Strengthen Your Neck Out Of Pain

The importance of the deep stabilizing musculature of the neck for spinal segmental support and control has been demonstrated and clinical research indicates that many patients with neck pain have inadequate support from these muscles. Insufficiency in the pre-programmed activation of the cervical muscles, altered motor control recruitment patterns, and increased fatigability have also been found in patients with neck pain. Further, the measured increased activation of the superficial cervical musculature in those with neck pain is thought to be a compensation for poor passive or active segmental support. This article will show you how to Strengthen your neck out of pain!

3 Exercises to Strengthen Your Neck

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It has been shown that neck muscle control/strength are linked with individuals with neck pain disorders. Research demonstrates that patients with neck pain exhibit increased EMG amplitude of the superficial sternocleidomastoid and anterior scalene muscles and reduce activation of the deep cervical muscles- Longus Colli and longus capitis (These are the 2 muscles we want to activate!) So how do we do this?

A lot of chin tucking!

Low load program of craniocervical flexion exercise (Aka Chin tucking) focusing on motor control and strength of the deep neck flexors has been shown through clinical trials to reduce Headache’s as well!

Here are 3 exercises to help improve your neck strength & motor control

Anti-Rotation Exercise

The deep stabilizing muscles of the neck are equivocally important as the deep stabilizing muscles of the low back. Similar to how the big superficial muscles of the back can become too active with low back pain, the same principle can be applied to the neck. The upper trapezius, levator scapulae, sternocleidomastoid, and scalenes are potential ‘global’ muscles that end up trying to do the job of the small stabilizing muscles, like the multifidi and longus colli.

CHECK OUT the small anatomy video clip in the bottom right where you can truly appreciate the amount of layers of muscle in the neck region.

According to the Neck Pain: Clinical Practice Guidelines – it has been recommended with strong evidence for clinicians to consider cervical stabilization exercises. Demonstrated here is a great exercise to start out with. There are important tips to consider with this exercises.

1. You can use a resistance band or even a shoe-string
2. Think about applying a very gradual, small force
3. If you feel every muscle in your neck and upper back working, you are doing way too much
4. Try it out, tag a friend or colleague, and remember less is more!

Multi-Directional Neck Isometric

First demonstration is an isometric exercise. Perform this by starting in a neutral spine ,your head should be directly over your trunk. Push with your hand on one side of your head, followed by the opposite side. When giving a force with your hand make sure to resist this force by pushing back with your head while keeping it still. The force from your hand can go in all directions from the front or the back of the head.

Second demonstration is an exercise designed for training the Cervical spine/Neck extensors. It is important to AVOID neck flexion & maintain craniocervical spine alignment during this exercise. Both of these exercises will allow for more stabilization and better neck posture, reducing the notorious forward head posture.

It is important to note that there is NO need for heavy resistance, only about 20% of maximal voluntary contraction is needed when exercising the deep cervical muscles, to minimize activity of the superficial larger neck muscles. This is especially important for those that have neck pain. The pain will actually inhibit these muscles from activating, therefore the low resistance will help control the deep neck muscles as well as having an immediate hypoalgesic effect compared to high-resistance exercises.

Quadruped Deep Neck Exercise

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Here a great exercise for your patients with neck pain, especially those with whiplash induced neck pain, that targets not just the 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 our opinion, within the rehabilitation community there is TOO HEAVY OF A FOCUS on training the deep cervical flexors (longus colli and longus capitis). The CERVICAL EXTENSORS ARE EQUALLY AS IMPORTANT FOR THE REHABILITATION OF PATIENTS WITH NECK PAIN. The deep cervical extensors (semispinalis cevicis, multifus, 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 high proportion (~70%) of slow twitch fibers.

Here some key facts about the cervical extensors that CLINICIANS NEED TO KNOW:
– Cervical multifus, unlike thoracic and lumbar, has origination directly from the capsules of the facet joints, and may partially explain their role in neck pain and injury
– Non-uniform activation of different fascicles of the semispinalis muscles suggest that it may be possible to selectively activate different fascicles during exercise, ie 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 selected 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
– 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.

In conclusion, start with low load exercises with the aim of inducing neurophysiological adaptations by specifically activating deeper muscles it 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. In addressing your neck pain, it is also important that you work on thoracic spine mobility in addition to scapula strengthening exercises like this, this, and this!

Citation:
“Function and Structure of the Deep Cervical Extensor Muscles In Patient’s with Neck Pain” By: Schomacher and Falla 2013.
 ”The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain”. By: Jull GA, Falla DL, Vicenzino B, Hodges PW. 2009.
“Therapeutic Exercise for Athletes With Nonspecific Neck Pain: A Current Concepts Review” by: Christopher Durall.

1 thought on “Strengthen Your Neck Out Of Pain

  • This is in response to your article on strengthening the c extensors.
    Can you please tell me how to specifically test for weakness of the cervical extensors.
    Thank you

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