Deep Cervical Flexors: A Key To Neck Pain Relief & Restoration Of Function & Posture
While 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 knowledgeable 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 correcting 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.
For those who are serious about these exercises, there is a device that can greatly assist. A 2015 study in the Journal of Physical Therapy Science found that using a neck stabilizer biofeedback device had significantly better results than those without for endurance and mobility in individuals with forward head posture.
A 2021 study confirms training with Pressure Biofeedback has proven to be more effective in improving endurance of deep cervical flexors in patients with mechanical neck pain.
A 2019 Systematic review with meta-analysis in Musculoskeletal Science & Practice found that increased control of the deep flexors using cranio-cervical flexion was more effective than other treatments for non-specific chronic neck pain. The less these muscles are used, the more problems with cervical spine stabilization. This is compensated by overuse of the more superficial, large muscles, which are prone to strain and overuse.
Deep flexors in the neck have been found to improve recovery from concussion, which often occur with neck injuries, like whiplash. We know that strengthening neck muscles helps prevent concussion, however; because the deep neck flexors are not large muscles, strengthening does not help in prevention, but improving endurance through these exercises assists in recovery predictively throughout rehabilitation according to a 2019 study in Musculoskeletal Science & Practice.
A 2020 study in the journal Healthcare found that gazing down at 20 degrees helps prevent activation of the superficial muscles when performing this. This can help increase the effectiveness to activate the deep flexors.
A 2021 study in Biomed Research International found that specific training of the deep flexors in addition to conventional exercises can improve neck pain and functional disability in those with occupational neck pain. In this study, 65 teachers age 25-45 years with more than 5 years of teaching experience participated.
A 2022 study in the Journal of Clinical Medicine found Neck flexor weakness was predictive of future neck disability.
A 2023 study in the Korean Journal of Pain found significant improvement in pain, posture, motion range and neck disability by applying deep cervical flexor muscle training in addition to conventional treatment.
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.
A 2023 report in the American Journal of Emergency Medicine indicates longus colli muscle acute calcific tendinitis is an inflammatory reaction brought on by the buildup of calcium hydroxyapatite crystals. Usually, overuse injuries and whiplash are linked to it. Neck pain that worsens over time is a typical inflammatory reaction symptom.
It is a rare but significant cause of neck pain that needs to be taken into account. The report indicates a woman presenting in an emergency room with mild sore throat that progressed to acute neck pain and stiffness with myalgias, fever, nausea, and fatigue. Calcific tendonitis was determined to be the cause verified by CT. The patient was discharged home with a short course of anti-inflammatories and corticosteroids with near-complete resolution of symptoms. Thus it is important to differentiate when neck pain is a medical emergency.