Postural Exercises for Neck Pain

For the first time here at Spinal (con)Fusion we welcome a guest contributor!  Summer Price is one of the most attentive and progressive physical therapists here in Wilmington.  Here, she gives us some advice on postural exercises for neck pain.  It should go without saying that reading these exercises here on this blog IS NOT a substitute for formal, supervised physical therapy.  Neither Summer nor I are advising you to perform these exercises and these exercises should not be done without the order of your physician.  For more information see my legal disclaimer.  Enjoy!
As a physical therapist, I see a lot of overuse and postural dysfunctions that create neck and upper back pain. Chronic or recurrent neck pain can be quite debilitating and can also be accompanied by thoracic pain, shoulder blade pain, and headaches. These symptoms, along with muscle imbalances and stiff joints, can make even the smallest daily activities painful.
The first step is to increase awareness of poor posture and faulty mechanics. Listed below are a few postural exercises to help decrease neck pain. 
Posture Set
You can practice this technique for proper posture while sitting or standing. Keep the top of the breastbone lifted, shoulder points wide and not forward, and the chin parallel to the floor to try to increase the length of the spine through the back of the head. Inhale a breath and lift up through the top of the breastbone. Exhale but do not let the breastbone drop (see figure 1). Practice this throughout the day with normal activities to get your body used to living in this position. Over time, finding this posture will get easier!
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Figure 1: Resetting your posture into proper alignment.
Chin Tuck
One of the most effective postural exercises for battling neck pain is the chin tuck. This exercise not only elongates the back of the neck to offload the cervical nerves but also strengthens the anterior neck (Longus colli) muscles which are key stabilizers of the spine. 
Chin tucks can be done throughout the day, such as when driving in the car or at your desk at work. Performance of this exercise throughout the day helps to re-train the cervical muscles to develop and maintain good postural habits.
To start, gently tuck your chin directly backward as if you are making a double chin.  This is a very gentle muscle engagement. It should feel like tightening deep in the neck, not a huge muscle contraction. You may choose to do repetitions (Hold 2-3 seconds, repeat for 2 sets of 10 reps) or choose to see how long you can maintain the posture with good form. (See figure 2)
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Figure 2: Chin tuck
Chin Tuck Neck Press
This exercise utilizes both the anterior and posterior stabilizers of the neck. These key stabilizers protect the neck with everyday motion such as bending down to pick up an object or looking both ways while driving.
Begin by lying on your back with a towel roll under your head and with your knees bent with a pillow supporting them; be sure to keep a slight natural curve in the neck. Engage the deep muscles of the neck by performing a gentle chin tuck.  Then, with about 10% of force, press the back of the head into the towel roll. Hold for 3-5 seconds. Release and repeat 10 repetitions. This should not be a huge muscle contraction, it should feel very gentle as to not over recruit the surrounding neck or shoulder muscles. (See figure 3)
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Figure 3: Chin tuck neck press
Reverse Wall Slides
The wall is a great tool to use as a tactile cue for proper postural alignment.  Begin by standing against the wall with your feet 8 -10 inches from the wall. The sacrum, upper back and back of the head should be against wall. Engage in a slight chin tuck and place arms in reverse goal post position.  While trying to keep hands and forearms against wall, slowly raise and lower arms by sliding them up and down the wall. This should be a slow and controlled movement (see figure 4).  Repeat 5-10 times within a pain free range. Be sure not to let your ribs come off the wall by maintaining a neutral spine.
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Figure 4: Reverse wall slides
Take Home Points
1.Be aware of your posture!  Monitor your neck posture with daily activities and adjust your workspace to maintain proper posture.  Beware of your neck posture in front of your computer (see figure 5) or while looking at your phone
Microsoft Word
Figure 5: Proper ergonomics at computer work station
3. Addressing posture is a dynamic and constantly changing process as we are always moving.
4. The more practice and conscious effort put towards posture, the easier the corrections will become over time. 
5. For every inch that the head moves forward, the forces on the neck increase by 10 pounds! 
Before beginning any neck home exercise program, patients are advised to consult a cervical spine specialist such as an appropriately trained physician or physical therapist. The purpose of the consultation is to accurately diagnose and treat the cause of the neck pain or stiffness, and not just the symptoms. It is also important to understand the correct form when performing the exercises, as doing the correct exercise with improper form is a common mistake and can lead to either lack of improvement or increased pain.
Depending on the clinical diagnosis and presenting symptoms, different treatments or exercises may be recommended. It is important to consider that every patient is different and that the cause of neck pain or dysfunction may vary from case to case. Although these exercises tend to be very helpful for postural awareness and cervical stabilization, they may not thoroughly address the root cause of pain. It is important to be thoroughly evaluated to determine the cause of the problem and to develop an individualized plan of care to maximize success!
Thanks for reading!
Summer Price PT, ATC
Lifeforce Physical Therapy and Wellness
6752 Parker Farms Drive suite 1
Wilmington, NC 28405
Tel: 910-679-4095 
Cohen SP. Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clin Proc 2015; 90.284. 
Kay TM, Gross A, Goldsmith C, et al. Treatment of neck disorders. Cochrane database Syst Rev 2005; CD004250. 
Robinson R. Cervicothoracic muscular stabilization training. Cervical and Lumbar Spine: State of the Art; 91, San Francisco, 1991. 
Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Appl Ergon. 2002;33:75–84.
Paris, SV. S3 Course Notes, Institute of Graduate Physical Therapy, Institute Press, St. Augustine, 1988. 
Picture credit: Elsevier Ltd. 2006.

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