Deep Muscle Training for Neck Pain: Another Fancy Complex Stupidity. A 2022 Review

In the world of medicine, there is always a critical shortage of effectiveness in treatments, but there is never lack of stupidity. Many critical thinker healthcare professionals are aware of the stupidity.

Since 1990s, in many medical fields including musculoskeletal medicine, self-critiques and calls for reform have become a stronger and stronger voice. The reason is that “The public are increasingly aware of health professions’ fallibilities, and are far more skeptical about their claims to be the best people to manage the health of the population” (Nicholls, D.A, 2018, 2021).

A Reformer's Fighting against Fancy Complex Bullshit

In physiotherapy community, Adam Meakins, a sports physiotherapist working in the NHS and private practice in the UK, is one of the most followed reform advocators across all social media platforms.

Meakins's main philosophy, in his words, is “to do the simple things really well and dont get distracted by all the fancy complex bullshit that's rarely needed but riddles the profession”. Meakins calls the stupidity in physicotherpy field “the fancy complex bullshit” (Meakins S, 2024).

I am not a PT. But as a health care practitioner, I found Meakins' strong voices against the bullshit or stupidity which is stifling or suffocating a profession applies to many other healthcare professions, although I would like to use “stupid echo chambers” in place of the word “b...t”.

Fancy Complex for Neck Pain: Craniocervical Flexion Training

In 2022, 5 researchers from Italy (Stefano G et al, 2022) published a review which assessed the efficacy of deep cervical muscle exercise for neck pain.

The authors described this intervention as an exercise program that targets specific deep cervical muscles. They named it “CCF Training” (craniocervical flexion training). The review compared CCF training with other exercises or interventions. 25 studies were qualified for review.

None of Any Significant Difference

“When compared with a proprioception exercise program, the CCF protocol did not show any significant difference in terms of pain intensity reduction, and neither therapeutic program demonstrated clinically relevant improvements.

Conflicting & Poorly Homogeneous

“If compared with other therapeutic proposals, the highlighted results are conflicting and the studies are poorly homogeneous in terms of exercise protocols described, treatment duration, frequency of the intervention, timing of assessments, and control groups used.

“Even if the CCF protocol is homogeneous in most of the trials analyzed with exercises performed under physical therapist guidance, in none of the assessed trials was it reported if the device for CCF training was also given to the participants for home exercises added to the treatment sessions.

“The overall quality of the comparisons was poor and ranged from very low to moderate."

Irony: None of Neck Pain Trials Considered Pain Relief as Primary Outcome

“Considering that pain intensity is one of the more relevant outcomes in people with neck disorders, it is remarkable that this was not considered as the primary outcome in any trial analyzed.”

Fancy Complex Not Any Fancier Than Plain Treatments

“...it seems that the CCF protocol offers results comparable with other exercise protocols.

“... it seems that CCF training would offer superior results than no treatment...”

Unanswered Questions

“Future studies with high methodological quality, larger samples, more uniform inclusion criteria, and treatment protocols are necessary to reach firm conclusions "

Let Patients Know Those Fancy Stuff Not Work

“...the comparisons are of low to very low quality. For this reason, we invite clinicians to share this information with their patients to choose the more appropriate and suitable intervention tailored to the individual’s needs ...”

A Deeper Thinking

In modern medicine that advanced to this 21 century, what we can honestly say to our patients with a simple pain at neck is:

“Yeah, exercise seems, perhaps, and possibly better than doing nothing. Scientists are still not very sure. Anyway I designed this complex exercise program for you which can be burdensome. But better than nothing. You think about it and then decide do it or not”.

Do we dare to dream of a magic wand in hand for neck pain? Then just a wave, pain vanishes and you became a saint in patients' eyes ...

That magic wand is under every one's nose.

References

Garzonio S et al. Effectiveness of Specific Exercise for Deep Cervical Muscles in Nonspecific Neck Pain: A Systematic Review and Meta-Analysis. Phys Ther. 2022 May 5;102(5):pzac001.

Meakins S, Painful Shoulder Complex Not Equals Complicated with Adam Meakins. Adammeakins.com (accessed in 2024)

Nicholls, D. A. (2018). The End of Physiotherapy. Oxon/New York: Routledge.

Nicholls, D.A., Physiotherapy Otherwise, Auckland University of Technology. December 14, 2021