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Specific Neck Training Induces Sustained Corticomotor Hyperexcitability as Assessed by Motor Evoked Potentials

Rittig-Rasmussen, Bjarne MMedSc, PT*; Kasch, Helge MD, PhD*,†; Fuglsang-Frederiksen, Anders MD, DMSc; Jensen, Troels S. MD, DMSc*,†; Svensson, Peter DDS, DMSc§

doi: 10.1097/BRS.0b013e3182975310

Study Design. Experimental investigation of short-term and long-term corticomotor effects of specific neck training, coordination training, and no training.

Objective. To determine the effects of different training programs on the motor neurons controlling the neck muscles as well as the effects of training on muscle strength and muscle fatigue, and the correlations between corticomotor control and motor learning.

Summary of Background Data. Training is usually recommended for unspecific neck pain and consists of neck and upper body coordination, strengthening, and endurance exercises. However, it is unclear which type of training is the most effective. No studies have previously investigated the neural effect of neck training and the possible differential effect of specific versus coordination training on corticomotor control.

Methods. Transcranial magnetic stimulation and electromyography were used to elicit and monitor motor evoked potentials (MEPs) from the trapezius and thumb muscles before and 30 minutes, 1 hour, and 7 days after training. Parameters measured were MEP amplitude, MEP latency, strength, learning effects, and muscle fatigue.

Results. Only specific neck training yielded a 67% increase in MEP amplitudes for up to 7 days after training compared with baseline (P< 0.001). No significant changes were seen after coordination training, no training, and in the within-subject control muscle. The mean muscle strength increased immediately after specific neck training from 56.6 to 61 kg (P< 0.001). No subjective or objective measures of fatigue were observed.

Conclusion. Specific neck training induced a sustained hyperexcitability of motor neurons controlling the neck muscles compared with coordination training and controls. These findings may prove valuable in the process of developing more effective clinical training programs for unspecific neck pain.

Level of Evidence: N/A

In this study, the use of chemoprophylaxis seemed to be safe in patients with spinal trauma at risk for postoperative venous thromboembolic event (VTE). There were no epidural hematomas recorded in this study. BMI, injury severity, neurological deficit, and number of spinal levels fused were all associated with an increased incidence of postoperative VTE.

*Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark

Department of Neurology, and

Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; and

§Clinical Oral Physiology, Department of Dentistry, Aarhus University, Aarhus, Denmark.

Address correspondence and reprint requests to Bjarne Rittig-Rasmussen, MMedSc, PT, Danish Pain Research Center, Aarhus University Hospital, Noerrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark; E-mail:

Acknowledgment date: November 28, 2012. First revision date: February 21, 2013. Second revision date: April 4, 2013. Acceptance date: April 10, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Association of Danish Physiotherapists' Research Foundation and Practice Foundation grant funds were received to support this work.

Relevant financial activities outside the submitted work: grant.

© 2013 by Lippincott Williams & Wilkins