The scalene and suboccipital muscles are most effectively stretched in conjunction with strengthening of the weakened postural muscles including the upper thoracic extensors and the deep cervical flexors.
The following neck strengthening exercises can help relieve neck pain:
One of the most effective postural exercises for combating neck pain is the chin tuck exercise. This exercise not only helps strengthen the muscles that pull the head back into alignment over the shoulders (upper thoracic extensors) but it also stretches the scalene and suboccipital muscles.
The chin tuck exercise can be done numerous times throughout the day, such as while sitting in the car or at the desk at work. The repetition of this exercise throughout the day also helps develop good postural habits. It is especially important to perform this exercise when the neck and shoulder blades first begin to hurt.
To perform the exercise for the first time it is often recommended that patients stand with the spine up against a door jam and the feet out about 3 inches from the bottom of the door jam (Figure 1).
- Keeping the spine against the door jam, pull the upper back and head back until the back of the head touches the door jam. It is important to make sure that the chin is down so that the head is pulled straight back and is not looking up (Figure 2).
- Hold the head against the door jam for 5 seconds.
- Repeat this ten times.
- After performing this exercise in a door jam about ten times, start doing the exercise in standing or sitting without a door jam.
- The exercise can be done 5 to 7 times per day.
- When in the car, use the headrest as a point to aim for when pulling the head back.
Patients may feel some stretching of the muscles on the side of the neck that go down to the collarbone. These are the scalene muscles. These muscles along with the muscles at the top of the neck at the base of the skull are generally the tight muscles. The muscles in the front of the neck and muscles of the upper back are generally the weak muscles that need to be strengthened.
In cases of extreme forward head posture, patients may not be able to pull their head all the way back to the door jam when they first start. In these cases it is advisable to pull the head back as far as possible without pain.
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A more advanced exercise that strengthens the muscles of the shoulder girdle as well as the neck and upper back is the prone cobra exercise. This is done lying on the floor face down. The face down position uses gravity as resistance in the strengthening process.
- Lying face down, place the forehead on a rolled up hand towel for comfort.
- Place the arms at the side, palms down on the floor.
- Place the tongue on the roof of the mouth (this helps stabilize the muscles in the front of the neck to assist in strengthening) (Figure 3).
- Pinch the shoulder blades together and lift the hands off the floor.
- Roll the elbows in, palms out and thumbs up (Figure 4).
- Gently lift the forehead about an inch off the towel keeping the eyes looking straight at the floor (do not tip the head back and look forward) (Figure 5).
- Hold the position for 10 seconds.
- Perform 10 repetitions.
Another important postural exercise is the back burn exercise. This exercise is done standing with the back up against a large flat wall and the feet about 4 inches out from the bottom of the wall.
- Assume the same position as the chin tuck exercise with the back of the head against the wall.
- Try to flatten the lower back against the wall.
- Place the elbows, forearms and the backs of the hands and fingers on the wall with wrists about shoulder height (Figure 6).
- Keeping the arms, hands, head and fingers all touching the wall as best possible, slowly slide the hands up above the head (Figure 7) and slowly back down (back to Figure 6).
- Repeat this 10 times, 3 to 5 times per day.