10 Features of a successful exercise programme for neck pain

Have you tried exercises for your neck pain in the past and not found them useful? It may be that they were the wrong exercises. Research has shown that most people can reduce their neck pain by at least 50% as long as the exercise programme follows certain principles.

In this article:

• How the neck is put together

• The neck also has “core” muscles

• I have an injury in my neck – how can exercise help?

• 10 Features of a successful exercise programme for neck pain

In this video I discuss the information in this article in a bit more detail.

How the neck is put together

Your neck is formed by 7 bones (vertebrae) stacked on top of each other. These bones are separated by discs that are made of cartilage. Each bone in your neck also has two little joints (facet joints) at the top and the bottom that they use to slot into the bone above or below them.

Image adapted from original by Anatomography found at https://commons.wikimedia.org/wiki/File:Cervical_vertebrae_lateral2.png

Your spinal cord runs from your brain down the middle of your neck bones. There are little openings to the sides of where 2 neck bones meet where the nerves that run to your arms exit from.

Several thick ligaments connect the neck bones together. As you know, your head is attached to the top of the neck and the neck itself is attached to your thoracic spine (where the neck meets the shoulder girdle).

Your neck has a whole load of muscles that connect the vertebrae to each other, to the head and to the shoulder girdle. I stopped counting at 27 (and that’s just on one side) but I’m sure I missed out a few.

The neck also has “core” muscles

The muscles in the neck can roughly be divided into deep and superficial layers.

The deep layer consists of smaller muscles that usually only run between 2 bones e.g. they connect 2 vertebrae together or connect the first bone in your neck to your skull. These deep neck muscles are thought to provide most of your stability in your neck and are seen as the “core” muscles. These are also the muscles that most often become weak when you have neck pain.

The superficial layer includes larger muscles like your Upper Traps and Scalene. They cross over several joints and their main function is to create movement. They often become painful and over-active when you have neck pain. These larger muscles all run from somewhere in the neck and attaches around the shoulder and shoulder blade. They tense when you use your arms e.g. push or pull or lifts stuff.

Your smaller "core" muscles' job is to keep your neck in a good posture - working against the pull of the big muscles e.g. your upper traps. If the stability muscles aren't strong enough, you may end up spraining your neck when you do things with your arms. That's why it's important to not push heavy weights in the gym if you can't keep your neck in the right posture.

I have an injury in my neck – how can exercise help?

By strengthening the muscles in your neck, you provide stability and support that helps to take the strain off the injury.

The research has shown that exercise programmes that are specifically developed to help neck pain works for all sorts of neck pain, including whiplash and nerve pain.

It may not always take all the pain away, but it can reduce the intensity of the pain, how often you get neck pain and headaches and help you to be more active and function better without getting the same level of pain.

10 Features of a successful exercise programme for neck pain

Looking at the current research, a successful neck exercise programme for neck pain should include the following:

1. The exercises has to be at the right level for you. If it is too hard it will likely aggravate your pain. There are a hundred different ways to strengthen the neck muscles and I’ve always managed to find one that works for my patients.

2. It must include specific exercises for the “core” muscles of the neck. These muscles are the ones that run between your neck bones and that should be supporting your injury.

3. “Core” exercises for your trunk and lower back should be included. Your neck sits on your torso. If your torso is jelly, the neck will have a hard time stabilising itself.

4. The exercises should teach you the correct way to move your neck. When we’re in pain we often develop funny ways to move as we try to avoid the pain, but these can often add to the problem.

5. The programme should help make you more aware of your posture and how to correct it. There is no such thing as perfect posture, but there are definitely positions and postures that put less strain on your neck and joints.

6. It should start with easy low load exercises that are done on most days

7. The programme should move on to include specific resistance training exercises for the neck. Resistance training should be done 2 to 3 times a week.

8. The exercise level or intensity must be progressed over time. How quickly you move on to more difficult exercises all depends on your specific situation. It should not be rushed and must be at the right level for you. But staying at the same level for ever is also not useful. I don’t tend to follow any recipes with my patients. I monitor my patient’s symptoms closely and use their feedback to decide when we should make things a bit more difficult.

9. You should not experience increased pain as a result of the exercises. Monitor your symptoms. It's not OK if you experience increased pain after doing the exercises. If this happens, your training programme is not right for you and should be adjusted.

10. You won’t always see instant results. Most of the research studies found that patients only started noticing positive changes in pain and how they functioned after 6 to 12 weeks.

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate.

References

• Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy 2008;38(9):A1-A34.

• Halvorsen M, Falla D, Gizzi L, et al. Short-and long-term effects of exercise on neck muscle function in cervical radiculopathy: A randomized clinical trial. Journal of rehabilitation medicine 2016;48(8):696-704.

• Lauche R, Wayne PM, Fehr J, et al. Does Postural Awareness Contribute to Exercise-Induced Improvements in Neck Pain Intensity? A Secondary Analysis of a Randomized Controlled Trial Evaluating Tai Chi and Neck Exercises. Spine 2017;42(16):1195-200. doi: 10.1097/brs.0000000000002078

• Ludvigsson ML, Peterson G, Dedering Å, et al. One-and two-year follow-up of a randomized trial of neck-specific exercise with or without a behavioural approach compared with prescription of physical activity in chronic whiplash disorder. Journal of rehabilitation medicine 2016;48(1):56-64.

• Ludvigsson ML, Peterson G, Peolsson A. Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash-Analyses of a randomized clinical trial. Scientific reports 2018;8(1):12409.