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Strengthening Exercise Prescription and Progression in Chronic Neck Pain: A Literature Review of Dosage and Symptom-Response Reporting

Year: 2026

Type: article

Abstract: Strengthening exercises are commonly used in chronic neck pain rehabilitation.However, incomplete reporting of exercise prescription, progression, and symptom-response monitoring may limit intervention reproducibility.This literature review examined how these components were reported in randomized controlled trials (RCTs) involving adults with chronic nonspecific or mechanical neck pain.PubMed, the Physiotherapy Evidence Database (PEDro), and Google Scholar were searched for studies published between 2000 and 2026.Eligible trials involved adults with neck pain lasting at least three months and identifiable cervical and/or scapulothoracic strengthening exercises.Data were extracted on exercise dosage, resistance, frequency, progression, individualized advancement criteria, symptom-response monitoring, adherence, and adverse events.Reporting completeness was examined using principles from the Template for Intervention Description and Replication (TIDieR) and Consensus on Exercise Reporting Template (CERT).Risk of bias was assessed using the Cochrane RoB 2 tool.The search identified 301 records, including 39 duplicates.Of 119 full-text reports assessed, 69 were excluded.Fifty publications representing 45 independent RCTs were included, with five companion publications linked to one original trial.Exercise frequency and program duration were generally reported, whereas initial resistance, individualized progression criteria, and symptom-based modifications were less consistently described.Explicit acceptable-pain thresholds, immediate or next-day symptom-response monitoring, and exercise regression or stopping criteria were frequently unreported.Adherence and adverse-event reporting varied, and participant retention did not consistently establish adherence to prescribed exercise dosage.Overall, 31 trials (68.9%) were judged to have a high risk of bias, 14 (31.1%) raised some concerns, and none were classified as low risk.Strengthening interventions were generally identifiable, but incomplete reporting of exercise dosage, progression, and symptom-response procedures limited clinical reproducibility and interpretation.More comprehensive reporting of these components, alongside adherence and adverse events, may support individualized physiotherapy practice.

Source: Cureus

DOI: 10.7759/cureus.119279