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Neck Pain and Headaches: How exercise can help!

Updated: May 19, 2021

A high percentage of people experience neck pain or recurring headaches during their lifetime. This can happen at any age and can result from a variety of reasons including motor vehicle accidents, sport injuries or postural syndromes. Repetitive strain injuries, that occur over time, from prolonged positions are very common for producing these symptoms. One part of treatment that will be the same whether the injury results in a hypo or hyper mobility, is endurance and muscle training for the neck.

After a neck injury, the muscle stabilizers (Deep Neck Flexors and Neck extensors), stop activating appropriately. The muscle activation pattern can change due to a high force strain, or, due to muscle pattern changes with repetitive postures overtime. Neck stabilizing muscles maintain spine alignment and activate to stabilize the spinal joints when we initiate movement. When they are not activating in the right pattern, the larger muscle groups tighten, due to overworking, as they take over the load of the stabilizers. This adds to the stiffness, pain and headaches experienced.

Why focus on activation and why endurance?

Stabilizers are signalled to activate immediately with any movement as they stabilize the spinal joints (which also support the spinal cord and nerves). We need to reteach the brain and muscles to activate appropriately so other muscles do not take over.

Stabilizers maintain spine alignment to support the weight of our head! This requires endurance to support the head throughout the day.

Muscles and joints in the neck have many proprioceptors (receptors that tell the body where it is in space). After injury or prolonged disuse, these receptors are not able to function properly. Strengthening, movement specific exercise and improving blood flow help these receptors to function appropriately again.

Below is a sample of exercises that may be given to build strength and endurance in the neck muscles. Repetitions and sets are not detailed because that will vary per individual. For a detailed exercise program, ask your Physiotherapist where you should start with strengthening these muscles.


The first step is to teach the muscles to properly activate. We do this by breaking down the movement. Below is a picture of a “chin nod.” Start by laying on your back with your head on a flat pillow or towel. Pretend there is a rod that runs through your ears, and that you are hinging on that rod. Nod your chin towards your throat as if giving yourself a double chin (without lifting the head up or pushing the head into the pillow/towel). It is a gentle movement. Hold for 5 seconds, relax your head back to your starting position and repeat. The larger muscles of the neck should not activate during this position.

How to start building endurance:

The next step is endurance. These muscles not only stabilize the neck, but are also working all day to provide support to the neck and head. See the picture below. Start with the “chin nod” described above. Maintain the “chin nod” as you curl your head up and forward , without lifting the shoulders off the ground. Hold for 5 seconds. As you lower your head, it is IMPORTANT to maintain the “chin nod” until the head is resting back on the pillow/towel. If the chin pokes out/up, the deep neck flexors are no longer activating, Time holds will increase as strength builds for up to 20-30 seconds depending on the person. If this exercise is too hard, there is a step that can be added to work into this progression.

Endurance progression:

Now that basic endurance has been built, the next step is to activate the muscles during movement and more strenuous positions. This includes activating stabilizers for neck extension, adding rotation to your movement against gravity, adding weight such as with a helmet, and/or in standing with dynamic positions that involve extremity movement or resistance.

Nancy Hillier, Registered Physiotherapist

Disclaimer: This post is to provide education on how exercises will help with decreaseing pain and headaches due to injuries, muscle imbalances and basic principles on exercises used. For a detailed program, ask your Physiotherapist so that they can individualize it to you!

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