Neck Extensor Exercises To Reduce Pain & Rehab Weak Muscles

The extensor muscles of the neck bend the head back and are important muscles to maintain proper posture. These muscles can become weak due to injury and overstretched from altered posture like forward head posture and military neck. Neck extensor exercises can help regain lost strength and reduce related pain.

The neck extensors help support the weight of the head which can weigh 9 or 10 pounds. Half of extension in the neck occurs in the upper cervical spine. The extensors consist of both superficial, middle and deep muscles. Often found to be involved in pain syndromes, targeting these specifically for neck pain or neck/shoulder pain may be a key to relief.

The superficial muscles are the trapezius and this also raises the shoulder and scapula and flexes the neck to the side.
The middle layer muscles include the splenus cervicis and the splenius capitis which extend, side bend and rotate the neck. The deep layer include the rectus posterior major and minor, semispinalis capitis and obliquus superior which also extend, side bend and rotate the neck.

There is a focus on neck extensor exercises because these are anti-gravity muscles. Many are long which allows increased torque and an better mechanical advantage.

There are two types of muscle fiber. Type 1 are recruited in long endurance tasks such as anti-gravity and are resistant to fatigue. They are more susceptible to inactivity and denervation atrophy. Type 2 are for quick motions and are more susceptible to things like cancer, diabetes, heart disease, and aging. Aging leads to loss of both types of muscle fibers, with a preference for atrophy and fiber transformation; from type 1 fatigue resistant to type 2 fatigable fibers.

The unique fibers of the neck extensor muscles causes transformation from type 1 fatigue resistant to type 2 fatigable with age and and also inflammatory muscle disease, and can predispose these muscles to stress, damage, and immune attack. When inflammatory and/or immune, it can lead to head drop syndrome as well as muscle degeneration.

Neck extension exercises addresses the complex biomechanics of neck extension and their predisposition to weakness with advancing age and inflammatory muscle disease, leading to pain syndromes and other problems with head support.

• A 2017 study in American Journal of Physical Medicine & Rehabilitation found neck extension exercise restores physiological cervical lordosis (normal curve of the neck) and reduces pain. At the end of 3 months, pain intensity was significantly reduced, about twice in the exercise group compared with the control group without exercise.

• A 2011 study in the Archives of Physical Medicine & Rehabilitation found altered activity of the extensor muscles in chronic mechanical neck pain using functional magnetic resonance imaging.

• A 2018 study in the Journal of Manipulative and Physiological Therapeutics found an important role of deep neck extensor muscles in providing neck stability and healthy function. They found the semispinalis capitis had less thickness in individuals with forward head posture, implying lower activity of the muscle.

Therefore, neck extensor exercises are an important part of any routine to reduce neck pain and improve posture. Focus on quality instead of quantity, especially at first. Stop if it produces and sharp or increase in pain. It can be counterproductive if you suffer facet joint syndrome. The below video shows isotonic exercise – where the muscle lengthens.

• A 2021 study in the Journal of Orthopaedic Surgery and Research found straightening of the cervical curve or slight reversal (cervical kyphosis) is associated with axial neck pain and may lead to its development. Axial neck pain is pain restricted to to the neck and immediate structures, but does not involve the arms, hands or fingers, as seen in radiculopathy associated with disc herniation or myelopathy.

• A 2021 study in the European Spine Journal found a correlation between pain and symptom duration with fatty infiltration of the deep cervical extensors. This often results from disuse atrophy.

• A 2017 study in American Journal of Physical Medicine & Rehabilitation used isometric (muscle does not lengthen) exercises for the extensors significantly improved over no exercise and there was cervical lordosis angle restoration. At 3 months, pain intensity was about twice in the exercise group compared with the no exercise group.

• A 2022 study in Musculoskeletal Science and Practice found functional and structural impairments of the cervical extensor muscles have been demonstrated in people with neck pain. An exercise approach targeting the extensor muscles has shown positive effects for pain and reduced neck disability.