Neck Exercises: A Key To Posture Correction And Pain Relief
Neck exercises should be a part of any program for pain relief. In general, these exercises/stretches are simple and easy to do and require no special equipment, just some determination – even a little imagination. This is not difficult once you see some results regarding pain relief. Take some time here; I feel this is the most important page on both relieving and preventing neck pain as well as the related headaches, disability and negative psychological aspects.
Reasoning For These Beginning Specific Exercises
- A 2021 systematic review with meta-analysis in Physical Therapy indicates specific neck exercises are more effective than alternative exercise interventions in reducing pain and disability in patients with nonspecific neck pain.
We are starting with 1) Retractions for proper posture by moving the head backward to a position over the shoulders. At the end of this motion, we will do as the next part, 2) Cranio-cervical flexion, which is a nodding action, to affect the deep flexor muscles targeting stabilizing the postural control muscles with these neck exercises.
1) Retraction exercises are going to be the main starting position. It is important to train this position, gaining awareness of the proper relationship between the head and shoulders relative to the center part, the neck. Neck pain has been on the increase. Working with computers, laptops, tablets and smartphones is a main culprit. Reading in bed and other poor postures protracts the head in relation to the shoulders. The head basically gravitates towards the object. This places stress into the cervical spine and, over time, can cause pain syndromes like headaches, stiff muscles and chronic pain conditions like degenerative disc disease.
- A 2015 study in the Journal of Physical Therapy Science indicates the protracted posture causes overstress in the the lower part of the cervical spine. They noted mainly the C6-7 segment, however, degeneration is often noted early in the lower part of the cervical spine; c4-5-6-7. The authors of this study recommend the retraction posture for patients with c6-7 degeneration. This posture decreases stress on the lower cervical spine and upper cervical segments as well.
So, the beginning of our program will focus on training of the retracted posture. This needs to be consciously done and practiced as part of the exercises, because years of neglect alters our sense of proper position.
2) Nodding exercises or the more technical term, cranio-cervical flexion helps stabilize and re-train the deeper neck muscles and can have a profound effect in relation to posture and neck pain symptoms.
- According to a study in a 2007 issue of the Journal of Pain, this part of the neck exercises has shown an immediate pain reduction response. It is noted that impaired muscle function has been shown to be a feature in painful neck disorders and exercises to retrain performance of the muscles is effective in the long term for alleviation of pain. It is thought that enhancement of muscular support to pain sensitive structures in the cervical spine is the means for relief for both long term and immediate pain modulating effects.
In this study, the data showed the nodding exercises to display the most significant immediate relief of pain which was 14-21% compared to other forms of cervical spine exercises (typical flexion exercises) which displayed only a 3-7% improvement. The authors state this specific exercise has the intention of providing immediate reduction of pain.
Neck Exercises In Basic And Modified Forms
These combined exercises help reverse the ill effects of poor posture, neck related headaches and the pain of neck arthritis or disc degeneration. They are a simple and pro-active approach to improve the coordination and fitness of the muscles. These exercises target the deeper muscles which guide movements and stabilizing these muscles are important for preventing injury as well as rehabilitation because they often become weak when you are in pain and thus require these specific therapeutic exercises to activate and train them.
You can see the neck component as the whole body is raised and the head retracted into proper posture aligning the ear over the shoulder and then the neck is placed into the nodding, cranio-cervical flexion as the back of the head is pulled slightly up and the chin slightly down and in. There is a small head nodding motion as if you are nodding “yes” and the chin pulls towards the neck and the back of the head arches slightly up. The third picture shows this motion and illustrates that you can apply small pressure to achieve the position.
The exercises can initially be performed lying down to help get the specific action of nodding or pulling your chin in towards your neck while slightly lifting the back of the head. This should cause a stretching sensation at the base of the skull. Breathing should be relaxed and full using the diaphragm and exhaling as you pull your chin in. When you breathe in – your belly should go out and when you breathe out – your belly should go in. Watch yourself in the mirror and make sure that when you breathe your neck muscles do not move. This has a relaxing effect, can lower blood pressure and oxygenates the body. Practice this breathing exercise at night lying in bed on your back with your hands on your belly pushing your hands in and out with your belly. Then use the exercises as detailed. Check out the exercises for breathing article for illustrated examples. This helps relax the muscles and oxygenate the body
There is a method to use 3 progressive stages to perform the exercises.
1) The beginning stage is sitting: Place your finger on the front of your chin. Then draw your chin away from your finger as you pull it in. This is basically a nodding movement with your head as if saying “yes” without dropping your head or looking down. You should feel a gentle pull in the back of your neck as this stretches tight muscles there. Perform 2 to 3 repetitions slowly. Hold: Pause for a second or two when the chin is in. Can be done every 20 to 30 minutes when sitting for extended periods of time. At least, try to remember to do it once an hour.
2) The intermediate stage begins in the sphinx position. Relax your head, upper back and shoulders towards the floor. Place your finger on the front of your chin. Then draw your chin away from your finger as you pull it in and up towards the ceiling. As you draw your chin in press your upper back away from the floor. 8-10 slow repetitions.
3) In the advanced stage, stand with your back against a wall. Place a small inflated ball behind your head. Nod “yes” by tucking your chin in and pressing your head against the ball. The ball should roll slightly along the wall. Avoid looking down. 8-10 repetitions slowly. Hold: Pause for a second or two when the chin is in. Perform twice a day. For those who need a more detailed look at this very important motion, follow here: muscle strengthening of the the deep cervical flexors for some detailed videos using beginning methods.
It is important that you concentrate on performing these with good form. With practice of these and other correction exercises you can re-train how your neck functions on an automatic basis. The approach may need professional supervision to advance you step by step through the three stages of motor learning: 1) awareness of the problem, 2) practice of the corrected postures and movements, 3) automatization of a new postural habit in your nervous system. Recovery from injury like whiplash or prevention of headaches and neck pain requires more than a symptomatic approach. It is necessary to improve the posture and fitness of your neck and upper back regions. There are many different exercises that can be prescribed. Often the correct ones can only be identified by careful supervision with a health care professional trained in rehabilitation.
Why Do This?
- A 2016 study in the journal Physical Therapy Science found patients performing this exercise three times per week for four weeks showed significant improvement in neck pain as well as posture. The authors concluded this was effective in relieving pain, improving function, and correcting forward head posture.
- A 2016 study in the Journal of Electromyography and Kinesiology found that doing this specific exercise, technically called the “craniocervical flexion exercise” has a positive effect on forward head posture. Forward head posture is known to have a negative effect on dysfunction of the musculoskeletal system; in particular, the neck. The study found that by including a simple muscle therapy technique called suboccipital release along with the exercise, the benefits for increasing neck muscle function and reducing forward head posture were increased.
- The fascia which surrounds muscles creates a functional unit between the jaw and the neck muscles. There is some evidence that contracting the jaw muscles when clenching can increase the effects of this exercise. A 2015 study in the Journal of Physical Therapy Science found that contraction of the jaw muscles to about 80% of maximum resulted in increased thickness of the longus colli (deep cervical flexor muscle) targeted in this exercise. It should be said that caution should be taken with any dental or jaw joint problems. Using a mouth guard device would be advisable.
Science & The Benefits Of Neck Exercises
The neck exercises may be helpful for cervical radiculopathy (pinched nerve).
- A 2000 study in the Journal of Orthopedic and Sports Physical Therapy found the retraction exercises to alter reflex amplitude which may promote nerve root decompression, reducing C7 radicular pain. This is a very significant finding and the results quite impressive.
A pinched nerve may cause pain to radiate into the arm or fingers. The exercises should be done with caution and should not increase pain. If there is nerve compression, the affected arm may be placed across the chest to reduce nerve tension while performing the neck exercises. Additionally, rotating the head to the right or left may additionally help to reduce symptoms. Finding a position that helps reduce any radiating pain during the exercises is an important and essential approach.
- The 2014 study from the Manual Therapy Journal indicated chronic neck pain individuals performing the nodding exercise achieved pain relief as well as improved control of the cervical spine. Pain relief in many cases was noted immediately and improved muscle function was noted after 3 minutes of performing the exercise!
- A 2013 study in the Journal of Clinical Diagnosis & Research examined the nodding part on Dentists, who have a neck pain rate of almost 75% due to things like prolonged stationary postures, repetitive movements, difficulty with lighting, and genetic factors. The study noted significant forward head posture correction, a decrease in both pain and and disability from chronic pain by doing this simple exercise.
- The motion of retracting the head is often used in the treatment of both head and neck pain, as well as restoration of poor posture. A 2014 study in Manual Therapy Journal gives some insight on the benefits of this exercise. The initial motion of retracting exercises the rectus capitis muscles, while the end range of the motion stretches the muscle. These are deep muscles and can have an effect on the spinal cord.
- According to a 2014 review in the Journal of the Canadian Chiropractic Association, the rectus capitis muscles provide bridges for anchoring to the spinal cord, helping to maintain an open space and stabilization for the cord. The anatomy and neurology is quite complex, however, improving the function of these muscles may help in cases where it has been weakened from conditions that cause dysfunction, like chronic poor posture and injuries resulting in cervical spine pain, headaches and other spinal cord related disturbances.
- A 2013 study in the Journal of Physical Therapy Science did a study with using school students with neck pain and poor posture. The authors noted that performing the nodding exercise is very important to restore neck posture, while continued maintenance of the deeper neck muscles effected using the exercise is necessary to improve neck and shoulder posture.
- In relation to compare the effects of manual therapy and stretching exercise on neck pain and disability, the 2007 Journal of Rehabilitative Medicine states: “Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain. The difference in effectiveness between the 2 treatments was minor. Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain, at least in the short-term.”
- As indicated in Effect of Therapeutic Exercise and Sleeping Neck Support on Patients with Chronic Neck Pain, in the 2007 Journal of Rheumatology, a neck support pillow can increase the effectiveness of a neck exercise program and can achieve the most favorable benefit for chronic neck pain. They stated “In our protocol, we have termed it “exercise”; with pain relief from the pillow, exercise can be more effective.” They recommend that subjects with chronic neck pain should be treated with both exercises and the appropriate use of neck support pillows during sleep.
- A study in the 2007 Archives of Physical Medicine and Rehabilitation indicated differences in isometric neck muscle strength between healthy women and women with chronic neck pain, Women with chronic pain have lower neck muscle strength in extension than a healthy female group.
We know that women suffer neck pain more than men in general. I feel neck exercises are an important link to this problem and a key factor in establishing normal cervical spine function and the reduction of head and neck pain.
- Clearly, specific exercises can have a positive effect on neck pain; however, it is also possible to help prevent neck pain by exercising. An study in the 2014 Occupational & Environmental Medicine indicates that a combination of exercises and stretching can help prevent incidents of neck pain by approximately 50% in office workers.
- A 2014 study in Biomed Research International indicated that exercises directed at the neck & shoulders at work was able to reduce neck pain and even headaches for office workers regardless of being supervised or not.
So, active involvement using exercises is clearly beneficial for the neck, as well as shoulder pain and headache symptoms.
- A 2015 study in the journal Muscle & Nerve found specific evidence of the benefits of exercises in patients suffering damage and pain from a chronic whiplash condition. Muscle damage in the neck can be seen on MRI consisting of fatty infiltration in the muscles and a decrease in the thickness of the muscle. This is called cervical muscle degeneration. In this study, women underwent 10 weeks of neck exercise. Significant increases in muscle thickness and reduction of fatty deposits were measured, which also related to decreased disability and increased muscle strength.
- A study in a 2015 journal Clinical Rehabilitation found a 4 week program of stretching exercises was effective for the relief of moderate to severe chronic neck/shoulder pain for office workers. The subjects were given information on ergonomics and proper positioning at work and performed the exercises 2 times per day, 5 days per week for 4 weeks. The results indicated decreased pain as well as improved neck function and quality of life.
- A 2016 systematic review in the Journal of Manual & Manipulative Therapy discovered that home exercises improve both non-specific and specific (neck related headaches, pinched nerve, whiplash related) types of neck pain, disability, function and quality of life.
- A 2017 study in the Journal of Back & Musculoskeletal Rehabilitation found that use of continuous heat at low level along with Ibuprofen increased compliance with home exercise and led to greater improvements in chronic, non-specific neck pain relief, disability and mobility than physical therapy alone.
- A 2017 study in the American Journal of Physical Medicine & Rehabilitation found that isometric exercises targeting the cervical extensors reduced pain and helped to restore the normal cervical spine curve.
- A 2018 study in Clinical Anatomy used MRI to measure the cross sectional area of neck muscles in those with loss of the cervical curve. The authors found a significant relationship between neck muscle imbalance and loss of the normal curve (cervical lordosis). They indicated an exercise program restoring the balance of flexor and extensor muscles along with extensor muscle strengthening is recommended for those with loss of the normal curve.
Isometric exercise tenses the muscle without shortening or lengthening it. It is very simple to do. It’s like just making a muscle with your arm. This is different than concentric (where you are doing an arm curl) – shortening the muscle, or eccentric (where the muscle lengthens) – holding tension while your arm goes all the way down to the side. So, if you lay on your back and press your head into the floor (with carpet), that is isometric exercise of the extensors, and you control the force.
Neck exercises: Mind – Body Connection
- A 2015 study in the International Journal of Sports Physical Therapy indicates the motor imagery added to exercises for the cervical spine can produce increased benefits. This is a strategy where imagining doing the exercises has beneficial effects to the neurological system. So, after you do your exercises, or when you have some time, relax and do the exercises in your mind. This can be beneficial during the initial stages of recovering from an injury, where there is much inflammation, and practicing this may help.
- A 2019 study in Biomedical Research found that motor imagery (imagining doing the exercise) combined with action observation (watching a movie of others doing the exercise) showed significant increases in shoulder strength on both sides at three weeks compared with the initial strength.
- A 2019 study in PeerJ further indicates mental practice improves cervical joint position sense in patients with chronic neck pain, a goal for exercises. The authors of the study concluded, “The therapeutic potential of the application of mental practice in a clinical context in the early stages of rehabilitation of NSCNP [Non Specific Chronic Neck Pain] should be considered.”
Therefore, we don’t suggest not doing physical exercises and do mental practice instead. Rather, a good mental image of performing correct motions can assist and have actual benefits, especially early in the process. When beginning, patterns of muscle activation and recruitment are altered in the presence of pain, therefore, when some motions are difficult to do or learn, mental imagery practice for 10 to 15 minutes can be helpful and in a non-stressful setting.
I know this page is long and how difficult it is to get motivated to do exercises. We all want something to put on, lay on, have performed for us or swallow a pill to fix it for us, however; if we can just manage to summon just a little strength and motivation, perhaps this can make a huge difference. With healthcare costs rising, it is nice to have something that has the possibility of making a difference that is all natural and absolutely free. Please give it a try. If you notice a difference, continue to practice and perform exercises on a regular basis. The nodding is a finesse motion, where quality counts more than quantity. That’s why we have gone into graphic detail regarding this motion. We also provide variations for variety and for different situations.
- The quality of the neck muscles are vital to rehabilitation and prevention of many neck related conditions. A 2019 study in Clinical Spine Surgery show that the volume of the muscles on either side of the neck have a significant association with balance and posture of the cervical spine as well as disc degeneration.
I am often asked what is the best product to help restore the cervical curve. While there are products to help, these exercises must be included for success. If there was just one method to be used, this would be it. Again, these look so simple, and they are, but do not overlook or discount them. In it’s most basic form: Head over shoulders – retraction, hold, nodding, hold and release. They are essential to help with neck pain and need to be included with any other method for managing pain. If there is only one thing you get from Neck Solutions in looking for a method to help neck pain, this is it – No charge!
The results from scientific studies serves to indicate just how important these exercises are for rehabilitating those with neck pain. The reduction of pain for those in the studies are significant. So, at the computer, reclining, driving, lying down are all good times to do this. Heat, traction and pillows are all used as a part of managing neck pain, but the exercises are a big part of it and a key to success.
Neck Exercises: The Next Step
So, this is the first part of the exercises. If you can’t do these, don’t do the next. But, if you have done these and have become proficient, the next part includes very specific neck stretches and is to be done only after you have practiced the above and feel comfortable with at least the beginning stage. It will increase mobility, continue to increase restoration of the normal cervical curve and can further aid in pain reduction and rehabilitation.
More Neck Exercises?
Yes! When the introductory neck exercises and stretches are mastered, exercises to improve the function of some of the larger weak muscles associated with neck pain can be looked into for strengthening and flexibility: trapezius myalgia exercises | posture exercises | neck pain exercises | neck strengthening exercises | neck shoulder exercises | neck lengthening exercise | neck extensor exercises. There is also a general simple home program.
This can be done for 20-30 seconds each time throughout the day to prevent the ill effects of the slumped posture.
Roll your shoulders back and down by squeezing your shoulder blades together, rotate your hands outward, then pull your chin straight back as if you are trying to touch your chin to your neck. Do not bend the head forward.
To begin, stand in a position of good posture and breathe as described previously.
Do not strain during these exercises. You should notice a gradual improvement over a period of time. If the exercise works for you then continue and try increasing the number and/or amount of time. At advanced levels, small weights can be held in your hands to increase the effect.
- A 2020 study in Clinical Rehabilitation found adding aerobic exercise to neck-specific exercise treatment for patients with neck pain reduced pain, disability, as well as neck related cervicogenic headaches.
We have some great tools to assist in performing these exercises. While not necessary, I have found that people tend to perform the exercises more often and get better results with these simple and easy to use devices. Also, to decrease correction time and aid in restoration, there are neck traction devices and a corrective support pillows to help passively restore the normal curve while actively restoring form and function. Neck supports are also a good passive method to help prevent prolonged forward bending of the head while at work or leisure, in conjunction with the exercises.
Some of the exercisers provide a great method of progressive resistance, which can be beneficial for chronic conditions.
- A 2020 study in Physiotherapy Research International found progressive resistance exercises resulted in significant improvement in neck strength, pain and disability in a clinical population suffering chronic neck pain.
- A 2021 study in Clinical Rehabilitation found that adding a home neck strengthening exerciser to office therapy was more effective than office therapy alone for patients with chronic neck pain.
How Much Of The Exercises Is Enough?
Gentle exercise and stretching is appropriate to tolerance and considering acute or chronic conditions. Resistance training is appropriate for both gaining strength and muscle mass, however; goals should be reasonable and seek to prevent further or re-injury.
- A 2019 study in Medicine and Science in Sports and Exercise indicates that strength benefits are maximized at a low volume of training, while increase in muscle size requires higher levels. Therefore, goals set to maximize strength need not require high levels of training, whereas increasing the muscle mass may not produce greater strength gains.
The study showed significant increases in strength and endurance through resistance training with just three 13 minute sessions per week, and these increases are similar to those achieved with five times the amount of time training. So, strength training can be done efficiently and in a cost effective manner, which may promote better compliance.
Increases in muscle size does not necessarily produce greater strength, but may be advantageous when there is muscle atrophy that is beneficial beyond strength increase. In the study, training consisted of 3 weekly sessions for 8 weeks. A goal of increasing muscle mass beyond increases in strength must consider not only intended goals, but risks as well, and the ability to modify both as needed.
Special Shout Out! Some of the images are from one of my favorite Chiropractors. If you are a health care professional, please check out his publications and seminars. Dr. Liebenson is the Director of L.A. Sports and Spine, and is actively engaged in research on the spinal stabilization system.