspezifischen Nackenschmerzen untersucht wurden. Die Patientinnen wurden randomisiert entweder einer von zwei Trainingsgruppen oder der Kontrollgruppe zugeteilt. Die Ausdauertrainingsgruppe führte dynamische Nackenmuskelübungen durch (Anheben des Kopfes, ausgehend von Supinations- und Pronationshaltung). Die Krafttrainingsgruppe betrieb intensive isometrische Übungen zur Kräftigung und Stabilisierung der Nackenmuskulatur mit Hilfe eines elastischen Bandes. Beide Trainingsgruppen führten dynamische Übungen für Schultern und Arme mit Hanteln durch. Alle Gruppen wurden angewiesen regelmäßig 3-mal pro Woche Aerobic und Stretching zu betreiben. Schmerzen und Störungen im Nackenbereich wurden mit Hilfe einer visuellen Analogskala, des Index für Schmerzen und Störungen an Nacken und Schulter sowie des Vernon-Index für Nackenbeschwerden festgestellt. Während der Studie wurde die Stimmungslage bezüglich Depressionen berücksichtigt sowie die maximale Nackenmuskelkraft und das Bewegungsausmaß der Nackenmuskulatur. Nach 12-monatiger Studiendauer hatten Schmerzen und Störungen im Nackenbereich in beiden Trainingsgruppen statistisch signifikant abgenommen im Vergleich zur Kontrollgruppe (p<0.005). In der Gruppe des Krafttrainings fand sich eine Verbesserung der Flexion um 110%, der Rotation um 76% und der Extension um 69%. Dem standen Ergebnisse der Ausdauergruppe von 28%, 29% und 16% und der Kontrollgruppe von 10%, 10% und 7% gegenüber. Auch das Bewegungsausmaß der Rotation hatte sich in beiden Trainingsgruppen statistisch signifikant verbessert verglichen mit der Kontrollgruppe. Statistisch signifikante Verbesserungen der Lateralflexion, der Flexion und der Extension wies jedoch nur die Krafttrainingsgruppe auf.

Abstract

Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies. This study evaluates the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles to alleviate pain and disability in women with chronic, nonspecific neck pain. An examiner-blinded randomized controlled trial was conducted between February 2000 and March 2002. A total of 180 female office workers aged 25–53 years with chronic, nonspecific neck pain were recruited from occupational health care systems in southern and eastern Finland. The patients were randomly assigned to either two training groups or to a control group with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly three times a week. Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures. At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<0.005). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the training group had statistically significant improvements in lateral flexion and in flexion and extension.

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Danksagung.

❚We thank the staff of Punkaharju Rehabilitation Center, especially physiotherapists Leena Nyrhinen and Tuula Lavonen and exercise physiologist Tapio Löppönen. We also thank physiotherarist Juha Jalovaara for administering the tests to all the patients in the study.

Author information

Authors and Affiliations

  1. Finnisch Institute of Occupational Health, Helsinki, Finnland

    E. P. Takala

  2. Punkaharju Rehabilitation Center, Punkajarju, Finnland

    M. Nykänen

  3. Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Jyväskylä, Finnland

    A. Häkkinen

  4. Department of Health Sciences, University of Jyvöskylä, Jyväskylä, Finnland

    E. Mälkiä

  5. Social Insurance Institution, Helsinki, Finnland

    T. Pohjolainen

  6. Social Insurance Institution, Helsinki, Finnland

    S. L. Karppi

  7. Rheumatism Foundation Hospital, Heinola, Finnland

    H. Kautiainen

  8. Department of Physical and Rehabilitaion Medicine, Kuopio University Hospital, Kuopio, Finnland

    O. Airaksinen

  9. Jyväskylä Central Hospital, Department of Physical and Rehabilitation Medicine, Keskussairaalantie 19, 40620, Jyväskylä, Finnland

    J. Ylinen

  10. Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Jyväskylä, Finnland

    J. Ylinen

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  1. J. Ylinen
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  2. E. P. Takala
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  3. M. Nykänen
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  4. A. Häkkinen
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  5. E. Mälkiä
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  6. T. Pohjolainen
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  7. S. L. Karppi
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  8. H. Kautiainen
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  9. O. Airaksinen
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Corresponding author

Correspondence to J. Ylinen.

Additional information

Diese Studie wurde von der Social Insurance Institution, Helsinki, Finland, finanziert.

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Ylinen, J., Takala, E.P., Nykänen, M. et al. Aktives Nackenmuskeltraining in der Behandlung chronischer Nackenschmerzen bei Frauen. Manuelle Medizin 41, 491–499 (2003). https://doi.org/10.1007/s00337-003-0268-2

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