The effect of 3 different exercise approaches on neck muscle endurance, kinesiophobia, exercise compliance, and patient satisfaction in chronic whiplash

J Manipulative Physiol Ther. 2015 Sep;38(7):465-476.e4. doi: 10.1016/j.jmpt.2015.06.011. Epub 2015 Sep 18.


Objective: The purpose of this study was to compare the effects of 3 different exercise approaches on neck muscle endurance (NME), kinesiophobia, exercise compliance, and patient satisfaction in patients with chronic whiplash.

Methods: This prospective randomized clinical trial included 216 individuals with chronic whiplash. Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise (NSE), NSE combined with a behavioral approach (NSEB), or prescribed physical activity (PPA). Measures of ventral and dorsal NME (endurance time in seconds), perceived pain after NME testing, kinesiophobia, exercise compliance, and patient satisfaction were recorded at baseline and at the 3- and 6-month follow-ups.

Results: Compared with individuals in the prescribed physical activity group, participants in the NSE and NSEB groups exhibited greater gains in dorsal NME (P = .003), greater reductions in pain after NME testing (P = .03), and more satisfaction with treatment (P < .001). Kinesiophobia and exercise compliance did not significantly differ between groups (P > .07).

Conclusion: Among patients with chronic whiplash, a neck-specific exercise intervention (with or without a behavioral approach) appears to improve NME. Participants were more satisfied with intervention including neck-specific exercises than with the prescription of general exercise.

Keywords: Exercise Therapy; Neck Pain; Rehabilitation; Whiplash Injuries.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Analgesics / therapeutic use*
  • Analysis of Variance
  • Behavior Therapy / methods
  • Chronic Disease
  • Exercise Therapy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Injury Severity Score
  • Kinesiology, Applied / methods*
  • Linear Models
  • Male
  • Middle Aged
  • Motor Activity / physiology
  • Neck Muscles / injuries
  • Neck Muscles / physiopathology
  • Pain Measurement
  • Patient Compliance / statistics & numerical data*
  • Physical Endurance / physiology
  • Prospective Studies
  • Risk Assessment
  • Sex Factors
  • Treatment Outcome
  • Whiplash Injuries / diagnosis*
  • Whiplash Injuries / rehabilitation*
  • Young Adult


  • Analgesics