Chronic Neck Pain: 3 Steps To Relief

With Strengthening, Endurance, and Coordination

Woman with chronic neck pain

When your neck pain won’t go away – after you’ve tried the heat, the stretching, the rest, even the pills – there’s no need to take drastic measures and there’s no need to give up altogether. Although instant relief may not be within reach, the research all points to implementing a program of strengthening, endurance training, and coordination of key muscles in the neck to reduce chronic neck pain and to improve function.

Let’s explore all about chronic neck pain – typically referred to as a “sprain” or “strain” of the neck. In our case, we refer to it as Neck Pain with movement coordination impairments…

What Does Chronic Neck Pain Look Like?

If your neck pain is acute or sudden, the issue is oftentimes due to mobility of the cervical and thoracic spine.

However, 50% of people with neck pain experience recurring and ongoing pain longer than 12 months1.

When your neck pain is chronic, or long-lasting, you might present with these distinct characterstics2,3,4,5,6,7:

  • Pain lasts longer than 12 weeks
  • Coordination, strength, and endurance of neck and scapular muscles may be lacking
    • Deep Neck Flexors
    • Middle Trapezius
    • Lower Trapezius
    • Serratus Anterior
  • Flexibility of neck and upper quarter muscles may be lacking
    • Scalenes
    • Upper Trapezius
    • Levator Scapulae
    • Pec Major
    • Pec Minor
  • Ergonomics and Postural issues, specifically in regards to repetitive activities, may be present

Deep Neck Flexors Strength and Endurance

If you’re someone with chronic neck pain, key impairments a Physical Therapist might find is weakness and a lack of coordination and endurance in your Deep Neck Flexor Muscles.

These muscles assist in stabilizing the cervical spine during neck movements8,9. Therefore, cervical spine function is directly influenced by the endurance of the Deep Neck Flexor Muscles.

In fact, people with chronic neck pain have significantly poorer performance when compared to people without neck pain on the craniocervical flexion test10, which measures the strength of the Deep Neck Flexor Muscles.

A similar test you can do on your own to see how you stack up to the norms, is the Deep Neck Flexor endurance test. Of course, to be reliable, this test should be monitored by a professional to make sure you’re doing it correctly. That said, you can still give it a try:

  • Lie on your back
  • Perform a chin tuck by nodding
  • Maintain this tuck while lifting your head just 2cm off the ground
  • Hold this position as long as you can
  • If you lose the tuck even a little bit, the test is over11
  • Norms are 39 seconds for men and 29 seconds for women12

How does Deep Neck Flexor strength and endurance affect pain?

When comparing two groups of participants with chronic neck pain, one group performs Deep Neck Flexor coordination and strengthening exercises for 6 weeks while the other group did not. At the 6-month follow-up, the exercise group had significantly lower pain levels13.

So, which is better – Deep Neck Flexor Strength or Endurance Training?

A recent study looked at two groups of women with chronic neck pain. One group did 12 months of Deep Neck Flexor strengthening, while the other did endurance training. After 3 years, both groups achieved long term benefits14.

My answer: do them both!

Deep Neck Flexor Exercises For Chronic Neck Pain

When it comes to finding relief for chronic neck pain, there’s no doubt that improving Deep Neck Flexor strength and endurance should be your primary goal.

Here is a great Deep Neck Flexor strengthening exercise that’s easy to perform:

  1. Resisted Chin Tucks for Deep Neck Flexor Strengthening
  • Sit up straight
  • Put an elastic resistance band behind your head and hold both ends in front of your face
  • Pull forward to apply resistance
  • Maintain a strong resistance throughout the movement
  • Tuck your chin back and hold for 5 seconds
  • Rest
  • Repeat until you fatigue

 

For improving Deep Neck Flexor endurance15, the craniocervical flexion exercise, or supine chin tuck with head-lift, is a great choice. A bonus for this exercise is that it has been shown to reduce neck pain immediately following the exercise16.

Here is a different version of the craniocervical flexion exercise in a prone (face-down) position – I find this version to be a little easier to perform without other, more dominant muscles compensating:

2. Prone Chin Tucks for Deep Neck Flexor Endurance:

  • Start in a Prone, face-down, position
  • Place arms up at your sides, elbows bent, resting on the ground
  • Gently brace the abdominals and breathe slowly
  • Gently press through the elbows as you left your head up by tucking the chin
  • Maintain this position until you fatigue

 

Proprioception Exercises For Chronic Neck Pain

In addition to strength and endurance issues, people with chronic neck pain also have altered proprioception (cervical joint position sense), balance disturbances, altered eye movement control, and altered postural activity of cervical muscles17.”

At the upper part of the back of the neck, the Suboccipital Muscles have reflex connections to the vestibular (balance), visual, and postural control systems in your body18,19.

Proprioceptive exercises are designed to target the suboccipital muscles and their reflex connections.

Such exercises have been shown to improve joint position error20,21 as well as decrease neck pain.

3. Neck Proprioception Exercise Sequence22:

  • Sit in a chair
  • Place 2 targets about 20 feet away from you, 10 feet apart from each other at eye-level
    • Rotate the head and the eyes together to look at each target side to side
    • Look at one target with eyes first, followed by the head, keeping the eyes focused on the target while the head moves
    • Rotate the Eyes and head to opposite sides, in both the left and right directions, back and forth
  • Each exercise can also be done with 2 targets placed vertically, up and down
  • Challenge yourself more by increasing the speed and range of movements

 

Question: What Other Deep Neck Flexor strengthening, endurance, or coordination exercises do you find helpful? You can leave a comment by clicking here.

  1. Hill J, et al. Predicting Persistant Neck Pain a One Year Follow-Up of Population Cohort. Spine. 2004;29(15):1648-1654. ↩︎
  2. Bronfort G, et al. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine. 2001;26:788-797; discussion 789-798. ↩︎
  3. Chiu TT, Lam TH, Chiu TH. Performance of the craniocervical flexion test in subjects with and without chronic neck pain. J Orthop Sports Phys Ther. 2005;35:567-571. ↩︎
  4. Sarig-Bahat H. Evidence for exercise therapy in mechanical neck disorders. Man Ther. 2003;8:10-20. ↩︎
  5. Taimela S, et al. Active treatment of chronic neck pain: a prospective randomized intervention. Spine. 2000;25:1021-1027. ↩︎
  6. Ylinen J, et al. Neck muscle training in the treatment of chronic neck pain: a three-year follo-up study. Eura Medicophys. 2007;43:161-169. ↩︎
  7. Ylinen J, et al. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003;289:2509-2516. ↩︎
  8. Harris KD, et al. Reliability of a measurement of neck flexor muscle endurance. Phys Ther. 2005;85:1349-1355. ↩︎
  9. Mayoux-Benhamou MA. Longus colli has a postural function on cervical curvature. Surg Radiol Anat. 1994;16:367-371. ↩︎
  10. Chiu TT, Law EY, Chiu TH. Performance of the craniocervical flexion test in subjects with and without chronic neck pain. J Orthop Sports Phys Ther. 2005;35:567-571. ↩︎
  11. Grimmer K. Measuring the endurance capacity of the cervical short flexor muscle group. Aust J Physother. 1994;40:251-254. ↩︎
  12. Domenech MA, et al. The Deep Neck Flexor Endurance Test: Normative Data Scores in Healthy Adults. PM&R. 2011;3(2):105-110. ↩︎
  13. Chiu TT, Lam TH, Hedly AJ. A randomized controlled trial on the efficacy of exercise for patients with chronic neck pain. Spine. 2005;30:E1-7. ↩︎
  14. Ylinen J, et al. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003;289:2509-2516. ↩︎
  15. Ylinen J, et al. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003;289:2509-2516. ↩︎
  16. O’Leary S, et al. Specific therapeutic exercise of the neck induces immediate local hypoalgesia. J Pain. 2007;8:832-839. ↩︎
  17. Jull G, et al. Retraining Cervical Joint Position Sense: The Effect of Two Exercise Regimes. Journal of Orthopaedic Research. 2007: 404-412; Published online in Wiley Interscience. DOI 10.1002 jor.20220. ↩︎
  18. Bolton P. The somatosensory system of the neck and its effects on the central nervous system. J Manipul Physiol Ther. 1998;21:553-563. ↩︎
  19. Peterson B, et al. Cervicocollic reflex: its dynamic properties and interaction with vestibular reflexes. J Neurophysiol. 1985;54:90-108. ↩︎
  20. Humphreys B, Irgens P. The effect of a rehabilitation exercise program on head repositioning accuracy and reported levels of pain in chronic neck pain subjects. J Whiplash Relat Disord. 2002;1:99-112. ↩︎
  21. Revel M, et al. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Arch Phys Med Rehab. 1994;75:895-899. ↩︎
  22. Revel M, et al. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Arch Phys Med Rehab. 1994;75:895-899. ↩︎
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  • jo lo

    thanks for the exercise recommendations. Just wondering for the exercise “Prone Chin Tucks” is that training the endurance of cervical extensors a bit more?

    • Michael Curtis

      Thanks Jo lo…cervical extensors are definitely working here, but the idea is to train the Deep Neck flexors to take more of the load off of them in this position. How often are our head looking down all day? Wouldn’t it be great if the DNF could take some stress off the extensors? It’s similar to the supine chin tucks in that the SCM can be dominant in a lot of people…but that’s all the more reason to train the DNF to contribute more. Just my thoughts…

      • jo lo

        I think training in a functional position is great but maybe can start with a low load exercise and eventually build it up to functional especially when patients have high level of pain?

        • Michael Curtis

          Makes sense Jo lo, thanks for the tip!