Neck Pain and the Deep Neck Flexors


It’s safe to say that if you haven’t had neck and/or shoulder pain, you probably will at some point in the future. Like lower back pain, once you’ve had neck pain, the chances of having a future episode are significantly higher. A 2012 study reported that over a 12-month period, 16-18% of participants complained of neck and shoulder pain and 21-38% sought medical treatment. Moreover, 13-21% lost work time because of their neck and/or shoulder pain. The study reported there was a “…strong episodic nature…” as this condition was found to frequently come and go. Neck pain can arise from a number of structures including muscles, ligaments, bone, joint capsules, and more. Typically, a patient presenting with neck pain is treated for a few weeks and is then quite satisfied with their result… until it comes back. Unfortunately, there is usually, “…a next time.” So, the question is, what can we do to prevent the re-occurrence of neck pain?


When considering the many causes of neck pain and the high rate of recurrence, one common finding in those with this popular “come and go” neck/shoulder pain pattern is weakness of the deep flexors muscles located in the front of the neck. One reason for this common finding is that it is very difficult to strengthen the deep, intrinsic muscles of the neck as they are “involuntary” muscles, which means we cannot consciously “flex” or purposely contract them. Also, the larger extrinsic muscles tend to be too tight and by reflex, “turn off” or inhibit the deep neck flexor muscles, compounding the problem.


Therefore, in order to exercise them, we must “trick” the deep muscles into contracting without contracting the larger, extrinsic muscles. This can be accomplished by doing a very specific, controlled exercise with our neck by laying on the back with a partially inflated blood pressure cuff (or by using a special device purposely made for this test and exercise) placed behind the neck. The inflatable bag is pumped up partially to about 20 mmHg and then in a VERY controlled manner, we tuck in our chin and flatten our neck pressing into the bag raising the pressure by 2mmHg and holding that steady for 3-5 seconds. This is repeated in increments by pushing down a little harder until the gauge reads 24mmHg and again, holding that for 3-5 seconds. This pattern is repeated five times or until you reach 30mmHg and the process is then reversed releasing the pressure in 2mmHg increments at 3-5 second holds until you reach 20mmHg again. Sound easy? Not quite!!! This exercise requires “fine motor control” to accomplish the task and most of us haven’t specifically addressed these fine moving muscles and end up only exercising the larger extrinsic muscles by doing traditional neck strengthening exercises, which further inhibits the deep neck flexors.


The first time you try this, you’ll be amazed at how challenging and tiring it is. But, after a few days of performing the exercise, you may find you feel much better! Of course, this depends on the degree of injury one has, but often, once cervical spine stability is improved by strengthening these deep neck flexors, symptoms usually improve as well. So, the question is, can we achieve good deep neck flexor strength by doing a more practical, upright position exercise rather than requiring a costly apparatus that requires a laying down position? In a recent study, researchers found a standing exercise using a movement called a “neck-lengthening maneuver” produced similar results as the laying down exercise (relaxation of the strong, extrinsic – outside – muscles and strengthening of the deep neck flexors). Simply tuck in the chin and stand tall, “lengthening” your neck!