06 Feb 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 in clinical research, which 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 fatiguability 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 teach you how to strengthen your neck out of pain with prehab exercises!
Why Do We Need Neck Strength?
Neck muscle control and strength matter when it comes to 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 reduced activation of the deep cervical muscles, which are the longus Colli and longus capitis. So how do we engage these deep neck flexor muscles? A lot of chin tucking exercises! A low load program of craniocervical flexion exercises, which is also known as chin tuck exercises, focusing on motor control and strength of the deep neck flexors has been shown through clinical trials to reduce headaches as well! This article is going to focus mainly on the strength and stability of our neck by showing you excellent exercises that can recruit the optimal musculature around the neck; however, if you want to learn the multifaceted approach to optimizing neck health, check out our program below!
[P]Rehab Your Neck and Mid Back!
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. This 2-phase program will expose you to various neck & mid back mobility, strength, and stabilization exercises supported by science. This program will bulletproof this region for anything life throws at you! Learn more HERE!
Check Out Our Youtube Episode On Alleviating Neck Pain!
Lets Start With The Basics: Neck Isometrics
Neck isometrics are a great place to start to strengthen your neck out of pain. Isometric exercise is a static contraction of a certain muscle, but that muscle is not moving through a range of motion. Therefore, isometrics can be a great place to start if someone is having some irritability around their neck. In addition, isometrics have been shown to have an analgesic (pain inhibiting) response, such as with rotator cuff tendinopathies or lateral epicondyalgia.
Neck Isometrics: Anti Flexion
- HOW: Begin the exercise by getting yourself set up in good posture sitting upright looking straight ahead. Then place your hand or fingers on the back of your head and try to push your head and neck forward, however, use the muscles in your head/neck area to match the resistance. Don’t let your head move.
- FEEL: You should feel the muscles in your head/neck area, more so the back-side muscles working to resist any movement.
- COMPENSATION: Do not lose position, don’t let your head or neck move. If it does, push less so that you can match the resistance.
Neck Isometrics: Anti Extension
Neck Isometrics: Anti Sidebend With Resistance
Add in a resistance band to your isometrics to promote further strength and muscle recruitment!
Strengthen Your Neck Out of Pain With Deep Neck Flexor Exercises
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: This muscle group consist of the longus capitus, longus colli, rectus capitus, and longus cervicus. All of these muscles help maintain neck stability and a high quality posture.
Supine Chin Tuck
- 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.
Supine Chin Tuck With Head Elevation
Adding in a head lift will progress the supine chin tuck, emphasizing an increase in stability needed to perform this movement correctly!
Supine Chin Tuck – Head Lift, Rotation
Quadruped Push Up Plus – Chin Tuck
Want More Exercises To Strengthen Your Neck Out of Pain?
This video below will show 3 exercises to strengthen your neck. Be sure to focus on the right form that Arash highlights in this article, and common mistakes that individuals may make with the chin tuck exercise.
3 Ways To Strengthen Your Neck
READ: [P]REHAB YOUR NECK PAIN!
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.
Anti-Rotation For Deep Cervical Spine Musculature
Check out the small anatomy video clip in the bottom right where you can truly appreciate the number 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 these exercises.
- You can use a resistance band or even a shoe-string
- Think about applying a very gradual, small force
- If you feel every muscle in your neck and upper back working, you are doing way too much
LISTEN: [P]REHAB GUYS TALKING POSTURE!
Do Not Neglect The Cervical Extensors!
When working on neck strength, many people will go heavy on the deep neck flexors. While it is important to address deep neck flexor weakness or endurance deficits, the cervical extensors are just as important to maintaining great neck health! The deep neck cervical extensors (semispinalis cevicis, 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 high proportion (~70%) of slow twitch fibers.
Deep Neck Extensors
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 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 multifidus, 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 suggests that it may be possible to selectively activate different fascicles during exercise, for example 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.
Quadruped Deep Neck Flexor and Extensor Exercise
Here is 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 conclusion, to strengthen your neck out of pain, start with low load exercises, with the aim of inducing neurophysiological adaptations by specifically activating deeper muscles it the cervical spine. From there, 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. Be sure to not only address your deep neck flexors, but also the deep neck extensors, as they are just as important for neck strength!
- “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.