Exercising with neck pain
Exercise has been shown to improve symptoms associated with spinal pain. It is important to remember that there is no magic recipe for what exercises you should perform.
Pain is much more complicated than we used to think. We know that pain can be affected by many different factors including fear, anxiety, social circumstances and mood amongst other things.
We know generally now than getting moving quickly after an injury is very important and lessens the possibility of someone developing chronic or persistent pain.
The key to success and getting the most out of your exercises is to:
You may find that these exercises slightly increase your symptoms initially. You should find that the exercises themselves become easier to do and that you begin to move more easily.
A rehabilitation programme starts with easier exercises and then needs to be progressed until you are able to do the activities you need to do with less pain, so don’t give up too early!
These exercises can take up to 12 weeks for you to notice a great improvement, although you may notice a difference sooner than this. If you do not improve over 12 weeks, or get worse despite the exercises, then please contact your health professional.
Pain after exercise
Your pain or other symptoms should return to your pre exercise baseline within 30 minutes of exercising. You should not feel an increase in your pain or stiffness the next morning.
It is normal to feel some muscle soreness from doing exercise that you have not been used to. You should not worry about this and it should improve with time.
Click HERE for a printable version of the first section
Before undertaking the suggested exercises please review our disclaimer. Please click HERE
Section 1: Mobility Exercises
Despite being in pain it is important to maintain your range of movement in each direction. Moving into slight discomfort is encouraged.
Remember it is normal to have some pain and discomfort when exercising which should improve the more you practice. If your pain worsens and does not ease by reducing your exercises or having more recovery time between sessions please contact your GP or health professional. If you experience dizziness doing any of these exercises, you should stop and seek the advice of your health professional.
Click HERE for a printable version of the mobility exercises.
Active Flexion/extension
In sitting – head in neutral position. Bring your chin towards your chest as far as you feel comfortable. Hold for 5 seconds and then return to starting position. Then look up towards the roof as far as you are able. Hold for 5 seconds.
Repeat this 20 times. 3 times per day
Active Rotations
In sitting – head in neutral position. Bring turn your head and look over your right shoulder. Hold for 5 seconds. Then return to starting position. Then turn your head and look over your left shoulder. Hold for 5 seconds and return to starting position. Repeat 20 times. 3 times per day.
Active Side Flexion
In sitting. Head in neutral position. Tilt your head so your left ear is moving towards left shoulder. Hold for 5 seconds then return to starting position. The tilt your right ear to your right shoulder. Hold for 5 seconds and return to the starting position.
Repeat 20 times. 3 times per day.
Section 2: Strengthening Exercises
People who have neck pain often have weakness in the muscles which help to support your neck and help you maintain good posture. Strengthening exercises have been shown to increase neck movement, reduce pain and build strength.
Click HERE for a printable version of strengthening exercises.
Deep Neck Flexors (Activation) In Lying
The aim of this exercise is to activate the deep neck flexor muscles and improve their endurance through range in lying Lie in supine with the weight of the head and the cervical spine supported by towel under the occiput in a neutral position. Place the tongue on the roof of the mouth, keep lips together and teeth slightly apart (to discourage activity of jaw depressors). Slowly nod the head in an action indicating “Yes” to roughly 2 cm to start. Hold this position for 10 seconds. Once the 10 second hold can be carried out pain free then move a further 2 cm (4cm in total) into more range hold for 10 seconds. Do this until pain free. Then further increase the range to 6cm and 8 cm respectively
Deep Neck Flexor (Activation) in Sitting
The aim of this exercise is to activate the deep neck flexor muscles and improve their endurance through range in sitting. In sitting with back of head supported on hall and rolled up towel in the natural hollow. Place tongue on the roof of the mouth, keep lips together and teeth slightly apart (to discourage activity of jaw muscles). Slowly nod 2cm in an action indicating “Yes” to roughly 2 cm. Hold this position for 10 seconds. Once this 10 seconds hold can be carried out pain free the move into a further 2cm range movement (i.e. 4cm from starting position). Hole for 10 seconds and continue until pain free. Then progress 6cm into range and 8 cm into range respectively.
Deep Neck Flexor Strengthening in Lying (Longus Colli)
The aim is to strengthen the deep neck flexor muscles in addition to the superficial neck flexors
Level 1 (Chin Tuck) – Lie in supine with weight of the head and the cervical spine supported by a towel under the occiput in a neutral position. Place tongue on the roof of the mouth, keep lips together and teeth slightly apart. Slowly nod 2 cm and then return to starting position. Do this for 60 seconds. 3 times. 3 times per day.
Deep Neck Flexor Strengthening In Sitting (Longus Colli)
The aim is to strength the deep neck flexors muscles in addition to the superficial neck flexors
Level 2 (Chin Tuck in Sitting) – In sitting with back of head supported on hall and rolled up towel in the natural hollow. Place tongue on the roof of the mouth, keep lips together and teeth slightly apart (to discourage activity of jaw muscles). Slowly nod 2cm in an action indicating “Yes” to roughly 2 cm. Do this for 60 seconds. 3 times. 3 times per day.
Deep Neck Flexor Strengthening in Lying (Longus Colli)
The aim to strengthen the deep neck flexor muscles in addition to the superficial neck flexors
Level 3 – Cervical Flexion Eccentric. Lie in supine with weight of the head and cervical spine supported by a towel under the occiput in a neutral position. Patient lift your head at the occiput into a flexed position and then lift head and shoulders off the bed. Remove hands that were supporting the occiput. Keep chin tucked in towards the chest. Keep this position and slowly lower your shoulders back down towards the bed. Slowly return back of head onto the towel with chin still tucked. Once head has returned to the towel slowly return back into a neutral position. Do this 15 times. 3 times per day.
Deep Neck Flexor Strengthening in Sitting (Unsupported)
The aim is to strengthen the deep neck flexor muscles in addition to the superficial neck muscles.
Level 4 – Unsupported Chin Tuck. In siting. Place tongue on the roof of the mouth, keep lips together and teeth slightly apart (to discourage activity of jaw muscles). Slowly nod 2cm in an action indicating “Yes” to roughly 2 cm. Do this for 60 seconds, 3 times, 3 times per day.
Deep Neck Flexor Strengthening in 4-point kneeling
The aim is to strength the deep neck flexor muscles in addition to the superficial neck muscles.
Patient in 4-point kneeling. Chin tuck. Then move head into a flexed position as far as possible keeping the chin tuck. Then extend head back to the neutral position whilst keeping the chin tuck. Then release the chin tuck position. Repeat 15 times. 3 times per day
Resisted Theraband Extension in Sitting
Patient starts in sitting with neck flexed as far as able. The theraband is then placed round back of head. Place tongue on the roof of the mouth, keep lips together and teeth slightly apart (to discourage activity of jaw muscles). Patient then tries to bend backwards against the resistance of the theraband. Patient’s hands at back of head supporting band with arms in externally rotated position. 15 repetitions. Repeat 3 times.
Resisted Theraband Flexion in Sitting
Patient in sitting. Head in neutral position. Theraband wrapped round forehead.
Place tongue on the roof of the mouth, keep lips together and teeth slightly apart (to discourage activity of jaw muscles).
Flex neck so chin comes towards chest then return to neutral position. 15 repetitions. Repeat 3 times
Resisted Theraband Side Flexion
Patient in sitting. Head in neutral position. Theraband round side of head. Place tongue on the roof of the mouth, keep lips together and teeth slightly apart (to discourage activity of jaw muscles). Move the ear towards shoulder without raising the shoulder. And return to neutral position. Repeat 15 repetitions. Repeat 3 times.
Section 3: Postural stability Exercises
People with longstanding neck pain are prone to problems balance and postural stability. It is important to do exercises to help with this. You should stop doing these exercises if they cause you to become dizzy or lose your balance
Click HERE for a printable version of the postural stability exercises
Narrow Stance
Stand in bare feet. Fold areas across chest so hands are touching each shoulder. Move feet together so ankle bones are touching. Hold for 30 seconds.
Progression same position but have eyes closed and hold for 30 seconds.
Tandem Stance
Stand in bare feet. Position feet in tandem stance with one heel in front of the other foot toes. Fold arms across chest so that your hands are touching each shoulder. Hold for 30 seconds
Switch feet position and hold for another 30 seconds.
Progression is repeat the exercise with your eyes closed.
Single Leg Stance
Stand in bare feet. Lift one leg up to 90 degrees and stand on one leg. Fold arms across chest with hands touching each shoulder. Hold for 30 seconds.
Switch feet position and hold for 30 seconds
Progression is repeat exercise with your eyes closed
Walking forwards and backwards with cervical flexion/extension & also rotations
Stand in bare feet. Slowly walk forwards whilst at the same time flexing and extending your neck
Do for 30 seconds.
If any dizziness then please stop
Repeat exercise rotating head left and right
Side Stepping with cervical rotation left and right & also flexion and extension
Stand in bare feet. Slowly side walk whilst at the same time looking over your right and left shoulders.
Do for 30 seconds.
If any dizziness the please stop
Repeat exercise flexion and extension
Section 4: Neurodynamic Exercises
Exercise 1 – Median Nerve Glide
To do this exercise – have affected arm out at side to shoulder height with palm facing up towards the roof. Side flex neck and then rotate head to look down towards the floor. Then flex and extend your wrist. Do for 30 second, repeat several times per day.
Exercise 2 – Ulnar Nerve Glide
To do this exercise – stand with arm raised in front of you to shoulder height. Wrist in extended position with palm facing up towards the roof. Side flex your head away from arm as you extend elbow so that your palm faces towards the roof then return to the starting position. Do for 30 seconds, repeat several times per day.
Exercise 3 – Radial Nerve Glide
To do this exercise – stand with your affected hand by your side. Make a fist and bend your wrist. Rotate your arm inwards and move your arm out to the side until you feel the tension.
Side flex your neck away from the affected arm as you rotate your arm inwards. Then as you straighten your head back to starting position. Twist back to the starting position. Perform the movement as one fluid movement. Do 30 seconds, repeat several times per day.