May 29, 2019

Neck pain and Physical Therapy


Imagine Physical Therapy

Read Time

5 minutes

               Patients with neck pain and headaches all tend to have one thing in common: weak deep neck flexors. Studies have attempted to determine the relationship between neck flexor strength and neck pain/headaches. It was found that patients with neck pain disorders lack control between the superficial and deep neck flexor muscles. The superficial muscles are the larger muscles and the deep muscles are the smaller ones. This muscle imbalance causes the superficial neck flexors to be used more than the deep neck flexors, which shrinks the deep muscles. This causes neck dysfunction leading to neck pain and headaches.  Physical therapists are the experts in fixing neck pain and headaches through a variety of treatment techniques.

               Physical therapists use a test known as the cervical flexion endurance test (CFET) to assess the strength of the deep neck flexors. This test is performed by having the patient lie down while the therapist supports their head. The patient makes a double chin, or a chin tuck, and holds it as the therapist slowly releases their head. The patient tries to maintain the chin tuck while holding their head up for as long as they can. The test is over when the patient comes out of that position or shows signs of maximal effort, such as trembling or shaking. The therapist records the time that the patient can hold this position.  The test can be repeated each visit to see how the patient’s neck strength is improving over time. Studies have determined the sufficient “normal time” for the CFET is 30 seconds, and this is often an initial goal while in physical therapy.

               The job of the physical therapist is to identify these weaknesses and address them with strengthening exercises. It is important to train these deep neck flexors to turn on so that the superficial neck flexors don’t take over. One way we can strengthen these is with neck crunches. Neck crunches are essentially a normal crunch, with the addition of a chin tuck. By performing a chin tuck, or making a double chin, the deep neck flexors are activated. Therefore, the first step is that the chin tuck must be maintained throughout the entire exercise. Once the chin tuck is maintained, the patient performs a normal crunch, or a mini sit-up. This can be repeated for however many times until something gets tired, whether it is the abs or the neck. These neck crunches are sustainable and can be performed anytime, anywhere, giving you the power to contribute to healing your neck pain and headaches. Neck crunches are great because they actually strengthen the core and the deep neck flexors at the same time, so it is a win-win exercise.

               By strengthening these weak deep neck flexors with a simple exercise such as neck crunches, patients can have significant improvement in their neck pain and headaches. Physical therapists use this exercise in addition to other pain-relieving techniques, such as massage, therapeutic dry needling, ultrasonic and electrical stimulation. As patients have less neck pain, they are able to exercise more effectively, therefore improving their overall neck function.

For all of your physical therapy questions, concerns, or to schedule an appointment, contact our team at Imagine Physical Therapy today!



1.       Jull, Gwendolen A, et al. “Clinical Assessment of the Deep Cervical Flexor Muscles: the Craniocervical Flexion Test.” Journal of Manipulative and Physiological Therapeutics, U.S. National Library of Medicine, Sept. 2008,

2.       Domenech, Manuel A, et al. “The Deep Neck Flexor Endurance Test: Normative Data Scores in Healthy Adults.” PM & R : the Journal of Injury, Function, and Rehabilitation, U.S. National Library of Medicine, Feb. 2011,

3.       Kim, Jin Young, and Kwang Il Kwag. “Clinical Effects of Deep Cervical Flexor Muscle Activation in Patients with Chronic Neck Pain.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, Jan. 2016,