Supervised Exercise Programs Perform Better than Home Exercise for Chronic Neck Pain

There is a preponderance of evidence in spinal research supporting the effectiveness of exercise therapy for neck pain, both alone and in combination with spinal manipulation.   However, researchers of a recent study published in Spine note it remains unclear to what degree spinal manipulation may add to a supervised exercise program or how supervised high-dose exercise compares to low-dose home exercise.

To elucidate these inquiries, researchers assigned 270 chronic neck pain patients in an outpatient setting to receive either (1) high-dose supervised exercise with spinal manipulation, (2) high-dose supervised exercise alone or (3) low-dose home exercise and health advice.  The primary outcome was measured by patient-rated pain scale with secondary outcomes measured including disability, health status, global perceived effect, medication use, and satisfaction.

High-dose supervised exercise therapy primarily involved individualized neck and upper body strengthening for 20, one hour sessions, focusing on a high number of repetitions and increasing loads.  Those in the combined spinal manipulation and exercise therapy group also received 15-20 minutes of spinal manipulation therapy by a licensed chiropractor in addition to the supervised exercise therapy protocol.  Patients allocated to the home exercise group received 2, one hour sessions, of instruction in low dose, non-individualized simple exercises to be continued on their own.

Patient-reported results were collected at 4, 12, 26 and 52 weeks.  Data demonstrated all three groups to show improved outcomes during the 12-week treatment period.  There was a consistent trend with supervised exercise both with and without spinal manipulation performing similarly and better than home exercise for all outcomes measured.  Specifically at the 12-week mark, both groups performed significantly better than home exercise with respect to pain, global perceived effect and satisfaction.  Additionally exercise therapy with spinal manipulation noted a significantly greater reduction in disability compared to home exercise.

By the end of the 52-week study period, the benefit of high-dose exercise therapy both with and without spinal manipulation over home exercise lessened to a level of no significance, except with respect to satisfaction.  The researchers noted, however, that linear mixed model analysis including all points, yielded significant differences with respect to pain, global perceived effect and satisfaction favoring both exercise therapy groups over home exercise.

The researchers also noted that side effects, including muscle soreness, upper extremity symptoms, headache, back pain, jaw pain, nausea and dizziness were reported more frequently in both supervised exercise groups. 

The authors concluded the lack of significant difference between the patient outcomes in both supervised exercise groups suggests spinal manipulation offers minimal additional benefit when combined with a high-dose supervised exercise program.  However, both supervised exercise protocols did result in decreased pain levels, increased global perceived affect and satisfaction over home exercise, especially in the short-term.

Of interest, nearly 41-42% of home exercise participants noted meaningful improvement in pain both in the short in long term.  The authors offer this may suggest home exercise to be a good first line of defense, which could be followed by a more intense supervised program if ineffective.

The researchers suggest recommendations regarding these therapies should take into consideration side-effects, preferences and costs.


Evans R, Bronfort G, Schulz C, Maiers M, Bracha Y, Svendsen K, Grimm R, Garvey T, Transfeldt E. Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial. Spine (Phila Pa 1976). 2012 May 15;37(11):903-14. doi: 10.1097/BRS.0b013e31823b3bdf.

Editor’s Commentary:

Many people get bored with home exercise programs and are motivated by participating with a group.  This has been reported over the years in the medical literature and in presentations at medical meetings.  A physical therapy clinic in Austria reported this at the American Back Society meeting in approximately 1982 when they found that the return to work rate was 90% with those patients that did their exercises in a group setting as compared to only 18% that returned to work who did their exercises at home.

Exercises can be enjoyable and fun as well if done in a group or social environment.  Exercise classes are available in some physical therapy clinics but not all.   These classes are available outside of the physical therapy facilities as well.

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