Deep Neck Flexor Muscle Strengthening for Forward Head Posture

Specific postural changes are seen in upper crossed syndrome, including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae. Forward head posture is shown by a curve in the neck which causes the head to thrust forward to the shoulder, rather than the vertical ideal. Source: Janda

Forward head posture, rounded shoulders, a hunched upper back, headache, shoulder pain, upper back and neck pain and tension.

These are the symptoms of upper crossed syndrome. Upper crossed syndrome is a common postural abnormality resulting in a weakening and lengthening of the back of the body’s upper back and neck muscles and a tightening and shortening of the opposing front of the body’s chest and neck muscles; hence the name upper crossed syndrome. Upper crossed syndrome involves what is called “reciprocal inhibition”, a process where muscles on one side of a joint are relaxing to accommodate contraction on the other side of that joint.

Specifically there is tightness of the upper trapezius, pectoralis major, and levator scapulae and weakness of the rhomboids, serratus anterior, middle and lower trapezius, and the deep neck flexors.

This pattern of imbalance creates joint dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment.

These postural changes decrease glenohumeral stability as the glenoid fossa (the shallow depression on the scapula bone that the head of the humerus fits into) becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This creates a loss of stability and this loss of stability requires the levator scapula and upper trapezius to increase activation to maintain the arm position in the shoulder joint.

There is also increased and constant activity of the supraspinatus, causing degeneration of the muscle.

As a result of these weakened muscles, postural deformity and degeneration is rapidly accelerated to the, ultimately affecting the discs and will lead to pain and dysfunction.

Upper crossed syndrome is typically promoted with a sedentary lifestyle sitting with bad posture, biking with a rounded upper back position, and/or imbalanced strength training such as a person who trains his chest while the back is rarely trained. All these can initiate upper crossed syndrome and in a vicious cycle, this muscle imbalance pattern worsens posture and exercise technique further.

Correcting upper crossed syndrome is complex. In this article, I will focus on strengthening the deep neck flexor muscles that support the head.

The deep neck flexors are the first muscles to weaken in forward head posture. The front deep neck flexor muscles called the longus capitis and longus colli attach to the front neck vertebrae and are the important stabilizers responsible for holding the head up and maintaining good head posture.

When these muscles become weak from forward head posture these muscles eventually fatigue and cause other muscles behind the skull, the sternocleidomastoid, subocciptial, upper trapezius as well as the other posterior muscles of the neck to become stretched as a result of these muscles trying to compensate from the significant weakness and imbalance from these deep neck flexor muscles. (“reciprocal inhibition”, a process where muscles on one side of a joint are relaxing to accommodate contraction on the other side of that joint).

Forward head posture leads to inflammation, dysfunction, degeneration and pain and is a serious issue. The head weighs twelve pounds. Forward head posture, adds an additional twelve pounds for every inch going forward and weakens these neck muscles. Every inch that the head goes forward adds an addition twelve pounds. Two inches forward makes the head weight thirty six pounds, three inches forward makes the head weigh forty two pounds. If you add up the hours, days and years of keeping the head in this position, this puts a tremendous load against gravity causing significant degeneration, arthritis, herniated discs, pinched nerves or spondylosis. These conditions cause rapid degeneration of the neck leading to inflammation, dysfunction, degeneration and pain.

It is essential to correct these muscle imbalance patterns, as they lead to poor exercise technique, compensation patterns, pain and injuries. Upper crossed syndrome is a complex issue. Here I address how I initially assist a client with their corrections by focusing on strengthening the deep neck flexors.

One of the most effective postural exercises for strengthening the deep neck flexors is the chin tuck exercise.

Exercise #1 Chin Tuck

Start slowly with one set of 12 daily. If at any time you feel soreness or increased pain, take a day off to rest. Severe pain warrants a call to your doctor or physical therapist.

Stand or sit and look straight ahead.

Pull your shoulders down and back by thinking about sticking your shoulder blades in your back pockets.

Lift your head as if it is being pulled upward by a string.

Lift chest up slightly.

Tuck chin straight back as if to make a double chin, keeping chin parallel to the ground.

Keep head lifted up and back.

Keep breathing normally.

Hold this 5 seconds then slowly release the tension.

You should feel a pull in your suboccipital muscles in the top back of your neck. You should feel your front neck muscles contract if you place your fingers on them. You are stretching the suboccipital and strengthening the deep neck flexor muscles.

Do this twelve times. You may do this three times a day.

After several weeks, when you feel you have mastered exercise #1, move to #2.

Exercise #2 Towel Press

Wrap a small towel behind your head at the base of your hairline.

Hold the towel endings in each hand. Hold the towel tightly to create resistance for the neck. Assume the same position as in Exercise #1 Chin Tucks and press against the towel.



Caution: Keep in mind that most trainers are not trained to deal with these issues. If you have upper crossed syndrome or other postural deviations, be cautious with the exercises that you choose to do or those that a personal trainer might have you perform. For instance, do not do neck plate curls or exercises using a neck harness as these can cause damage.

When choosing a personal trainer, look for one with advanced certifications such as Advanced Health and Fitness Specialist or Medical Exercise Specialist. Only those personal trainers with a four-year degree in exercise science and those that have over 300 hours of personal training experience are eligible to take the exam for these certifications. Training of individuals with upper crossed syndrome requires someone with in-depth knowledge of the appropriate type of activity that will most benefit them, taking their limitations into consideration.



Does Exercise Increase Longevity?

Doing a few hours of exercise every week will probably help you live longer.

JAMA Intern Med. 2015 Jun;175(6):959-67. doi: 10.1001/jamainternmed.2015.0533.Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship.

Study size: 660,000 people ages 21 to 98.

People who got some exercise, but not enough to meet the physical activity recommendations to get 150 minutes of moderate activity per week or 75 minutes of vigorous activity per week were still 20 percent less likely to die over a 14-year period than those who did not do any physical activity.

People who engaged in the recommended level of physical activity saw even more benefit: They were 31 percent less likely to die during the study period, compared with those who did not engage in any physical activity.

The maximum benefit was seen among people who engaged in three to five times the recommended levels of physical activity; they were 39 percent less likely to die over the study period than people who did no exercise.

Found no link between very high levels of physical activity (10 or more times the recommended level) and an increased risk of death.

The people most likely to benefit from increasing the amount of exercise they do are those who do not currently do any.

Study author said: “Doctors should target this group with exercise counseling. Physicians who seek out the segment of the population that performs no leisure-time physical activity could receive the most payback in their patient’s health”.


The Work Out Anywhere No Equipment Travel Workout

The Work-Out-Anywhere Workout by Maria Faires, RD, ACE-PT, ACE-MES

Even if you don’t have access to a full hotel gym, this list of travel exercises provides you with some body weight exercises you can do in your room so that you don’t lose your fitness gains while you’re traveling. There are lots of exercise options here. Feel free to pick and choose. For best results warm up with cardio, do the first 3 exercises as a dynamic warm up then choose at least 1 or 2 exercises that target the back, the legs, the core. If time allows, stretch after your are done.

Warm up cardio: It is always important to warm up before working out. Options are running in place, dancing, step ups, jumping jacks, jump rope, run around the block a couple of times or walk up and down a stairwell.

Ankle Touches: Run in place, turning your knees slightly outward, bringing the inside of the leg up toward the chest and reaching your hands to touch the inside of your ankles.

Shoulder circle: Stand with your arms straight out from your sides, parallel to the floor. Slowly rotate both arms forward in big circles. Continue for 30 seconds, then draw big backward circles for 30 seconds.

Fire Hydrant Circles: Get in hands and knees position, hips over knees and shoulders over wrists. Keep the arms straight throughout. Pull belly button to spine. Lift one leg off the ground with knee bent and perform circles from the hip; getting as large a range of motion as possible without moving your spine. Do big circles then reverse the circle then switch sides. Make sure your spine is staying stable and all the movement is coming from the hips.

Forward Leaning Lunges: get in lunge position, bend forward, place palms on floor.

Glute Bridges: Lying face up on ground with arms to side, knees bent, and heels on ground (or chair). Lift hips off the ground until knees, hips, and shoulders are in a straight line, hold 3 seconds, return to start position and repeat.

Push-ups: If these are too difficult, do standing pushups. This exercise works your chest, shoulders and arms. Kneel on the floor with about 75 percent of your weight balanced on your palms. Pull your abdominals in so your back doesn’t sag and your spine is in alignment. Bend your elbows and lower your body towards the floor. Once your upper arms are parallel with the floor, press back up to the start.

Ski Jumps: side to side plyos with feet together.  

Wall-Sits: From a standing position, lean back against a wall or a solid stationary object and bend your knees sliding down the wall until your thighs are parallel to the ground. Hold this position for as long as you can. If this position is uncomfortable to you just go to a depth that you feel comfortable with and then work at being able to get into the thighs parallel position as you progress through the weeks of your program. Your feet should be 18 to 24 inches away from the wall to minimize knee stress. Continue to breathe throughout the entire time.

Squat Thrust/burpees: Stand with feet together. Squat down and place your hands on the floor next to your feet. In an explosive movement, jump feet backwards into a push-up position (keep core braced), jump feet back between hands and stand up. Leap up as high as possible from the squat position.

Side lunge windmills. Lunge to right side and touch left hand to right foot, bring right hand up and behind you. Stay low I a lunge and move to other side. Keep back straight.

Jumping Jack: Stand upright with feet together and hands at your sides. Raise hands up above your head, while jumping up just enough to spread your feet about twice shoulder width apart. Immediately reverse movement back to start position without stopping. Repeat as many times as necessary as quickly as possible.

Squats: Stand tall with your feet hip width apart and your hands on your hips. Bend your knees and lower your body. How low you go will depend on your strength and flexibility, but never go so low that your rear is lower than your knees or your knees shoot out over your toes.  Stand slowly back up.

Bench Walkouts to forearm plank: Toes on bench and palms on floor, walk hands back towards bench, walk back out, one arm down to forearm, other arm down to forearm, back up to palms, walk back towards bench.

Single Leg Balance. Standing on one leg, maintain your balance Try to hold for 1 minute. Once this exercise is too easy progress to eyes closed.

High Knee Jog 30 seconds

Hamstring Plate Slides. Lie on back knees bent with heels on paper plates. Tighten butt, slide plates away.

Bench Burpees: toes on bench or sturdy stable chair, hands on floor. Hop toes to floor then back on bench.

Calf Raises: Standing, lift heels off the floor and repeat.

Rear Blasters: Get down on your hands and knees. Slowly extend your right leg behind you until its straight and in line with your back. To get additional effect, squeeze at the top for a couple of seconds. Now slowly lower your leg back into the starting position.

Skipping: forward and back.

Low Ab March: Bend knees and keep bent. Brace abdominals, lift one leg at a time, marching slowly.

Plank: Get into a pushup position and lower your forearms to the floor. Look down at the floor, pull in your belly button and brace your abs. If this is too hard put your knees on the floor. Keep your body in a straight line from ears to toes with no sagging. Hold this position for as long as you can.

Side Plank: Lie on side, knees straight, upper body propped on your elbow and forearm. Hold.

Clam Shell. Lie on your side. Stack your legs one on top of the other, and tuck your knees forward about 45 degrees. Lean your hips forward. Lift the top knee up, keeping your feet stacked. Your legs should look like an open clamshell. Then close your legs. Repeat this movement 10 to 15 times, keeping your pelvis steady throughout the movement.

Bird Dogs: Kneel on hands and knees with legs and hands slightly apart. Raise arm out straight beside head while raising and extending leg on opposite side up out behind body. Hold 8 seconds. Lower arm and leg to floor to original position and repeat. Perform movement with opposite arm and leg.

Cool-down stretch: Take two minutes to walk until your heart rate slows and your breathing returns to normal. Then proceed with stretching.

Stretching Do a stretch for all major body parts: Chest, Back, Shoulders, Arms, Quads, Hamstrings, Calves.