Skip to main content

Randomized Controlled Trial of Physiotherapy and Feldenkrais Interventions in Female Workers with Neck-Shoulder Complaints


The present study aimed to investigate whether physiotherapy or Feldenkrais interventions resulted in a reduction of complaints from the neck and shoulders (prevalence, pain intensity, sick leave, and disability in leisure and work roles) in 97 female industrial workers (not on long-term sick leave). Range of motion of neck and shoulders, VO2, endurance score (i.e., summation of pain intensity ratings during a static shoulder flexion), cortical control according to the Feldenkrais methodology, and physiological capacity according to a dynamic endurance test of the shoulder flexors with simultaneous surface EMG were also recorded. The workers were randomized to: (1) physiotherapy group (PT-group; treatment according to the ergonomic program of the PTs of the occupational health care service), (2) Feldenkrais group (F-group; education according to the Feldenkrais methodology), or (3) control group (C-group; no intervention). Pre- and post-tests were made at one-year intervals. The two interventions lasted 16 weeks during paid working time. The F-group showed significant decreases in complaints from neck and shoulders and in disability during leisure time. The two other groups showed no change (PT-group) or worsening of complaints (C-group). The present study showed significant positive changes in complaints after the Feldenkrais intervention but not after the physiotherapy intervention. Possible mechanisms behind the effects in the F-group are discussed.

This is a preview of subscription content, access via your institution.


  1. 1.

    Gerdle B, Brulin C, Elert J, Eliasson P, Granlund B-M. Effect of a general fitness program on musculoskeletal symptoms, clinical status, physiological capacity and perceived work-environment among home care personnel. J Occup Rehab 1995; 5: 1–16.

    Google Scholar 

  2. 2.

    Kilbom Å, Hagberg M. Work-related musculoskeletal diseases-high risk jobs and risk factors (in swedish). Arbete & Hälsa 1990; 19: 1–45.

    Google Scholar 

  3. 3.

    Kilbom Å. Intervention programmes for work-related neck and upper limb disorders: strategies and evaluation. Ergonomics 1988; 31: 735–747.

    Google Scholar 

  4. 4.

    Beckerman H, Bouter LM, van der Heijden GJMG, De Bie RA, Koes BW. Efficacy of physiotherapy from musculoskeltal disorders: what can we learn from research? Br J Gen Prac 1993; 43: 73–77.

    Google Scholar 

  5. 5.

    Feine JS, Lund JP. An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain. Pain 1997; 71: 5–23.

    Google Scholar 

  6. 6.

    Koes BW, Assendelft WJJ, van der Heijden GJMG, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine 1996; 21: 2860–2871.

    Google Scholar 

  7. 7.

    Wigeus-Hjelm E, Hagberg M. Prevention of musculoskeletal disorders in nursing aides. A randomized stury of physical training. In: Hagberg, M. Kilbom A. eds. Proceedings from the international scientific conference on prevention of work-related musculoskeletal disorders. Arbete & Hälsa 1992; 17: 338–340.

  8. 8.

    Dyrssen T, Svedenkrans M, Paasikivi J. Muskelträning vid besvär i nacke och skuldror effektiv behandling för att minska smärtan. Sjukgymnasten 1989; No. 10: 12–15.

    Google Scholar 

  9. 9.

    Cady LD, Bischoff DP, O'Connell ER, Thomas PC, Allan JH. Strength and fitness and subsequent back injuries in fire fighters. J Occup Med 1979; 21: 269–272.

    Google Scholar 

  10. 10.

    Battié MC. The reliability of physical factors as predictors of the occurrence of back pain reports. Göteborg. Medical Dissertation, 1989.

  11. 11.

    Gyntelberg F. One-year incidence of low back pain among male residents of Copenhagen aged 40–49. Danish Med Bull 1974; 21: 30–36.

    Google Scholar 

  12. 12.

    Mostardi RA, Noe DA, Kovacik MW, Porterfield JA. Isokinetic lifting strength and occupational injury. Spine 1992; 17: 189–193.

    Google Scholar 

  13. 13.

    Troup JDG, Foreman TK, Baxter CE, Brown D. The perception of back pain and the role of psychological tests of lifting capacity. Spine 1987; 12: 645–657.

    Google Scholar 

  14. 14.

    Kellett KM, Kellett DA, Nordholm LA. Effects of an exercise program on sick leavel due to back pain. Phys Ther 1991; 71: 283–291.

    Google Scholar 

  15. 15.

    Mayer T, Gatchel R, Kishino N. Objective assessment of spine function following industrial injury. Spine 1985; 10: 482–483.

    Google Scholar 

  16. 16.

    Block AR. Multidisciplinary treatment of chronic low back pain: a review. Rehab Psych 1982; 27: 51–63.

    Google Scholar 

  17. 17.

    Bono SF, Zasa ML. Chronic low back pain and therapy: a critical review and overview. Behav Ther 1988; 11: 189–198.

    Google Scholar 

  18. 18.

    Hildebrandt J, Pfingsten M, Saur P, Jansen J. Prediction of success from a multidisciplinary treatment program for chronic low back pain. Spine 1997; 22: 990–1001.

    Google Scholar 

  19. 19.

    Fordyce WE, Fowler RS, Lehmann JF, Delateur BJ, Sand PL, Treischmann RB. Operant conditioning in the treatment of chronic pain. Arch Phys Med Rehabil 1973; 54: 399–408.

    Google Scholar 

  20. 20.

    Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P. Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 1997; 73: 177–185.

    Google Scholar 

  21. 21.

    Lunblad I. Preliminary Report. SödertN-0304;lje. Företagshälsov N-0304;rden, Scania, 1995.

    Google Scholar 

  22. 22.

    Hagberg M. Occupational musculoskeletal stress and disorders of the neck and shoulder: a review of possible pathophysiology. Int Arch Occup Environ Health 1984; 53: 269–278.

    Google Scholar 

  23. 23.

    Holmström EB, Lindell J, Moritz U. Low back and neck/shoulder pain in construction workers; occupational workload and psychosocial risk factors. Part 2: Relationship to neck and shoulder pain. Spine 1992; 17: 672–677.

    Google Scholar 

  24. 24.

    Armstrong TJ, Buckle P, Fine LJ, Hagberg M, Jonsson B, Kilbom Å, Kuorinka IA, Silverstein BA, Sjögaard G, Viikari-Juntura ERA. A conceptual model for work-related neck and upper-limb musculoskeletal. Scand J Work Environ Health 1993; 19: 73–84.

    Google Scholar 

  25. 25.

    Gerdle B, Elert J, Henriksson-Larsén K. Muscular fatigue during repeated isokinetic shoulder forward flexions in young females. Eur J Appl Physiol 1989; 58: 666–673.

    Google Scholar 

  26. 26.

    Elert J. The pattern of activation and relaxation during fatiguing isokinetic contractions in subjects with and without muscle pain. UmeÑ. Medical dissertation, 1991.

  27. 27.

    Elert J, Rantapää-Dahlqvist S, Henriksson-Larsén K, Lorentzon R, Gerdle B. Muscle performance, electromyography and fibre type composition in fibromyalgia and work-related myalgia. Scand J Rheumatol 1992; 21: 28–34.

    Google Scholar 

  28. 28.

    Fredin Y, Elert J, Britschgi N, Vaher A, Gerdle B. A decreased ability to relax between repetitive muscle contractions in patients with chronic symptoms after whiplash trauma of the neck. J Musculoskel Pain 1997; 5: 55–70.

    Google Scholar 

  29. 29.

    Elert J, Rantapää-Dahlqvist S-B, Almay B, Eisemann M. Muscle endurance, muscle tension and personality traits in patients with muscle or joint pain—a pilot study. J Rheumatol 1993; 20: 1550–1556.

    Google Scholar 

  30. 30.

    Veiersted K, Westgaard R, Andersen P. Pattern of muscle activity during stereotyped work and its relation to muscle pain. Int Arch Occup Environ Health 1990; 62: 31–41.

    Google Scholar 

  31. 31.

    Veiersted KB, Westgaard RH, Andersen P. Electromyographic evaluation of muscular work pattern as a predictor of trapezius myalgi. Scand J Work Environ Health 1993; 19: 284–290.

    Google Scholar 

  32. 32.

    Lundblad I, Elert J, Gerdle B. Worsening of neck and shoulder complaints are correlated with frequency parameters of the EMGobtained one year earlier. Eur J Appl Physiol 1998; 79: 7–16.

    Google Scholar 

  33. 33.

    Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sörensen F, Andersson G, Jörgensen K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987; 18.3: 233–237.

    Google Scholar 

  34. 34.

    Borg GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–381.

    Google Scholar 

  35. 35.

    Karlsson S, Erlandsson B, Gerdle B. A personal computer-based system for real-time analysis of surface EMG signals during static and dynamic contractions. J Electromyogr Kinesiol 1994; 4: 170–180.

    Google Scholar 

  36. 36.

    Elert J, Gerdle B. The relation ship between contraction and relaxation during fatiguing isokinetic shoulder flexions. An electromyographic study. Eur J Appl Physiol 1989; 59: 303–309.

    Google Scholar 

  37. 37.

    Ellis BK. Feldenkrais-physical therapy and research. A literature review. Sjukgymnasten, Vetenskapligt supplement 1995; 2: 34–41.

    Google Scholar 

  38. 38.

    Grönholm J. The Feldenkrais method (in swedish). In: Grönholm J, ed. The Feldenkrais method (in Swedish), Falun: Natur & Kultur, 1996, pp 1–118.

    Google Scholar 

  39. 39.

    Hanna T. The body of life. Alfred A Knopf, 1987.

  40. 40.

    Gutman GM, Herbert CP, Brown SR. Feldenkrais versus conventional exercises for the elderly. J Gerontology 1977; 32: 562–567.

    Google Scholar 

  41. 41.

    Simons DG, Mense S. Understanding and measurement of muscle tone as related to clinical muscle pain. Pain 1998; 75: 1–17.

    Google Scholar 

  42. 42.

    Manniche C, Hesselöe G, Bentzen L, Christensen I, Lundberg E. Clinical trial of intensive muscle training for chronic lowback pain. Lancet 1988; 31: 1473–1476.

    Google Scholar 

  43. 43.

    Manniche C, Lundberg E, Christensen I, Bentzen L, Hesselöe G. Intense dynamic back exercises for chronic low back pain: A clinical trial. Pain 1991; 47: 53–63.

    Google Scholar 

  44. 44.

    Risch SV, Norvell NK, Pollock L, Risch ED, Langer H, Fulton M, Graves JE, Leggett SH. Lumbar strengthening in chronic low back patients—physiological and psychological benefits. Spine 1993; 18: 232–238.

    Google Scholar 

  45. 45.

    Horn S, Munafó M. Theories of pain. Pain. Theory, research and intervention. Buckingham. Open University Press, 1997.

    Google Scholar 

  46. 46.

    Parenmark G, Engvall B, Malmkvist A-K. Ergonomic on-the-job training of assembly workers. Arm-neck-sholder complaints drastically reduced amongst beginners. Appl Ergonomics 1988; 19: 143–146.

    Google Scholar 

Download references

Author information



Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lundblad, I., Elert, J. & Gerdle, B. Randomized Controlled Trial of Physiotherapy and Feldenkrais Interventions in Female Workers with Neck-Shoulder Complaints. J Occup Rehabil 9, 179–194 (1999).

Download citation

  • Feldenkrais
  • intervention
  • musculoskeletal
  • neck
  • pain
  • physiotherapy
  • rehabilitation
  • shoulders
  • women
  • work-related