After a full day at the computer, your neck often stiffens by late afternoon and makes cracking sounds when you turn your head. Most ordinary neck pain is not caused by serious disease, and regular movement is something you can do for yourself that has evidence behind it. The neck pain guideline of the American Physical Therapy Association (Blanpied and colleagues, 2017) puts exercise among the recommended interventions for both new and long-lasting neck pain.
We have put our set of neck exercises together as a printed handbook with pictures, which we give to patients after their visit. You can download the PDF at the end of this article.
Why we don’t roll the neck in a full circle
The neck exercise people share most often is rolling the head in a full circle: bending forward, tilting toward one shoulder, tipping all the way back, then coming around again. When putting the handbook together, we split this movement into separate directions. When looking up, you raise your head only moderately, with your eyes on the spot where the ceiling meets the wall.
The worrying part is when the head tips all the way back. In that position, the small joints at the back of the cervical spine are pressed together, and the longer you hold it, the more they are pressed; older people, or people who get dizzy easily, often feel lightheaded right at that moment. The NHS (UK) set of neck exercises also splits bending forward and back, tilting and turning into separate moves. If you want to keep the pleasant feeling of a “neck roll”, do a half circle in front: let your chin glide from one shoulder across your chest to the other shoulder, without circling to the back.
The three groups of moves in the handbook
Gentle mobility
The first six moves are for getting your flexibility back: bending forward and looking up, tilting your head to each side, turning your head to look over your shoulder, the front half circle, the chin tuck and shoulder rolls. Do each move slowly over 3 to 5 seconds, stop where you feel the stretch, and don’t jerk.
The chin tuck is a move many people are not used to. With your eyes still looking straight ahead, draw your whole chin straight back as if making a double chin; keep your head level and don’t nod down. This move brings a head that juts forward back over your shoulders, which suits people who spend long hours at a screen. The musculoskeletal physiotherapy textbook by Jull and colleagues (2015) describes a similar exercise done lying down, called craniocervical flexion: your head rests on a pillow, you nod only slightly, and the movement happens mainly in the upper neck. In the study cited there, after one session of about 3 minutes, the most painful spot in the neck was less tender to pressure than with the exercise of lifting the head off the pillow.
Isometric holds
The next four moves are for when your neck already hurts less, usually from the second week. Place your hand in turn on your forehead, the back of your head, your temple or your cheek. Your head pushes into your hand while your hand holds it back; the two forces are equal, so your head doesn’t move but the muscles still have to work. Use about three-tenths of your strength, light enough that you can talk while pushing, and hold for about a slow count to 10.
This group helps the muscles around the neck get stronger little by little without making the joints move much, so people whose neck still hurts easily when turning can do it too.
Gentle stretches and chest opening
The last two moves are a neck and shoulder stretch (tilt your head, rest your hand lightly on top of your head, hold for 20 to 30 seconds) and a chest opener that squeezes the shoulder blades together, with both arms bent into a W shape. During the stretch, your hand rests on your head only for its weight; don’t use your hand to pull your head down further.
How much exercise is enough
Exercise 2 to 3 times a day, 10 to 15 minutes each time. In the first week, while your neck still hurts, do only the six gentle mobility moves at the lowest number of repetitions. In the second and third weeks, build up gradually and add the isometric holds. From the fourth week, you can do all three groups and keep it up as a habit. The handbook has a 14-day tracking chart where you tick off each session and rate your pain from 0 to 10. Bring this chart to your follow-up visit; the doctor will use it to add or remove moves.
Outside exercise time, your neck has to brace much less if your eyes don’t have to look down: raise your screen to eye level and hold your phone higher. About every half hour of sitting, stand up, turn your head and do a few chin tucks. How to set up your desk and chair is covered in our article on sitting correctly while working; if tired eyes are making your neck stiff, see also our article on the eyes and upper back pain. Traditional medicine sees the nape of the neck as a place where cold wind gets in easily, so don’t sit right where a fan or air conditioner blows on you, and don’t go to bed with wet hair.
Who should ask a doctor before exercising
See a doctor before you start if you have had neck spine surgery, or have severe osteoporosis, rheumatoid arthritis or ankylosing spondylitis; if you have recently had a blow, a fall or an accident affecting your head or neck; or if you get dizzy whenever you look up or turn your neck. Women who are pregnant or have recently given birth and develop a new, severe headache or neck pain should also be examined first. People who have numbness, weak hands or a clumsy grip also need an examination first; how to tell this kind of numbness apart is covered in our article on numb hands at night.
Signs to stop exercising and see a doctor
Stop exercising and let the clinic know if:
- After exercising, the pain increases and lasts more than 2 hours, or it hurts more the next morning than the day before;
- Numbness, tingling or weakness spreads down into your arm or hand;
- You feel dizzy or nauseous, or your vision blurs while exercising;
- Your hands get clumsier over time, and buttoning your shirt becomes hard;
- You are unsteady when walking or standing.
Go to the emergency department right away if you have sudden, severe neck pain or headache that is completely different from any you have had before, especially with a drooping eyelid, double vision, difficulty speaking, difficulty swallowing, facial numbness, weakness on one side of the body or staggering when you walk. The IFOMPT framework for examining the neck region (Rushton and colleagues, 2020) puts this group of signs first, because they can be signs of a blood vessel disease in the neck. Neck pain with a high fever, a stiff neck you cannot bend forward or drowsiness, or severe neck pain with numbness or weakness in the arms or legs after an accident or fall, is also an emergency.
When you exercise regularly and your neck is still stiff
Some people exercise regularly for a few weeks and their neck is still stiff, or it gets better for a few days and then hurts again. In that case, the doctor needs to find out what the neck is bracing to make up for: a tilted pelvis, a clenched jaw, tired eyes or long-lasting stress. At the clinic, Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine) examines the neck together with the related areas, combining the four examinations of traditional medicine with Applied Kinesiology muscle testing. Then, depending on the pattern, he uses acupuncture, moxibustion (warming points with burning mugwort) or herbal medicine. How muscle testing helps find the source of persistent pain is explained in our article on long-lasting neck and shoulder pain; and the case of neck pain spreading to the shoulder that eased once the pelvis was treated shows why the doctor does not look at the neck alone.
Download the handbook
The PDF has 4 A4 pages, with drawings of all 12 moves. Print it and stick it next to your desk, and you will find it easier to remember to exercise.
This article is part of the clinic’s Self-Care at Home series.
Worth keeping
- A little exercise every day lasts longer than cramming it all into one session;
- Look up only moderately, and don’t roll your neck back in a circle;
- Save the isometric holds for when your neck already hurts less;
- If pain increases and lingers, your hands go numb or weak, or you feel dizzy while exercising, stop and see a doctor;
- Sudden, severe neck pain or headache with a drooping eyelid, difficulty speaking or weakness on one side of the body is an emergency.
References
- Blanpied PR, Gross AR, Elliott JM et al. Neck Pain: Revision 2017. Clinical Practice Guidelines. J Orthop Sports Phys Ther. 2017;47(7):A1–A83.
- NHS (UK). Exercises for neck pain. nhs.uk.
- Jull G, Moore A, Falla D et al. Grieve’s Modern Musculoskeletal Physiotherapy, 4th ed. Elsevier; 2015. Chapter 41, p. 413.
- Rushton A, Carlesso LC, Flynn T et al. International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy (OMT) Intervention. IFOMPT; 2020 (PMID 36099171).