The neck is an area that often gets neglected in regards to exercise, and therefore is not our strongest asset! Having weakness and poor recruitment of the deep neck muscles has been correlated with increased pain and disability in our population. In this article, we demonstrate great exercises for people with neck pain, especially those with whiplash-induced neck pain, that target not only the popular deep cervical flexors but also the deep cervical extensors! Pay close attention to the cueing, as activation of the deep cervical extensors should be emphasized at selected spinal levels for the management of segmental dysfunction. In this article, learn the secret to improving neck strength by targeting the deep cervical extensors!

 

What Are The Deep Cervical Extensor Muscles?

Muscles that are not very apparent to the eye like the biceps, for example, the deep neck muscles play a crucial role in the overall health of the neck. Often neglected, it is common for these muscles to be weak, leading to potential issues of neck pain and decreased functional ability. There are both deep neck flexors and deep neck extensors in our neck.

Deep Neck Flexors

Deep Neck Flexors: This muscle group consists of the longus capitus, longus colli, rectus capitus, and longus cervicus. All of these muscles help maintain neck stability and a high-quality posture.

 

Deep Neck Extensors

Deep Neck Extensors: The deep cervical extensors (semispinalis cervicis, multifidus, and rotators) along with the cranio-cervical extensors (rectus capitis posterior major/minor and obliquus capitis superior/inferior) are KEY MUSCLES for cervical spine segmental support due to their relatively small moment arms, attachments to adjacent vertebrae, and possessing a high proportion (~70%) of slow-twitch fibers.

 

Improve Your Neck Strength and Overall Neck Health!

We have to build capacity in order to promote longevity, especially in our necks. The Neck and Mid Back [P]rehab Program is a physical therapist-developed, step-by-step program that teaches you how to optimize your neck & mid back health. 

 

Why Do These Muscles Become Weak?

Why is it common for these neck muscles to become weak? The answer is quite simple, when muscles are not trained consistently, they can become weak! Most people do not incorporate neck exercises into their exercise routine. In addition to not being trained, we often are placing increased strain on these muscles due to the way we sit and interact with computers, phones, etc. Yes, there is no perfect posture; however, if we’re constantly placing stress on our necks with a bad posture and not performing movements or exercises that work against these stresses, then it can lead to potential issues at the neck. In our blog article below, you can read more about how to improve postural pain!

READ: IMPROVE POSTURAL PAIN

 

Forward Head and Upper Cross Syndrome

The upper cross syndrome has been something highly debated within the fitness and rehab world. This is because it was established a long time ago and the concern is it promotes fear or too much emphasis on posture, which we referenced earlier is not something to demonize. However, the thought is poor posture can lead to tightness in certain areas and weakness in other areas due to adaptive shortening and lengthening of muscles. As you can see from the photo above, the upper trapezius, levator scapulae, and pectoralis (chest muscles) are often tight, whereas the lower trapezius, serratus anterior, and deep neck flexors are often weak. This is where ‘bad postures’ got all of their bad reputations because the concern was if you spend too much time in these positions this will happen! The good thing is that if you are aware of your posture, and also move more consistently, you can avoid this! We are here to help you and show you ways that you can improve your neck strength and your posture all at once!

 

Having Neck Pain? Get Rid of It!!

Many of us may wake up with a cranky neck on occasion. Whether you slept funny on a long flight or had a long day at work the day before, your neck may become tight and angry! This [P]Rehab Youtube Episode will show you other ways that you can relieve your neck pain. In addition to strengthening which we have discussed in this article, other variables can play a role in neck pain, including mobility or movement coordination issues! This video will show you other exercises that you can add to your routine to help you combat neck discomfort.

 

Exercises To Improve Neck Strength: Why The Deep Cervical Extensors Matter!

In our opinion, within the rehabilitation community, there is too heavy of a focus on training the deep cervical flexors (longus colli and longus capitis). Yes, the deep neck flexors are important; however, the deep cervical extensors are equally as important for the rehabilitation of patients with neck pain! We are going to explain why below. 

Here are some key facts about the deep cervical extensors that clinicians need to know:

• Cervical multifidus, unlike thoracic and lumbar, originate directly from the capsules of the facet joints, and may partially explain their role in neck pain as well as injury

 

• Non-uniform activation of different fascicles of the semispinalis muscles suggests that it may be possible to selectively activate different fascicles during exercise, i.e targeting the site of greatest pain where structural or functional changes in the muscle may be more evident. When manual static resistance is applied to the vertebral arch of C2, the semispinalis cervicis (recorded at C3) was selectively activated relative to the splenius capitis!

 

• Fatty tissue infiltration of the multifidus and the semispinalis cervicis has been observed in patients with whiplash-induced neck pain

 

• The transformation from type I to type II fibers is observed for both cervical flexor and extensor muscles in patients with neck pain

 

• The superficial cervical extensors typically showed increased activation in patients with neck pain, as well as delayed offset after activity. On the other hand, the deep cervical extensors show reduced activation.

 

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Other Deep Cervical Extensor Exercises For Neck Strength

Here are some more progressive exercises you can work on to train your deep cervical extensor muscles! You can find exercises similar to these and more in our [P]rehab Exercise Library!

Quadruped Push Up Plus – Band Around Head

Sample Neck and Mid Back [P]rehab Program Exercise Video

• HOW: Begin in a quadruped position on your hands and knees with a band wrapped around the back of your head. Spread your shoulder blades by pushing your chest away from the floor. In this position perform a chin tuck, try creating a double chin. While maintaining a chin tuck perform scapula push-ups by moving the scapula out and in slow and controlled.

 

• FEEL: You will feel your neck and shoulder muscles working with this exercise. You can alter the amount of resistance placed from the band by slackening or tightening it.

 

• COMPENSATION: Avoid arching your neck as you perform this, you should keep your chin tucked (not rounded) for the entirety of this exercise.

 

Neck Isometrics – Anti-Extension, Band

Anchor a resistance band about head height then wrap one end around the top of your head. Turn your body away from the anchor, you will be working the muscles on the front of your neck. Walkout as far as you feel comfortable, hold, and return to starting position. You will feel the muscles on the front of your neck working with this exercise. Avoid arching the neck or leaning your body into the band. Keep your head upright and your chin tucked for the entirety of this exercise.

 

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Deep Neck Flexor Strengthening

Below are some exercises to work on your deep neck flexors. These are more commonly prescribed within the rehabilitation setting, but again, don’t forget about the deep cervical extensor exercises we discussed above. Ultimately, by working on all of the deep neck musculature, you will ensure that you are bulletproofing your neck with the adequate strength it needs to remain stable and healthy!

Supine Chin Tuck

Sample Neck and Mid Back [P]rehab Program Exercise Video

• HOW: Begin by lying face up then perform a chin tuck. The chin tuck is created by pushing the small of your neck in towards the floor. Think about creating a double chin to perform the tuck. Pushing your tongue on the roof of your mouth may make it easier for you to activate the neck muscles.

 

• FEEL: You will feel the muscle on the front of the neck working with this exercise. You may also feel a stretch in the back of your neck.

 

• COMPENSATION: Avoid arching or rounding your neck, keep your eyes facing the ceiling throughout this movement. Also, be aware of compensatory actions of the secondary flexors of the neck, including the scalenes or sternocleidomastoid.

 

Supine Chin Tuck With Head Elevation

This is a progression of the chin tuck once that exercise has become easier. By adding in a head lift, it is challenging you to further stabilize your neck. When performing this exercise, the head lift should not be far. Imagine that someone would be able to slide just a piece of paper under your head once it is lifted. By keeping the movement small with the head lift, it will help to prevent any compensatory muscle actions of the surrounding, superficial neck musculature.

 

Standing Chin Tuck – Ball, Rotation

Adding in dynamic movements with a chin tuck is another excellent progression. Place your forehead against the ball on the wall. Add a slight chin tuck then slowly rotate from side to side. Move with control, and maintain the chin tuck as you rotate. You will feel the muscles on the front of your neck work with this exercise. Do not allow your neck to arch as put your forehead against the ball. Avoid allowing your motion to come from your body, the movement should be isolated to the neck.

 

Closing Thoughts

In conclusion, we have shown you in this article exercises to improve your neck strength. A key takeaway is that yes the deep neck flexors are important to improve neck strength, but often our cervical extensors are neglected, and they should not be!  These muscles play an equal and key role to our deep neck flexors in ensuring a healthy cervical spine. Start with low load exercises like this one with the aim of inducing neurophysiological adaptations by specifically activating deeper muscles in the cervical spine. Then, progress to high-load exercises with the aim of inducing morphological adaptations in order to increase the strength and endurance of the selected muscles and movements!

 

Take Ownership of Your Neck Health

Environments are set up with most things in front of us meaning we spend all day pushing. When we spend all that time pushing the anterior or frontside musculature becomes dominant and overused. To every action, there is an equal and opposite reaction. As the anterior becomes dominant the posterior or backside of the neck and mid-back become weak and under-used. This is the typical recipe for neck and mid-back injury. Luckily, you’ve decided to use a different recipe, one that leads to optimal health and performance!

 

References

1. Schomacher and Falla 2013. “Function and Structure of the Deep Cervical Extensor Muscles In Patient’s with Neck Pain”.

 

About The Author

Michael Lau, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Product Officer

Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport fo

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.