NECK PAIN AND NEUROMUSCULAR NECK SYSTEM CHANGES: A LITERATURE REVIEW

Introduction Neck pain is a disorder able to produce significant pain and disability. It is characterized by remission and exacerbation periods and tendence to chronicity. This trend may be partially related to an insufficient neuromuscular function recovery, given the relevant role of the neuromuscular system on the biomechanical spine stabilization. The aim of this literature review was to investigate the relationship between neck pain and structural/functional cervical neuromuscular system changes and the role of therapeutic exercise. Method Between September and October 2012, the databases PubMed, CINHAL e PEDro were consulted by three independent reviewers (AR, VB and EF). A third reviewer (CV) was involved in case of disagreement. The search was limited to studies published in the last 10 years and to English or Italian languages. Studies regarding the morphological and functional neuromuscular system changes related to mechanical, traumatic or non-traumatic, acute or chronic neck pain were included. Studies on specific neck and/or arm pain (radiculopathies, stenosis, systemic diseases, etc.) were excluded. Results Research carried out in the databases provided 34 studies, including 10 on the morphological and structural changes and 24 on the functional changes. A relevant correlation between neck pain and cervical muscles dysfunction was found. This dysfunction includes muscle structure changes (cross sectional area, fat infiltration, fiber type), behavior changes (timing and level of activation) and functional changes (strength, endurance). The research also highlighted the role of therapeutic exercises to modify these impairments effectively. Conclusions The strong evidence of correlations between structure, behavior, functional changes of the neuromuscular system and neck pain suggests that in subjects with neck pain the cervical muscles ability to generate and sustain precise force moment for optimal function is modified. Moreover, the neuromuscular dysfunctions appear related to the neck pain tendency to become chronic and recurrent. Therapeutic exercise can effectively improve pain and disability and might prevent or reduce neck pain recurrencies.