Integrating Upper Cervical Flexion with Postural Exercises

chin nod with shoulder w exercise

Several weeks ago I published a quick video tip on a variation of the chin tuck exercise, the chin nod exercise.  I received a lot of nice feedback regarding the use of the nod and wanted to share the next phase of the progression, integrated the chin nod into exercises.

Just like any other aspect of our rehabilitation and corrective exercise programs, the ultimate goal should be to groove motor patterns with simple exercises and slowly integrate them into more complex functional movement patterns.  While the chin nod is a great choice to work on upper cervical flexion in those with postural adaptations and an upper body cross syndrome, it is really only a small part of the pattern.

We always talk about strengthening the lower trap and serratus and performing manual therapy on the pecs, subclavius, upper trap, and levator (just to name the big ones…).  The chin nod is also a simple way to set your posture prior to some of these activities.

As an example, I shot a quick clip on integrated the chin nod into the shoulder W exercise, which is fantastic for posterior cuff and lower trap strengthening, as well as opening up the anterior shoulder.  By adding the chin nod prior to performing the exercise, you essentially enhance the outcomes of the exercise by assuring proper alignment.

YouTube Preview Image

This isn’t rocket science, but by integrating the chin nod into exercises like this, it really helps groove the correct motor pattern better.  Incidentally, this is one of my favorite exercises for those with cervicogenic headaches and neck pain.  Have them sit up tall in the car at red lights and perform this exercise.  Great, even without Theraband.  I even use this integrated chin nod and shoulder W exercise as my breaks while sitting at the computer!


The Chin Tuck and Chin Nod Exercises

Chin Tuck Chin Nod ExerciseToday’s post is a quick and dirty video technique post on the chin tuck exercise technique.  The chin tuck is a pretty common exercises used for neck pain and postural adaptations.  The chin tuck exercise essentially works on upper cervical extension and lower cervical flexion.  I like using it as part of my reverse posturing series of exercises to get out of the forward head, rounded shoulder posture that we see so often, essentially Janda’s Upper Body Cross Syndrome.

While I do use the chin tuck exercise, I do sometimes find that it can be performed too aggressively by some, especially if you are having some acute neck pain.  You don’t want to jam you neck straight back and combine upper cervical flexion with a shear force.  My good friend and excellent therapist Todd Howatt turned me on to this over a decade ago.

Rather than aggressively shear your upper cervical spine, you may want to start with more of a chin nod rather than a chin tuck.  Perhaps this is just nomenclature, but the visual shouldn’t be “jam your head straight back” but rather to imagine a dowel going through your head between both ears.  You want to rotate your head around this dowel and essentially perform a nodding motion.  I tell my patients to focus on feeling a stretching sensation in their suboccipital region.

This movement can be performed both standing (or sitting in your car, wink, wink…) and lying on your back.  I usually start lying down to prevent the jamming back movement.  I will often instruct to use your hands on each side of your head to help with the rotational movement around the dowel concept.  You can use this as part of reverse posturing, repeated movements, or for deep neck flexor strengthening.  To focus on strengthening, gradually work up to slightly lifting your head off the table and holding for a duration of time.

Check out the video below for some visuals:

YouTube Preview Image

What do you think?  I am still pro using the chin tuck exercise at times, but also incorporate a chin nod exercise when the chin tuck is uncomfortable or with acute neck pain.




Exercise Considerations for Neck Pain

Today’s post is written by Rick Kaselj.  Rick is the creator of the Muscle Imbalances Revealed products that I have mentioned in the past.  I reviewed both the lower extremity and upper extremity editions of Muscle Imbalances Revealed in the past.  Rick has a nice presentation on the neck in the upper body edition and wanted to share this post on the topic.  Thanks Rick!


Exercises for Neck Pain

Often times our clients with neck pain will get all kinds of diagnostics tests, have all kinds of assessments, and have a stack of labels before they get to us.  With all that information, it is sometimes challenging to design a proper program.

The first exercise component that most of us go for is stretching the neck, but is this right?  Should you be stretching someone with neck pain?  After stretching, we start strengthening.  Now, do the good old 3 sets of 10 repetitions work for neck pain?  What kind of strengthening exercises do you do for the neck?  Should I be doing cable machine neck exercises?

These are all common questions that the research can help us answer.


Strengthening and Stretching Leads to Better Neck Pain Results

Lets start off with looking at headaches caused by neck pain and how exercise can help.  Looking at Ylinen 2010 where they had a 2 week clinical and home based exercise program that was done 5 days a week.  They had two groups in the study, one was a strength group and the other was an endurance group.

The endurance group lifted their heads up from a supine position for 3 sets of 20.


The strengthening group used a dynamic isometric hold with tubing in a sitting position for 1 set of 15 in 4 directions.


Both groups performed shoulder shrugs, shoulder presses, bicep curls, pec flys and pull overs with 2 kg dumbbells for 3 sets of 20.  The control group only performed shoulder and neck stretches.

YouTube Preview Image
What the researchers found was that the endurance group had the greatest decrease in headaches after 12 month follow up.  The authors suggest that stretching alone is not enough but an endurance or strengthening program along with stretches may be the best choice.

[EDITOR’S NOTE – My friend Phil Page has a really nice review of this article as well, be sure to check that out here.]


2 Minutes a Day of Exercise will Decrease Neck Pain

Anderson in 2011 performed a study with 174 women and 24 men who worked at least 30 hours a week and who reported frequent neck/shoulder pain.  They had one group that did 2 minutes of exercise and one group that did 12 minutes of exercise for 5 days a week.

After the 10 week program, they found both groups had a reduction of pain and tenderness.  The exercise that they performed was a resistive tubing, lateral raise in the scapular plane.  The 2 minute group performed the exercise for one set to failure while the 12 minute group performed 5 to 6 sets of 8 to 12 repetition.

Very cool.  Now a little more info on isometrics.


Isometric Strengthening is Not A Very Sexy Thing

Ylinen in 2006 reported that “the change in neck pain and disability indices correlated with the isometric neck strength.”  Has to make you wonder.  Keep stretching and get minimal results with neck pain or start doing isometrics and have happy clients and happy necks.


Are Home Programs that Good?

People that start a home program, do great at the start but things taper down as time passes.  We have experienced that in our clients and even in ourselves.  Häkkinen in 2006 noted that “progressive loading, supervision of training, and psychosocial support is needed in long-term rehabilitation programs to maintain patient motivation.”

I know many clinicians are good at this but encouraging your clients to come back and see you in order to review the exercises, provide support and motivation is a good idea to do.



There are a few key points to take away from this article regarding neck exercises:

  1. When strengthening, you are focusing on the neck being in neutral and the contraction is isometric.
  2. Even just 2 minutes of shoulder strengthening a day can help decrease neck/shoulder pain.
  3. Combine strengthening and stretching for better results.
  4. Jari Ylinen, is the man when it comes to exercise and neck pain.  He is Finish and if you do much research into how Scandinavian rehabilitate injuries, they go hard.
  5.  Improving isometric neck strength decreases neck pain.  It would be a good idea to add some to a neck pain program.
  6.  Encourage your clients to see you regularly in order to progress, review, support and motivate.


About the Author

Rick Kaselj, MS.  Rick is an exercise physiologist that has spent his 17 year professional career helping clients recover from injury and prevent injury through exercise. Rick has shared his tips, tricks and exercises when working with injuries to well over 5033 fitness professionals in Canada and the USA.  The foundation to Rick’s books, manuals, DVDs and presentations is his educational background which includes a Bachelors Degree in Kinesiology and a Masters of Science Degree in Exercise Science.  Rick helps clients in Surrey, BC, Canada and also writes a leading fitness education blog on exercises and injuries,

Be sure to check out his latest product Muscle Imbalances Revealed Upper Body, I have a review of it here.

Muscle Imbalances Revealed Upper Body Review



  • Andersen LL, Saervoll CA, Mortensen OS, Poulsen OM, Hannerz H, Zebis MK. (2011). Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain. 2011 Feb;152(2):440-6. Epub 2010 Dec 21.
  • Blangsted AK, Søgaard K, Hansen EA, Hannerz H, Sjøgaard G. (2008). One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. Scand J Work Environ Health. 2008 Feb;34(1):55-65.
  • Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H. (2001). A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.Spine (Phila Pa 1976). 2001 Apr 1;26(7):788-97; discussion 798-9.
  • Häkkinen A, Kautiainen H, Hannonen P, Ylinen J.(2008).  Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study. Clin Rehabil. 2008 Jul;22(7):592-600.
  • Häkkinen A, Ylinen J, Kautiainen H, Tarvainen U, Kiviranta I. (2005). Effects of home strength training and stretching versus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up. Arch Phys Med Rehabil. 2005 May;86(5):865-70.
  • Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002 Sep 1;27(17):1835-43; discussion 1843.
  • Kay TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G; Cervical Overview Group. (2005). Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD004250.
  • Salo PK, Häkkinen AH, Kautiainen H, Ylinen JJ. (2010). Effect of neck strength training on health-related quality of life in females with chronic neck pain: a randomized controlled 1-year follow-up study. Health Qual Life Outcomes. 2010 May 14;8:48.
  • Taimela S, Takala EP, Asklöf T, Seppälä K, Parviainen S. (2000). Active treatment of chronic neck pain: a prospective randomized intervention. Spine (Phila Pa 1976). 2000 Apr 15;25(8):1021-7.
  • Ylinen J, Nikander R, Nykänen M, Kautiainen H, Häkkinen A. (2010). Effect of neck exercises on cervicogenic headache: a randomized controlled trial. J Rehabil Med. 2010 Apr;42(4):344-9.
  • Ylinen J. (2007). Physical exercises and functional rehabilitation for the management of chronic neck pain. Eura Medicophys. 2007 Mar;43(1):119-32.
  • Ylinen JJ, Häkkinen AH, Takala EP, Nykänen MJ, Kautiainen HJ, Mälkiä EA, Pohjolainen TH, Karppi SL, Airaksinen OV. (2006). Effects of neck muscle training in women with chronic neck pain: one-year follow-up study. J Strength Cond Res. 2006 Feb;20(1):6-13.
  • Ylinen JJ, Takala EP, Nykänen MJ, Kautiainen HJ, Häkkinen AH, Airaksinen OV.
  • (2006).Effects of twelve-month strength training subsequent to twelve-month stretching exercise in treatment of chronic neck pain. J Strength Cond Res. 2006 May;20(2):304-8.
  • Ylinen J, Takala EP, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, Karppi SL, Kautiainen H, Airaksinen O. (2003). Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003 May 21;289(19):2509-1