# Exercise as it relates to Disease/Chronic Neck Pain in the Workplace - The Effectiveness of Resistance Training Interventions
### Why Do We Need to Address Chronic Neck Pain?

Chronic pain has become Australia's third most costly health condition. With workplaces requiring increasing time spent sitting at computers, repetitive movements of the upper extremities combined with postural deficiencies are becoming more frequent. In Australia, 2012, Chronic neck pain accounted for 40% of forced retirements from the workplace and more than 50% of workers who spent >15 hours per week at a computer develop upper extremity pain symptoms inside the first year. With these statistics in mind, implementing strategies to combat these common issues can benefit organisations, individuals and, on a larger scale, economies.

### Conducting the Research

This 10-week controlled trial included 30 women who were divided in to 2 groups. One group was given a set of resistance based exercises to complete for 2-minutes daily using resistance bands. The other group was to continue working as normal. While participants were undertaking their work day, Electromyography (EMG) electrodes were attached to assess muscle activity in both the upper trapezius and splenius muscles.
EMG traces were analysed with researchers looking for the frequency and length of time gaps between muscle activation at 0.5% of EMGmax. Time spent under 0.5% of the EMGmax was considered to be complete relaxation, indicating a favourable pattern for pain reduction.

## Results
### What Were The Results?

Assessment of the EMG traces acutely post resistance training demonstrated decreases of almost 35% in splenius EMG gaps. This result is unfavourable in terms of acute pain reduction but when considering the long term 300% increases in EMG gaps, this acute worsening is inconsequential as long as participants are notified of the long term benefits and continue with the protocol. Results for the splenius were more pronounced than those of the trapezius suggesting, in accordance with Anderson et al, 2011, that the splenius and other neck extensors are more likely centres for pain sensation than the trapezius.
Another possible reason, outlined by previous investigations include the possibility of reduced pain as a result of increased capillarization and therefore oxygenation of the affected muscle, assisting the muscle in it's relaxation. Further studies should explore these factors along with accumulation of Calcium in the affected areas as a possible precursor to pain.

### How Does The Research Compare?

Many investigations have been performed with aims to better understand, treat and prevent chronic neck pain in office workers. There is an array of studies which agree with this research in that strength and resistance training interventions are effective in pain reduction. Although the results of this study were positive, Anderson et.al. (2012) investigated the effect of frequency and duration of training interventions which poses the question; Is a 2-minute daily program the best way to reduce pain?
Andersons' 2012 study concluded that the ideal frequency for intervention was 3 sessions per week, although results were not dramatically different when sessions were dispersed differently. The recommendation provided by Anderson et.al. was to participate in programs in such a way that suits the organisation and the individual best, whether that be more frequent shorter sessions or less frequent longer sessions. Adherence to training programs is dependent on intensity and duration, though. Adherence was higher when sessions were shorter and more frequent, though strength gains were higher in those who completed fewer, longer sessions. Through communication with participants, those administering programs should set out a plan which will benefit the individual and the organisation using these considerations.

## Conclusions
### What Conclusions Can We Take From This Research?

There isn't much doubt, considering the outcomes of this particular research article, that resistance training interventions are beneficial for those who suffer from neck pain or are at risk of developing chronic neck pain. Although, care does need to be taken when outlining the intervention. Informing participants of the likely short term increases in pain is important in the adherence to training for the programs duration.
Such positive outcomes from a 2-minute daily intervention should provide confidence to those advising the workplace about injury reduction via resistance training. The practicality of this intervention makes it a very adoptable method for most workplaces. With no equipment required, a short time frame, no financial burden and low level physical abilities required to complete the training, it would be hard for an employer to argue against implementing such programs.

### Benefits

* Increased relaxation time
* Increased muscle strength, lesser activation required, therefore-
* Decreased Calcium concentration (decreased pain)
* Reduction in sick days
* Increased productivity

### Exercise and Ergonomic Recommendations

Although these interventions are effective, being physically active is also shown to decrease neck pain incidence. Those in charge of employee well-being should encourage adequate physical activity strategies throughout the workday and outside of work hours. Educating employees of the Physical Activity Guidelines and adverstise the associated brochure provided by the Australian Department of Health.
In conjunction with exercise and resistance training methods, postural education is important in reduction of neck pain and employers should be responsible for ensuring workers are provided with adequate ergonomic workstations. Education Queensland provides a good example of postural guidelines for office workers which can be found here - Education QLD - Office Ergonmics

## References

* ↑ Schofield el al. (2012) Quantifying the Productivity impacts of poor health and health interventions. Health economics, University Sydney Oct 2012.
* ↑ Cagnie, B., Danneels, L., Van Tiggelen, D., De Loose, V., & Cambier, D. (2007). Individual and work related risk factors for neck pain among office workers: a cross sectional study. European Spine Journal, 16(5), 679-686.
* ↑ Andersen L. L., Hansen K., Mortensen O. S., and Zebis M. K., “Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain,” BMC Musculoskeletal Disorders,vol.12, article169,2011
* ↑ F. Kadi, C. Ahlgren, K. Waling, G. Sundelin, and L.-E. Thornell, “The effects ofdifferent training programs on the trapeziusmuscle of women with work-related neck and shoulder myalgia,” Acta Neuropathologica,vol.100,no. 3, pp.253–258,2000.
* ↑ Ylinen J, Takala E, Nykänen M, et al. Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women: A Randomized Controlled Trial. JAMA. 2003;289(19):2509-2516. doi:10.1001/jama.289.19.2509.
* ↑ Pedersen, M. T., Andersen, L. L., Jørgensen, M. B., Søgaard, K., & Sjøgaard, G. (2013). Effect of specific resistance training on musculoskeletal pain symptoms: dose-response relationship. The Journal of Strength & Conditioning Research, 27(1), 229-235.
* ↑ Andersen, L. L., Saervoll, C. A., Mortensen, O. S., Poulsen, O. M., Hannerz, H., & Zebis, M. K. (2011). Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. PAIN®, 152(2), 440-446.
* ↑ Andersen, C. H., Andersen, L. L., Gram, B., Pedersen, M. T., Mortensen, O. S., Zebis, M. K., & Sjøgaard, G. (2012). Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial. British journal of sports medicine, 46(14), 1004-1010.
* ↑ Organisational Health Unit, Department of Education Training and Employment, Queensland Government, 'Office Ergonomics Guidelines', February (2013) V1.
Main article -
* ↑ Mark Lidegaard, Rene B. Jensen, Christoffer H. Andersen, et al., “Effect of Brief Daily Resistance Training on Occupational Neck/Shoulder Muscle Activity in Office Workers with Chronic Pain: Randomized Controlled Trial,” BioMed Research International, vol. 2013, Article ID 262386, 11 pages, 2013. doi:10.1155/2013/262386