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MSK Pain – Neck Pain – Improves physical function

Evidence Summary (Updated 2022)

There is moderate quality evidence that physical activity and exercise interventions may improves function in patient with neck pain.
Using a standardised exercise programme which includes cervical strengthening, rotations and flexibility has been shown to improve physical function, with a NNT of five. A moderate degree of improved function can be achieved with a combination of stretching and strengthening exercises of the cervical and scapulothoracic muscles immediately post-treatment, at intermediate follow up and at long-term follow up according to a Cochrane review (1).

However a systematic review and network meta-analysis by de Zoete et al comparing physical exercise interventions to controls found no good quality data to support improved physical function in people with chronic neck pain (2).

Patients with cervical radiculopathy were found to have improved function, as measured by the neck disability index (NDI) when comparing exercise interventions to passive controls e.g. wait and see, manual therapy (5).

Quality of Evidence
Grade B – moderate quality

Strength of recommendation
Grade 2 – weak recommendation

Physical activity should be encouraged in those with neck pain, but it is important to include specific stretching and strengthening exercises of the musculature throughout the neck and shoulder.


  1. Gross AR, Paquin JP, Dupont G, Blanchette S, Lalonde P, Cristie T, et al. Exercises for mechanical neck disorders: A Cochrane review update. Man Ther [Internet]. 2016 Aug 1 [cited 2022 Aug 24];24:25–45. Available from:
  2. Mj De Zoete R, Armfield NR, Mcauley JH, Chen K, Sterling M. Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. Available from:
  3. Chen X, Coombes BK, Sjøgaard G, Jun D, O’leary S, Johnston V. Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis [Internet]. Vol. 98,  Physical Therapy. 2018. Available from:
  4. Denham-Jones L, Gaskell L, Spence N, Pigott T. A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions. Musculoskeletal Care [Internet]. 2021 May 24 [cited 2022 Jan 5]; Available from:
  5. Liang L, Feng M, Cui X, Zhou S, Yin X, Wang X, et al. The effect of exercise on cervical radiculopathy A systematic review and meta-analysis The effect of exercise on cervical radiculopathy: A systematic review and meta-analysis Systematic Review and Meta-Analysis Medicine ® OPEN 1. Medicine (Baltimore) [Internet]. 2019;98:45. Available from:
  6. Ireland J, Window P, O’Leary SP. The impact of exercise intended for fitness or sport on the prevalence of non-specific neck pain in adults: A systematic review. Musculoskeletal Care [Internet]. 2022 Jun 1 [cited 2022 Aug 24];20(2):229–44. Available from: