Building Resiliency with Neck Pain Exercise

Pain changes the way muscles work together to provide support and movement for the body. In the case of neck pain, the larger muscles at the back of the neck, shoulder, and front of the neck and jaw override many of the smaller, more supportive muscles that are important for good function. After getting the neck moving (see section 2), using exercise for neck pain is the next step in re-establishing these proper relationships.

Research in exercise for neck pain indicates that retraining many of these smaller muscles at the front of the neck helps decrease pain and improve overall function quite effectively. These exercises are small movements that focus on sustained muscle engagement for a duration of time — endurance-focused — rather than the total force production during the exercise. We call the muscles targeted with these exercises “Deep Neck Flexors”.

3A – Deep Neck Flexor Exercise

3A.1 – As mentioned, this exercise is endurance-focused and specific to small muscles — so the total force production and creation of significant movement are not as important for this as they are for many other “regular” exercises.

To do this appropriately, it often takes a two-step approach. This exercise is often described as a retraction exercise — or creating a double-chin appearance — however, the most important movement to achieve is a simple sliding of the head up and down while maintaining contact with the ground.

To begin, lie on your back so the back of your head is in contact with the ground, and the shoulders are in contact with the ground — you are welcome to place a small pillow under the back of the neck if you like, for comfort.

Try to nod your head “yes” from this position, and you should feel the back of the head slide “up”. Once here, as you return to the start you feel the back of the head slide “down”. Repeat this a few times while maintaining contact between the back of the head with the ground (maintaining a “sliding” movement). Once you have a good sense of how to do this, move on to the next step.

3A - Deep Neck Flexors

3A.2 – The second step is to apply gentle downward pressure into the floor along the back of the neck while sustaining the sliding “yes” head nod. You are likely to feel muscles engage along the front of the neck and underside of the jaw if you have completed this movement correctly. Hold this position for 10 seconds, allow a brief rest period (~3-5 seconds), and repeat 8-10 times if possible.

The head should not come out of contact with the floor at any time. Really focus on the sliding movement at the back of the head “up” while nodding the head “yes” as the main key, and try to achieve the pressure along the back of the neck secondary to that. And keep breathing — don’t hold your breath!

This is can also be completed in a seated position in order to progress the exercise, but that only becomes an option once you are able to master the version while lying down.

3B – Isometric Neck Exercises

Isometric exercise for neck pain can be used to re-active muscular control before introducing movement through painful ranges. These exercises creates muscular activation without movement — ie. pushing against an unmoving surface still recruits the muscle even though no movement occurs.

Once again, maximum force production is not the target of this exercise — so the aim should be to produce ~50% resistance, so long as no pain is produced.

To re-engage the muscles of the neck with isometrics, we return to the six planes of movement of the neck from 2E: flexion, extension, lateral flexion (both sides), and rotation (both sides).

For all:

  • Recruit around 50% of your ability — just enough to engage the muscles in the direction that you want.
  • Do not continue with an isometric exercise if it produces pain.
  • Hold the contraction for 10 seconds each. Provide a short break (3-5 seconds) and move on to the next exercise.
  • Keep breathing! Don’t hold your breath.
3B.1 – Flexion
  • Sit tall, in a “stacked” position.
  • Use the heel of both palms on the forehead as resistance.
  • Holding your head from moving with your palms, look down in a chin-to-chest action to create ~50% resistance.
3b1 - Isometric Flexion Neck Pain Exercise
3B.2 – Extension
  • Sit tall, in a “stacked” position.
  • Use the palms of both hands on the back of the head as resistance.
  • Holding your head from moving backwards with your palms, look up in an eyes-to-sky action to create ~50% resistance.
3b2 - Isometric Extension
3B.3 – Lateral Flexion
  • Sit tall, in a “stacked” position.
  • Use the palm of one hand on the same side of the head to provide resistance.
  • Holding your head from moving to that side with your palms, make an ear-to-shoulder action to create ~50% resistance.
  • Repeat with the opposite side.
3b3 - Isometric Lateral Flexion
3B.4 – Rotation
  • Sit tall, in a “stacked” position.
  • Use the palm of one hand on the side of the head you will turn towards as resistance, while supporting behind the opposite ear with the other hand.
  • Holding your head from turning with your palm, make a shoulder-check action to create ~50% resistance.
  • Repeat with the opposite side.
3b4 - Isometric Rotation

3C – Cervical Retraction

Finally, while 3A focused on the “nod” movement of the upper neck, and 3B on the global recruitment of neck muscles, this exercise works the overall ability of the neck and upper shoulders to resist the forward head posture position originally discussed in the first segment (see 1B).

Cervical retraction, like the others above, is not about maximum force production — so the target remains ~50% resistance created.

I recommend using an elastic resistance band if you have one available — or if you don’t, a towel or old t-shirt will do as well. This is fairly simple exercise to complete:

  • Sit tall, in a “stacked” position.
  • Place the resistance band behind the back of the head, holding both ends with your hands.
  • Tension the band by pressing forward with your hands and arms.
  • Resist the forward movement created by the band’s tension — do not allow your head to be drawn forward — so that it takes ~50% effort.
  • Maintain this position for 10 seconds. Repeat 8-10 times.
3C - Cervical Retraction Neck Pain Exercise

Completing all three sections of the above neck pain exercise will provide you with a solid foundation for building resiliency within the muscles of the neck when dealing with neck pain.

Scapular retraction, depression, stabilization, and other shoulder exercises have also been shown to be helpful as supplementary exercises to improve neck pain. If you are familiar with this type of exercise already, they will also be helpful. If you are not, we’ll cover that in an upcoming series for shoulders.

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