Why Are the Deep Cervical Neck Flexor Muscles Important?

The deep cervical neck flexor muscles consist of: the longus colli, longus capitus, rectus capitus and longus cervicus – they are a group of muscles that are located on the front of the neck and are responsible for maintaining neck stability, nodding movement, and supporting the head. The deep neck flexor muscles are often referred to as the ‘core’ of the neck, just like how the abdominal muscles are often referred to as the ‘core’ of the lower back. Research supports the importance of having a strong core to help prevent lower back pain, however, most people are unaware of the importance of having strong deep neck flexors to prevent neck pain.

(Photo credit: https://burnabyphysiocare.com/deep-neck-flexor-treat-neck-pain/)

Why Might I Need to Strengthen Them?

The deep neck flexors can become weak due to poor posture, such as in sustained positions with forward head and rounded shoulders (commonly seen in prolonged computer and phone use) (Harrison et al. 2003). Any weakness or dysfunction in the deep neck flexors can result in neck pain and other symptoms. In addition, the other larger muscles around the neck (such as the sternocleidomastoids, scalenes, upper traps and levator scapulae) begin to overcompensate as they take on the role of the weakened deep neck flexors in stabilisation of the neck (Jull 2000). These compensatory strategies can lead to imbalances on both the front and back of the neck, resulting in worsening posture (Arora & Veqar 2010). You may feel like you need to stretch your neck out, but no matter how many times you stretch it always tightens back up, as your deep neck flexors may be the underlying source. A study conducted in 2016 investigated the effects of deep cervical flexor muscle activation in patients with chronic neck pain (Kim & Kwag 2016). They randomised the 28 patients with chronic neck pain into control and intervention groups over 4 weeks, with the intervention group receiving deep cervical flexor activation exercises (Kim & Kwag 2016). They found that deep cervical flexor activation exercises were able to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain (Kim & Kwag 2016). A similar study in 2021 looked into the effect of 4 weeks of deep cervical muscle flexion exercises in patients with headache and forward head posture, and found that these exercises were able to improve quality of life and activities of daily life by easing headaches and sleep disorders (Choi 2021). Deep cervical flexor training has also been suggested to reduce dizziness (Thoomes-de Graaf & Schmitt 2012).

So How Do I Strengthen Them?

Once assessed, your physiotherapist you may be advised to perform single exercises for strengthening the deep neck flexors, such as chin tucks and gentle head nods. These should be performed comfortably and pain free, your physio will help guide you on correct form and activation, as well as progressing your strength program when indicated.

If you have any questions or are experiencing neck pain, dizziness, or headaches – feel free to get in contact with Barossa Physiotherapy for an assessment.

Nirmay Rai (Final Year Physiotherapy Student)

References:

Arora, D & Veqar, Z 2010, 'Correlation between endurance of deep cervical flexors and lower scapular stabilisers in computer users with chronic neck pain', British Journal of Sports Medicine, vol. 44, no. Suppl 1, p. i11.

Choi, W 2021, 'Effect of 4 Weeks of Cervical Deep Muscle Flexion Exercise on Headache and Sleep Disorder in Patients with Tension Headache and Forward Head Posture', Int J Environ Res Public Health, vol. 18, no. 7, p. 3410.

Harrison, DE, Harrison, DD, Betz, JJ, Janik, TJ, Holland, B, Colloca, CJ & Haas, JW 2003, 'Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial', J Manipulative Physiol Ther, vol. 26, no. 3, Mar-Apr, pp. 139-51.

Jull, GA 2000, 'Deep Cervical Flexor Muscle Dysfunction in Whiplash', Journal of Musculoskeletal Pain, vol. 8, no. 1-2, 2000/01/01, pp. 143-54.

Kim, JY & Kwag, KI 2016, 'Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain', Journal of physical therapy science, vol. 28, no. 1, pp. 269-73.

Thoomes-de Graaf, M & Schmitt, MA 2012, 'The Effect of Training the Deep Cervical Flexors on Neck Pain, Neck Mobility, and Dizziness in a Patient With Chronic Nonspecific Neck Pain After Prolonged Bed Rest: A Case Report', Journal of Orthopaedic & Sports Physical Therapy, vol. 42, no. 10, 2012/10/01, pp. 853-60.