Deep Cervical Flexors: A Key To Neck Pain Relief & Restoration Of Function & Posture

deep cervical flexorsWhile some take to stretching or exercise of the deep cervical flexors right away, there are others that need more detailed instruction of the craniocervical flexion exercises. We have outlined the many documented benefits of specific neck exercises, describe and picture three different methods of the nodding motion that is critical to strengthening the deep cervical flexors.

This section is for those with chronic neck pain and headaches, as well as those looking to correct misalignment of the cervical curve. It is for those with particularly difficult conditions, requiring special details and practitioners looking to expand their knowledge base and clinical acumen. While many can progress to the second focus of the neck stretching, we are going to stop here and concentrate on the craniocervical motion. The reason is there have been many inquiries to learning to strengthen the neck flexors in a more detailed manner, as well as those who are having difficulty with this part. This is very crucial for those who cannot seem to progress past a certain point, or who are getting frustrated with lack of results.

Many do not have the resources or time to seek personal professional help. I remember rehab for my first shoulder surgery n 2014. Early in the process during passive table stretching, I was next to a woman undergoing therapy for her chronic neck pain. Although I might have been paying more attention to my own therapy, I was very impressed with the instruction she was receiving by a very knowledgable Physical Therapist. Trying to keep my comments to myself, the woman made some significant gains in a short period of time.

A 2016 study in the Journal of Physical Therapy Science compared Pilates and a basic stretching and resistance program for corecting forward head posture. Forward head posture is not just a movement of the head forward, it is a coupling distortion of the cervical spine. The craniocervical stretching is a part of puzzle in restoring cervical function, but a key piece. It is directly related to the craniovertebral angle clinically. In the study, strengthening the deep cervical flexors was incorporated. While this is not to compare disciplines, it is rather the practitioner than the specific discipline, the study did show that Pilates was better at improving the craniovertebral angle and range of motion. The study showed both groups had a decrease in pain and disability.

The first two videos show Tara demonstrating deep flexor muscle work and is very good. Try to work through the outside noise.



This next one is a more clinical perspective and explanation.


Finally, we have two videos which delve in fairly deep into these exercises. The use of the stabilizer pressure biofeedback device is demonstrated.



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A low force loading craniocervical flexion test is used clinically to assess the function of the deep cervical flexors, particularly the longus capitis and longus colli muscles. This is a scientifically supported clinical test method to document assess a patient’s ability to perform as well as hold a specific upper neck flexion motion while not engaging the muscles of the mid and/or lower cervical spine. It is an air-filled inflatable pressure sensor employed to guide the patient through five stages (20 to 30 mm/Hg). The biofeedback unit is placed behind the cervical spine and inflated up to 20 mm/Hg. The goal in using the pressure biofeedback device is control in performing the deep cervical flexors with gradual increase of the pressure up to 30 mm/Hg & holding the pressure without using any compensation strategy for 10 seconds.

A 2013 study in the Journal of Physical Therapy Science concluded, ” Selective DCF [Deep Cervical Flexors] contraction exercises are considered very useful in the treatment of patients with neck pain.”

The function of the deep cervical flexor muscles provide essential support for the cervical lordotic curve as well as the joints. A 2004 study in the journal Experimental Brain Research, atrophy of the deep cervical muscles along with a delay in activation was discovered in patients with chronic neck pain.

A 2008 research study in Journal of Manipulative and Physiological Therapeutics indicates the craniocervical flexion test to be a valid clinical and research tool in neck pain and impairment. The authors indicate patients with neck pain and related disorders exhibit an alteration of the neuromotor control during craniocervical flexion featuring a reduction in deep cervical flexor activity, with an increase in superficial flexor activitys often associated with abberant motion strategies and reduced deep cervical flexor isometric endurance. The craniocervical flexion motion retrains these muscles and is incorporated as a program for motor relearning in patients with neck pain, headaches and whiplash. This should also accompany ergonomic postural strategies.

A 2016 study in the journal Manual Therapy used EMG to confirm that an increase in activity of the superficial neck flexors during the craniocervical flexion test reflects a reduction in the activity of the deep flexors in subjects with neck pain

Interesting results from a 2016 Journal of Electromyography and Kinesiology study indicated the incorporation of suboccipital release techniques with the craniocervical flexion exercise provide additional benefits in muscle activation levels and correction of forward head posturing.