What is the Evidence for the Effectiveness of Scapulothoracic Strengthening Exercises in Individuals with Neck Pain: A Systematic Review

Neck pain is a highly prevalent issue, ranked as the fourth greatest issue worldwide in terms of overall disease burden, and consequently, places a substantial impact upon the healthcare system. Scapulothoracic exercises appear as a promising avenue for the treatment of neck pain amongst the various treatment options currently available. However, there is uncertainty surrounding the effectiveness and clinical application of this approach. Purpose: The aim of this review was to establish the evidence surrounding the clinical application and effectiveness of scapulothoracic strengthening exercises to reduce neck pain. Methods: A systematic search of four electronic databases, including Ovid Medline, Scopus, Ovid Embase and The Cochrane Library was conducted by two independent reviewers (EW, GW). Studies of adult participants who were receiving scapulothoracic strengthening exercises to reduce neck pain and improve functioning were included. Inclusion criteria were set to exclude participants with neck pain related to headaches or as a result of surgery, trauma, physiological abnormalities or neurological conditions. A total of 2,665 articles were evaluated for inclusion in this systematic review, with 39 included in a full-text screen and five included in the final review. Methodological quality was evaluated by three independent reviewers (AZ, HW, LO) using the PEDro critical appraisal tool and the National Health and Medical Research Council (NHMRC) hierarchy of evidence was used to determine included studies. Results: Five randomised controlled trials, encompassing a total of 329 participants, were included in this systematic review. Four of the studies investigated strength training for the non-painful scapulothoracic muscles, and one study included exercises targeting the painful upper trapezius muscle. Scapulothoracic intervention duration ranged from 20-90 minutes, with a varying frequency of 3-5 times per week. All five studies demonstrated some improvements in neck pain, with two included studies revealing short-term positive influences on activities of daily living and the neck disability index. One study showed significant improvements in neck range of motion and similarly, maximal voluntary contraction of cervical musculature improved in another study. Overall, analysis of the five included studies provided evidence that scapulothoracic strength exercises may be effective in alleviating neck pain. Conclusion: A limited number of studies have investigated the effect of scapulothoracic strengthening exercises as a primary modality in the treatment of neck pain. Scapulothoracic strengthening exercises could be considered in the treatment of neck pain, although the evidence is variable. Scapulothoracic strength training may have positive impacts across subjective and objective parameters including pain, and sequentially, activities of daily living, neck range of motion, and strength. However, the current literature base is limited by considerable diversity in intervention and outcome measures, and limited long-term follow up