Cervical Exercise: - KnowYourBack.org

Walking erectly with “neutral” head position(Figure 1): Make an effort to “walk tall”(chest up, shoulders back) and with your headpositioned in “neutral.” This means your earsare aligned directly over your shoulders whenviewed from the side. Allowing your headto fall into a forward position is a bad habitworth breakingbecause it so oftencontributes to neckpain and prolongsrecovery. It initiallyrequires an effort toconsistently drawyour head backwardbut, over time, thisneutral position willbecome your newhabit.Figure 1. Neutral headpositionSupine neutral head position (Figure 2): Thisexercise enables you to establish and maintainthe “neutral” head position with very little effort,while resting. By lying on your back withas thin a pillow as is comfortable, or ideally withno pillow, let your head fall backward so yourears move toward being aligned with your shouldersand hips as much as you comfortably can.Spending 5-10 minutes in this position, perhapsevery couplehours if necessary,often decreasesor helpseliminate neckpain and allowsyour head tomove further andfurther into thatideal alignment.Figure 2. Supine neutralhead position

Selecting Exercises...continuedSupine retraction (Figure 3): While lying onyour back with your head in neutral position,place your fingers on your chin and push downwardso your chin tucks and your head is pusheddownward into its resting surface. Be sure tofeel a stretch in the back of your neck and a senseof “crowding” in the front of your neck. Repeatthat stretch 8-10 times while monitoring yourpain for either improvement or worsening. Stopthe exercise if your pain is worsens as a result.Figure 3. Supine retraction

Sitting or standing neck retraction (Figure 4):This exercise often reduces or eliminates painby taking your head as far backward as possible,often well past the “neutral” position (Figure 1).Place your fingers on the front of your chin tohelp push your head backward as far as it will go,but maintain your face in a forward-direction.You will again feel a stretch in the back of yourneck and a sense of “crowding” your throat infront. Hold that “retracted” stretching positionfor 1-2 seconds and then release, allowing yourhead to return to neutral. Repeat that movement8-10 times and perform 3-4 such sessions eachday, especially if you are finding it is reducingyour pain. Often, as pain reduces, your head willretract further andfurther backward,making the exerciseeven more beneficial.Even afteryour pain is eliminated,continue thisexercise 3-4 timesdaily for anothertwo weeks to helpprevent your painfrom returning,or return to it anytime your paindoes begin again.Figure 4. Sitting orstanding neck retraction

Posture Is Very ImportantTooIf your symptoms worsen while sitting, meaningthey intensify or move away from your neck,toward or into your shoulder, or down yourarm, it’s likely related to your posture. Mostof us have a habit of slouching and letting ourhead protrude forward(Figure 5). A forwardhead position, especiallywhen maintained for anextended period of time,commonly produces andaggravates painful neckconditions. To your painfullower neck, it is theequivalent of forwardbending at the waist thatso commonly aggravates apainful low back.Figure 5. Forwardhead positionGood neck posture means placing and maintainingyour head in a “neutral” position so, lookingfrom the side, your ears are aligned directlyover your shoulders (Figure 6). When you areunaccustomed to this position, it initially can feelawkward, like a chin-tucking position. But thisnew position places the weight of your head directlyover your supporting spine, like a golf ballnicely sitting on a small golf tee. That minimizesthe stresses on the discs and supporting ligamentsin your neck. It is helpful to sit with the same

hollow in our lower backthat we have with standingand walking (Figure 6).The use of a lumbar rollor support for that hollowcan make sitting erectlymuch easier, especiallyif the buttocks are positionedagainst the back ofan upright chair. Avoidingdeep soft chairs also assistsin sitting erectly.Figure 6. Neutralhead position whilesittingIt also helps at first to approach this new erectsitting posture as an exercise. That helps youpractice finding this new head position as well asbuild the necessary stamina to hold this posturefor longer and longer periods of time. Many alsofind pain relief by creating that same neutral headposition by lying on their back using as thin apillow as possible, or even no pillow at all.Establishing and maintaining the neutral headposition is challenging at first, but can be a keyto both recovery and preventing the return ofyour pain. You can determine the usefulness ofthese posture modifications by monitoring yourown pain: specifically whether you are able todiminish, centralize or even eliminate it. If noexercise, movement or posture is found that willcause your pain to centralize, you may needfurther evaluation to determine your other treatmentoptions.

Exercising Once Pain HasLessenedIn many cases, it may take only one or two daysto control or eliminate symptoms. Once yourpain is much better or gone, gradually and carefullyreturn to any activities you’ve temporarilyavoided and start some simple exercises. Continueas long as your symptoms do not return,get worse, or move away from the center of theback.Establishing that habit of sitting more erectlywith your head in a neutral position, thus avoidingthe protruded head position, is often necessaryand valuable to establish long-term comfort.

Strengthening ExercisesMany people with neck pain also have weakmuscles in the neck, upper back and core. Bystrengthening and stretching those muscles,more blood flow comes to the area to help repairinjury. Your ability to function in your dailyactivities also improves. Stronger muscles providegreater stability to the neck and trunk tohelp establish and maintain good posture andenhance all body movements. Increasing strengthhelps protect you from future problems. Moderatestrength training is one of the most valuablethings you can do for your overall health and isespecially important if you have neck pain. Continueexercises as long as your symptoms do notreturn, get worse, or move away from the centerof the back.Special equipment and gyms can be helpful, butthere are good, low-tech, inexpensive ways tostrengthen neck muscles at home. Five simpleexercises can help strengthen the muscles in yourneck and upper back:

Strengthening Can HelpIsometric strengthening:1. Sit in a chair with your back supported andyour head in the neutral position (Figure 6).Place your hand across your forehead. Pushyour head and neck forward as hard as you areable while firmly resisting any movement ofyour head with your hand (Figure 7). Push for10 seconds, then relax, and repeat three times.2. Similarly, place your hand against the backof your head as you try to push your headbackward (Figure 8) against the resistance ofyour hand. Push as hard as you are able for 10seconds, relax, and repeat three times.3. Do the same by bending your neck to eitherside, again pushing as hard as you can againstthe resistance of your hand that is placedagainst the side of your head (Figure 9). Pushfor 10 seconds, relax, and repeat three times.Figure 7.ForwardisometricstrengtheningFigure 8.BackwardisometricstrengtheningFigure 9.SidwardisometricstrengtheningPerform one set of each of these exercises twice aday. As you repeat them over time, you can varythe position of your head and neck as your handresists your movement, bending slightly forward,backward, or to each side. These exercises willincrease your neck strength in all directions ofmotion.

Prone Head Lifts (Figure 10): Lying face downon a firm surface, raise your chest, shouldersand head up by resting on your elbows. Letyour head hang fully downward so your chin ison or near your chest. Lift your head upwardto the head-neutral position, being sure toretract your head (tuck your chin) as you move(Figure 6). Then continue lifting your head upwardand backward as far as it will go in an attemptto look skyward. Hold that position for5 seconds before slowly returning through thathead-neutral position to the original downwardhead-hanging position. Repeat that exercise 5times, twice a day.Figure 10. Prone head liftSupine Head Lifts (Figure 11): Lying on yourback on a firm surface, raise your head fullyoff the surface, taking your chin to your chest,and hold for 5 seconds before returning to yourstarting position. Repeat that lift 8-10 times,twice a day.Figure 11. Supine head lift

Scapular Retraction (Figure 12): Stand withyour arms at your sides. Keep your head andneck in neutral position (Figure 1). With chestlifted, gently but firmly pull both shouldersbackward while squeezing both shoulderblades backward and downward. Hold for 10seconds and work up to 30 seconds. Performone set of 5 repetitions, twice a day. You mayadd some resistance by stretching a towel or anelastic band across your chest while you pullyour shoulders backward.Figure 12. Scapular retraction

Neck Rotation (Figure 13): While sitting orstanding with your head and neck in neutral position(Figure 6), slowly turn your head to theleft as far as you comfortably can and hold forfive seconds. Similarly, slowly turn the head tothe right and hold for 5 seconds. Perform oneset of 5 repetitions each direction, twice a day.Figure 13.Neck rotationSummaryExercising your neck is a very good thing todo, whether you are having pain or wishingto avoid it. Good neck care includes pain-relievingexercises that also help restore full neckmovement, attention to head and neck posture,followed by moderate strengthening. Thesetechniques can help you recover and provide agood defense against future symptoms.

For More Information,Please Contact:North American Spine Society7075 Veterans BoulevardBurr Ridge, IL 60527Phone (866) 960-NASS (6277)Fax (630) 230-3700Visit Us on the Internet at:www.KNOWYOURBACK.ORGDISCLAIMERThis brochure is for general information andunderstanding only and is not intended to representofficial policy of the North American Spine Society.Please consult your physician for specific informationabout your condition.© 2012 North American Spine SocietyPrinted on recycled paper.