Deep Neck Flexor Endurance and Neck Pain: What is Normal?

If someone has back pain, a common refrain is “you need to strengthen your abdominals.”  And with good reason, the abdominals are important stabilizers for the lumbar spine.

So how do we do our figurative “sit-ups for neck pain? 

The deep neck flexors – these muscles are the “abdominals of the neck.”

A number of studies have demonstrated an association between decreased endurance in the deep neck flexors and neck pain.[i]   

I see the effects of this decrease in endurance of these important stabilizers for the cervical spine plays out in a common pattern in people with neck pain.  The deep neck flexors fatigue, are able to do less work and other muscles are recruited to help hold the head up.  This pattern of impaired motor control leads to overload and a cycle in broad tension in muscles stabilizing the neck.  Evidence for this pattern of overload has been confirmed in studies that show accessory muscles are more commonly recruited in individuals with neck pain and decreased endurance in deep neck flexors.[ii]

There evidence that strengthening and improving endurance in the deep neck flexors can help with neck pain rehabilitation.[iii] 

In thinking about training it is helpful to know what our goal is.  A recent study published in the journal PM&R sheds some light what is normal and abnormal with deep neck flexor endurance.  The researchers looked at so-called normal subjects without neck pain.  They found that hold times for activation of the deep neck flexors (http://www.backexercisedoctor.com/journal/2010/6/22/deep-neck-flexor-training-engaging-the-abdominals-of-the-nec.html) was 38.9 +/- 20.1 seconds in men and 29.4 +/- 13.7 seconds in women.[iv]

So, try holding this deep neck flexor exercise for 30-60 seconds.  It is a lot harder than you might think.  But even if you start with holding for only 5 seconds there is still value in building endurance in these “abdominals of the neck.”

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[i] Clin J Pain. 2011 May;27(4):309-14.

[ii] Spine.  2004 Jul 1;29(13):1436-4.

[iii] Phys Ther.  2007 Dec;87(12):1619-32. Epub 2007 Oct .

[iv][iv] PM&R.  2011 Feb;3(2):105-10.