Introduction

This article is part of a series produced within the course Professional in Physiotherapy, which is included in the physiotherapy degree programme. It was created as part of the evidence-based physiotherapy section of the course. Working in small groups, students practiced elements of a systematic literature review, including systematic information retrieval, critical appraisal using the PEDro Scale, and writing up the results in the form of a scientific article.

This blog article is based on a literature review about adults’ non-specific neck pain. Neck pain is a common complaint, and in most cases, it is non-specific or benign, with a good prognosis for recovery. However, serious conditions must always be excluded (Niskakipu (aikuiset): Käypä hoito –suositus, 2017). The most common cause of neck pain is muscle tension, which may result from physical or mental strain (Saarelma 2021). Other risk factors include age, female gender, overweight, and previous episodes of neck pain (Niskakipu (aikuiset): Käypä hoito –suositus, 2017).

Physiotherapy is one of the most commonly used treatment approaches for neck pain (Dickerman 2018). Despite the prevalence of neck pain, strong evidence supporting specific treatment methods is lacking (Niskakipu (aikuiset): Käypä hoito –suositus, 2017). Nevertheless, physiotherapy may include therapeutic exercise, exercise guidance, manual therapy, and preventive instructions even before symptoms arise (Verhagen 2020).

This topic is significant because neck pain is the fourth most common musculoskeletal disorder globally (Verhagen 2020). Rehabilitation can be challenging due to the absence of a precise diagnosis, although this is not always necessary given the generally favorable prognosis. Another challenge is the limited evidence supporting treatment efficacy (Niskakipu (aikuiset): Käypä hoito –suositus, 2017).

To address this issue, the aim of this article is to investigate the effectiveness of physiotherapy interventions in adults with non-specific neck pain.

Methods

The research question is structured using the PICO framework as follows: In adults with non-specific neck pain (Population), do physiotherapy interventions such as therapeutic exercise, manual therapy, or exercise guidance (Intervention), compared to no treatment or other conservative approaches (Comparison), lead to a reduction in pain and improvement in function (Outcome)

This review focuses on randomized controlled trials (RCTs) published within the last five years, with full-text articles available for free. The target population includes adults aged 18 years and older experiencing neck pain. Studies were included only if physiotherapy or exercise interventions were provided to the target group. The search was conducted using the PubMed database with the keywords “neck pain,” “adults,” and “exercise.” The search terms used were “neck pain” AND “exercise.”

Studies were excluded if they involved participants under the age of 18, were not RCTs, or if the full article was not freely accessible. Additional exclusion criteria included the presence of specific medical conditions such as cancer, rheumatic diseases (e.g., rheumatoid arthritis, ankylosing spondylitis), neurological disorders (e.g., multiple sclerosis, Parkinson’s disease), or acute trauma (e.g., fractures, whiplash injuries). Studies were also excluded if physiotherapy was not part of the intervention. The methodological quality of the studies was assessed using the PEDro Scale.

Results

Several studies indicate that regular and guided neck-shoulder exercises can significantly alleviate pain and improve functional capacity. Dalager et al. (2022) emphasize that high-quality, supervised training twice a week effectively reduces pain. The study, which received a PEDro score of 5/10, supports the importance of structured strength training in managing neck-shoulder discomfort.

Similar findings were reported by Johnston et al. (2021), where combining ergonomics and exercise (EET) proved more effective in the short term than health counseling alone (EHP), especially among individuals experiencing pain. Although the differences between the groups leveled out after 12 months, the study—also rated 5/10 on the PEDro scale—highlights the short-term benefits of targeted interventions.

The type of exercise also influences outcomes. In the study by Kang and Kim (2022), resistance training—such as chin tucks and rowing—improved mobility and reduced stiffness and pain more effectively than trapezius muscle massage. With a PEDro score of 6/10, this randomized controlled trial suggests that active approaches may outperform passive treatments in chronic cases.

Meanwhile, Bernal-Utrera et al. (2020) found that manual therapy provided faster pain relief, but therapeutic exercise led to greater improvements in functional capacity. Although the overall impact between the two approaches did not differ significantly, the study—rated 6/10 on the PEDro scale—emphasizes the long-term value of exercise-based rehabilitation.

Conclusion

The collective evidence from the reviewed randomized controlled trials highlights the central role of targeted exercise in the management of chronic and recurrent neck pain. Office-based interventions demonstrated that strength training adherence and exercise compliance are strongly associated with clinically relevant reductions in neck and shoulder pain, emphasizing the importance of regular participation. Comparisons between manual therapy and therapeutic exercise indicated that, while both approaches can alleviate symptoms, exercise tends to yield more sustained improvements in pain relief and functional capacity. Similarly, resistance exercise programs focusing on cervical and scapular muscles proved superior to passive interventions such as trapezius massage, supporting the prioritization of active rehabilitation strategies. Furthermore, workplace trials combining ergonomics with neck-specific exercise achieved greater benefits than ergonomics supplemented with general health promotion, underlining the added value of tailored, condition-specific exercise programs in occupational settings.

Overall, these findings strengthen the evidence base for implementing active, exercise-based modalities, particularly strength and resistance training, into both clinical practice and workplace health strategies for neck pain management. While manual or passive therapies may provide short-term relief, long-term benefits appear most consistently linked to structured exercise interventions with high adherence. Future research should continue to refine exercise protocols, explore strategies to enhance compliance, and investigate their integration into multidisciplinary approaches to optimize outcomes for individuals with chronic neck pain.

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Authors:

Ira Väänänen, physiotherapy student, Savonia University of Applied Sciences

Juuli Grenfors, physiotherapy student, Savonia University of Applied Sciences

Martta Kellosaari, physiotherapy student, Savonia University of Applied Sciences

Lilli Taskinen, physiotherapy student, Savonia University of Applied Sciences

Marja Äijö PT, PhD, Principal lecturer of Gerontology and Rehabilitation, Savonia University of Applied Sciences

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References:

Bernal-Utrera, C., Gonzalez-Gerez, J. J., Anarte-Lazo, E., & Rodriguez-Blanco, C. (2020). Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial. Trials, 21(1), 682. https://doi.org/10.1186/s13063-020-04610-w

Dalager, T., Welch, A., O’Leary, S.P., Johnston, V., & Sjogaard, G. (2022). Clinically relevant decreases in neck/shoulder pain among office workers are associated with strength training adherence and exercise compliance: Explorative analyses from a randomized controlled trial. Physical Therapy. https://doi.org/10.1093/ptj/pzac166

Dickerman, R. (2018). Physical Therapy for Neck Pain Relief. Spine-health.com. . Viitattu 1.10.2025, saatavilla: https://www.spine-health.com/treatment/physical-therapy/physical-therapy-neck-pain-relief

Johnston, V., Chen, X., Welch, A., Sjøgaard, G., Comans, T. A., McStea, M., Straker, L., Melloh, M., Pereira, M., & O’Leary, S. (2021). A cluster-randomized trial of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion for office workers to manage neck pain – a secondary outcome analysis. BMC Musculoskeletal Disorders, 22, 945. https://doi.org/10.1186/s12891-021-03945-y

Saarelma, O. (2021). Niskakipu. Terveyskirjasto.fi. . Viitattu 1.10.2025, saatavilla: https://www.terveyskirjasto.fi/dlk00310

Suomalaisen Lääkäriseuran Duodecimin, Societas Medicinae Physicalis et Rehabilitationis Fenniae ry:n ja Suomen Yleislääketieteen yhdistyksen asettama työryhmä. (2017). Niskakipu (aikuiset). Käypä hoito –suositus. Helsinki: Suomalainen Lääkäriseura Duodecim. Viitattu 1.10.2025, saatavilla: https://www.kaypahoito.fi/hoi20010?tab=suositus#K1

Taewoo, K., & Beomryong, K. (2022). Cervical and scapula-focused resistance exercise program versus trapezius massage in patients with chronic neck pain: A randomized controlled trial. Medicine. https://doi.org/10.1097/MD.0000000000030887

Verhage, A.P. (2020). Physiotherapy management of neck pain. Journal of Physiotherapy, 67, 5–11. https://doi.org/10.1016/j.jphys.2020.12.005. Viitattu 1.10.2025.