Resources and Strategies

The Evidence-Informed Chiropractor


Week 10 - Neck Exercises



What may work better than using manipulation/adjusting alone for neck pain?


The literature is clear; adding exercise to adjusting as part of your management plan


Specifically of the deep neck flexors.

Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache.
  • Gross AR, Goldsmith C, Hoving JL, et al. Conservative management of mechanical neck disorders: a systematic review. J Rheumatol. May 2007;34(5):1083-1102.
  • Gross AR, Hoving JL, Haines TA, et al. A Cochrane review of manipulation and mobilization for mechanical neck disorders. Spine. Jul 15 2004;29(14):1541-1548.
  • Kay TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2005(3):CD004250.
  • O'Leary S, Jull G, Kim M, Vicenzino B. Specificity in retraining craniocervical flexor muscle performance. J Orthop Sports Phys Ther. Jan 2007;37(1):3-9.

Although there are specific devices that can be used, performance of these exercises can be accomplished without equipment by simply using gravity or a hand for resistance.

For example:
  • Instruct the supine patient to lift the head while tucking the chin while maintaining the craniocervical area in neutral for a goal of 3 sets of 12 repetitions.
  • The patient initially uses head weight against gravity. If unable to perform the 12 repetitions, the table is tilted to reduce the effect of gravity until the patient reaches the 12 repetitions goal.
  • After three sets of 12 repetitions is reached 0.5 kg are added with the goal of 12 repetitions always as the target.
  • Eventually, over a four-week program the goal is 3 sets of 20 repetitions.

In-Depth Discussion with Video

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