Updated: Jul 28

Key points

  • Neck strength is important for neck alignment and posture.

  • Poor neck strength can lead to forward head posture neck pain, headaches and increased thoracic kyphosis.

  • Neck strength can be tested and improved. Women should aim for 30 seconds and men 40 seconds.

Why is neck strength important.

A lack of strength of the muscles that support your neck can lead to painful strain on other structures including the sensitive nerves at the back of the skull. This in turn can lead to headaches, mid-back and shoulder pain, and nerve symptoms in the arms (Falla, Jull and Hodges, 2004).

This is particularly true of two muscles that run deeply on the front of your cervical spine, longus coli, and longus capitus, collectively referred to as the deep neck flexors (DNF). Inadequate strength of the DNF's leads to a progressive forward head posture and overuse of other muscles often referred to as 'postural stress syndrome' or 'text neck'. For every 2.5 centimetres forward the head moves there is approximately 4.5 kilograms of extra force on the neck (Kapandji, 1974). If the DNF's fail to support the neck properly more superficial muscles like sternocleidomastoid (SCM) take over resulting in increased pressure on the neck and other sensitive structures.

Image. In this image the deep neck flexors in red are weak resulting in:

  • forward head posture (black arrow)

  • increased neck pressure (blue arrow)

  • increased thoracic rounding (green arrow)

How to test.

In practice we use two special orthopaedic tests to measure your deep neck flexor capacity - the Cranio-Cervical Flexion Test (CCFT) and the Deep Neck Flexor Endurance Test (DNFET). As a rough guide of endurance at home, women should be able to hold their head about 2 centimetres off the floor while lying on their back with their knees bent for 30 seconds, and men for 40 seconds (Domenech et al., 2011).

How to improve.

An easy way to improve DNF strength is to use the DNFET position and practice holding your head up for 10 second intervals. Rest for 5-10 seconds in between and try and repeat 3-5 10 second holds. This should be felt in the front of the neck behind your throat and not at the back of the neck. If it irritates the back of your neck or is too hard, try performing it from a small pillow.

Domenech, M., Sizer, P., Dedrick, G., McGalliard, M. and Brismee, J., 2011. The Deep Neck Flexor Endurance Test: Normative Data Scores in Healthy Adults. PM&R, 3(2), pp.105-110.

Falla, D., Jull, G. and Hodges, P., 2004. Patients With Neck Pain Demonstrate Reduced Electromyographic Activity of the Deep Cervical Flexor Muscles During Performance of the Craniocervical Flexion Test. Spine, 29(19), pp.2108-2114.

Kapandji, I., 1974. The physiology of the joints. Annotated diagrams of the mechanics of the human joints. Vol. 3: The trunk and the vertebral column (2.ed.). Edinbourgh: Churchill Livingstone.

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