Exercise Considerations for Neck Pain

Today’s post is written by Rick Kaselj.  Rick is the creator of the Muscle Imbalances Revealed products that I have mentioned in the past.  I reviewed both the lower extremity and upper extremity editions of Muscle Imbalances Revealed in the past.  Rick has a nice presentation on the neck in the upper body edition and wanted to share this post on the topic.  Thanks Rick!

Exercises for Neck Pain

Often times our clients with neck pain will get all kinds of diagnostics tests, have all kinds of assessments, and have a stack of labels before they get to us.  With all that information, it is sometimes challenging to design a proper program.

The first exercise component that most of us go for is stretching the neck, but is this right?  Should you be stretching someone with neck pain?  After stretching, we start strengthening.  Now, do the good old 3 sets of 10 repetitions work for neck pain?  What kind of strengthening exercises do you do for the neck?  Should I be doing cable machine neck exercises?

These are all common questions that the research can help us answer.

Strengthening and Stretching Leads to Better Neck Pain Results

Lets start off with looking at headaches caused by neck pain and how exercise can help.  Looking at Ylinen 2010 where they had a 2 week clinical and home based exercise program that was done 5 days a week.  They had two groups in the study, one was a strength group and the other was an endurance group.

The endurance group lifted their heads up from a supine position for 3 sets of 20.

The strengthening group used a dynamic isometric hold with tubing in a sitting position for 1 set of 15 in 4 directions.

Both groups performed shoulder shrugs, shoulder presses, bicep curls, pec flys and pull overs with 2 kg dumbbells for 3 sets of 20.  The control group only performed shoulder and neck stretches.

What the researchers found was that the endurance group had the greatest decrease in headaches after 12 month follow up.  The authors suggest that stretching alone is not enough but an endurance or strengthening program along with stretches may be the best choice.

[EDITOR’S NOTE – My friend Phil Page has a really nice review of this article as well, be sure to check that out here.]

2 Minutes a Day of Exercise will Decrease Neck Pain

Anderson in 2011 performed a study with 174 women and 24 men who worked at least 30 hours a week and who reported frequent neck/shoulder pain.  They had one group that did 2 minutes of exercise and one group that did 12 minutes of exercise for 5 days a week.

After the 10 week program, they found both groups had a reduction of pain and tenderness.  The exercise that they performed was a resistive tubing, lateral raise in the scapular plane.  The 2 minute group performed the exercise for one set to failure while the 12 minute group performed 5 to 6 sets of 8 to 12 repetition.

Very cool.  Now a little more info on isometrics.

Isometric Strengthening is Not A Very Sexy Thing

Ylinen in 2006 reported that “the change in neck pain and disability indices correlated with the isometric neck strength.”  Has to make you wonder.  Keep stretching and get minimal results with neck pain or start doing isometrics and have happy clients and happy necks.

Are Home Programs that Good?

People that start a home program, do great at the start but things taper down as time passes.  We have experienced that in our clients and even in ourselves.  Häkkinen in 2006 noted that “progressive loading, supervision of training, and psychosocial support is needed in long-term rehabilitation programs to maintain patient motivation.”

I know many clinicians are good at this but encouraging your clients to come back and see you in order to review the exercises, provide support and motivation is a good idea to do.


There are a few key points to take away from this article regarding neck exercises:

  1. When strengthening, you are focusing on the neck being in neutral and the contraction is isometric.
  2. Even just 2 minutes of shoulder strengthening a day can help decrease neck/shoulder pain.
  3. Combine strengthening and stretching for better results.
  4. Jari Ylinen, is the man when it comes to exercise and neck pain.  He is Finish and if you do much research into how Scandinavian rehabilitate injuries, they go hard.
  5.  Improving isometric neck strength decreases neck pain.  It would be a good idea to add some to a neck pain program.
  6.  Encourage your clients to see you regularly in order to progress, review, support and motivate.

About the Author

Rick Kaselj, MS.  Rick is an exercise physiologist that has spent his 17 year professional career helping clients recover from injury and prevent injury through exercise. Rick has shared his tips, tricks and exercises when working with injuries to well over 5033 fitness professionals in Canada and the USA.  The foundation to Rick’s books, manuals, DVDs and presentations is his educational background which includes a Bachelors Degree in Kinesiology and a Masters of Science Degree in Exercise Science.  Rick helps clients in Surrey, BC, Canada and also writes a leading fitness education blog on exercises and injuries, http://www.ExercisesForInjuries.com.

Be sure to check out his latest product Muscle Imbalances Revealed Upper Body.

Muscle Imbalances Revealed Upper Body Review


  • Andersen LL, Saervoll CA, Mortensen OS, Poulsen OM, Hannerz H, Zebis MK. (2011). Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain. 2011 Feb;152(2):440-6. Epub 2010 Dec 21.
  • Blangsted AK, Søgaard K, Hansen EA, Hannerz H, Sjøgaard G. (2008). One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. Scand J Work Environ Health. 2008 Feb;34(1):55-65.
  • Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H. (2001). A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.Spine (Phila Pa 1976). 2001 Apr 1;26(7):788-97; discussion 798-9.
  • Häkkinen A, Kautiainen H, Hannonen P, Ylinen J.(2008).  Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study. Clin Rehabil. 2008 Jul;22(7):592-600.
  • Häkkinen A, Ylinen J, Kautiainen H, Tarvainen U, Kiviranta I. (2005). Effects of home strength training and stretching versus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up. Arch Phys Med Rehabil. 2005 May;86(5):865-70.
  • Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002 Sep 1;27(17):1835-43; discussion 1843.
  • Kay TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G; Cervical Overview Group. (2005). Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD004250.
  • Salo PK, Häkkinen AH, Kautiainen H, Ylinen JJ. (2010). Effect of neck strength training on health-related quality of life in females with chronic neck pain: a randomized controlled 1-year follow-up study. Health Qual Life Outcomes. 2010 May 14;8:48.
  • Taimela S, Takala EP, Asklöf T, Seppälä K, Parviainen S. (2000). Active treatment of chronic neck pain: a prospective randomized intervention. Spine (Phila Pa 1976). 2000 Apr 15;25(8):1021-7.
  • Ylinen J, Nikander R, Nykänen M, Kautiainen H, Häkkinen A. (2010). Effect of neck exercises on cervicogenic headache: a randomized controlled trial. J Rehabil Med. 2010 Apr;42(4):344-9.
  • Ylinen J. (2007). Physical exercises and functional rehabilitation for the management of chronic neck pain. Eura Medicophys. 2007 Mar;43(1):119-32.
  • Ylinen JJ, Häkkinen AH, Takala EP, Nykänen MJ, Kautiainen HJ, Mälkiä EA, Pohjolainen TH, Karppi SL, Airaksinen OV. (2006). Effects of neck muscle training in women with chronic neck pain: one-year follow-up study. J Strength Cond Res. 2006 Feb;20(1):6-13.
  • Ylinen JJ, Takala EP, Nykänen MJ, Kautiainen HJ, Häkkinen AH, Airaksinen OV.
  • (2006).Effects of twelve-month strength training subsequent to twelve-month stretching exercise in treatment of chronic neck pain. J Strength Cond Res. 2006 May;20(2):304-8.
  • Ylinen J, Takala EP, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, Karppi SL, Kautiainen H, Airaksinen O. (2003). Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003 May 21;289(19):2509-1
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  6. Mark Brennan
    Mark Brennan says:


    Thanks for the post. Again in our profession we seem to be focusing on one problem such as neck pain as a homogenous group. I agree some necks need strengthening or endurance training but so often with necks I see a great deal of over activity of global muscle activation and the main goal , I feel , is actually to switch off some muscles that are working too hard and adding compressive forces on the neck. Neck patterning and motor control of movement , I feel, is of greatest importance.

    Many Thanks


    • Rick Kaselj
      Rick Kaselj says:

      It depends on why you are doing it.

      Are you doing repeated chin tuck movement for mechanical neck pain in order to improve the alignment of the neck or are you doing it as a cueing strategy prior to performing an exercises.

      I would use it for both situations.

      Rick Kaselj

  7. Barry Wrench, PT, DPT
    Barry Wrench, PT, DPT says:

    This info comes as no surprise to me. I have found great success in treating neck pain by first, decreasing pain using joint mobilizations, grade 1-5, dry needling to release trigger points, as well as modalities. Once the persons pain is under control, I start neuromuscular reeducation for longus colli, scapular retraction and basic postural exercise. I typically progress people from a supine to prone isometric, then add Theraband, then have them hold a longs colli contraction isometrically with a band while performing dynamic stabilization activities with the upper extremities using Theraband or a physioball. I find that if we show people and practice the exercises for a week or so, they are soon ready to do them at home, at which point I make the clinical exercise harder. The key to having them continue their program after d/c is making a positive change in the first or second visit. If we can make them better quickly, they will see the benefit of listening to what we have to offer as advice for ongoing exercise and health. So off my soapbox, I think isometrics combined with dynamic extremity movement is the best current way to rehab neck pain functionally.

  8. Jen Miller
    Jen Miller says:

    In the first video with the endurance exercise, there seems to be more cervical protraction (a dysfunctional movement indicating deep cervical flexor weakness) versus cervical flexion. I find that promoting protraction would be odd. Is that what was done in that study?

    • Rick Kaselj
      Rick Kaselj says:

      Excellent point.

      I had done a first take with minimal neck movement (mainly neck flexion) but it did not look like I was doing anything so I increased the movement in order for it to be clear in the video.

      The focus of the exercise is neck flexion compared to neck protraction.

      With the second exercise, the neck is meant to be in a neutral position with no protraction. I used tubuing compared to tape because it is more common in a fitness setting.

      I have contacted Dr. Jari Ylinen for clarification of the exercises.

      Rick Kaselj

  9. Steven Rice Fitness
    Steven Rice Fitness says:

    I always like seeing exercise recommended, but I need help understanding the particular strengthening exercises shown. I would expect that for most people cervical extension would be more beneficial, and that neck flexion training would increase the very common head-forward posture. Anterior shoulder and torso exercises are also mentioned, which is the opposite of what I would expect.

    Perhaps I’m showing some ignorance here, but I’m more interested in learning.

    • Rick Kaselj
      Rick Kaselj says:


      Excellent questions.

      I would focus on strengthening the neck in neutral.

      I would focus on isometric contraction for the neck.

      The variety of upper body exercises are to train and support the neck in a variety of movements.

      Take care.


  10. Thomas Lam
    Thomas Lam says:

    Great post. Thanks for sharing. I’m certain that considerations to scapular setting, scapular control, thoracic mobility, establishing proper breathing patterns and neck and scapular perturbations are also considerations in addition to neck isometrics (plus others), to help resolve neck and shoulder pain.

    Great job.

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