Surface EMG activity during cervical and upper limb tasks in individuals with neck pain: a systematic review.

Abstract

BackgroundNeck pain has been associated with altered neuromuscular function, including changes in muscle activation and coordination. However, inconsistencies across studies have limited clinical interpretation and hindered the identification of consistent differences in muscle activation patterns between individuals with neck pain and asymptomatic controls. This systematic review aimed to synthesise evidence on surface electromyography (sEMG) activity during cervical and upper limb tasks in individuals with neck pain compared with asymptomatic controls.MethodsA systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted from inception to 5 October 2025. Observational studies were eligible if they compared sEMG activity between individuals with and without neck pain during cervical or upper limb tasks and reported sEMG outcomes normalised to a reference contraction. Two reviewers independently screened articles, extracted data, and assessed methodological quality using the Joanna Briggs Institute checklist.ResultsEighteen studies involving 756 participants met the inclusion criteria. Sixteen reported significant between-group differences in sEMG outcomes, most frequently showing increased amplitude in superficial muscles such as the sternocleidomastoid, upper trapezius, and splenius capitis. Alterations were more consistently observed during cervical tasks, particularly those assessing motor control, whereas findings during upper limb tasks were more variable. Considerable heterogeneity was identified across studies in task design, muscles assessed, and sEMG normalisation procedures.ConclusionsSixteen of eighteen studies reported altered muscle activation in individuals with neck pain, particularly during cervical tasks. These findings suggest that altered activation patterns may reflect task-specific adaptations rather than uniform dysfunction, highlighting the importance of considering task-specific neuromuscular responses when assessing and managing individuals with neck pain.