As a physiotherapist I am constantly encouraging my clients to exercise more. Think of yourself as the athlete!” is a common refrain in my office, the desired attitude being that if you are doing consistent physical training toward a specific goal, whether it’s recovering from a broken ankle or sprinting a 10 second 100 meters, you are behaving like an athlete.
Neck dysfunction after a traumatic accident (Whiplash after a car accident, sports injury etc...) is one of those situations where people tend to get a little anxious around performing physical exercise. I think that this is because of concerns around protecting the spinal cord and peripheral nerves which people can view as being more vulnerable than other body structures.
My guess is that these fears are even more acute for anyone of an age (like I am) where they are likely to have seen any of Steven Segal’s neck breaking extravaganza action flicks of the early nineties.
Of course if you have had a neck injury, be sure you have been cleared for exercise before you careen headfirst (pun intended) into a new exercise program. This is especially true if you have had a traumatic injury like a car accident, a slip and fall or a sports related injury. In these cases it’s crucial to have a professional assessment to rule out any serious pathology.
However, once you have been cleared of serious injury, exercise is one of the fundamental treatments you’ll want to engage in during your neck rehab. Typically you’ll be ready (and safe) for exercise once the initial acute phase of the injury is over. This means that the pain is no longer constant and throbby. ‘Hot and swollen’ should not be a feature of your injury!
Also note that if you are experiencing radicular pain, that is electric or burning pain (or numb/tingle) that extends down your arm past the elbow, you may not be ready for the type of exercise described here and should visit a professional to discuss a best treatment for your situation.
Exercise for neck dysfunction typically starts with work on the deep stabilising musculature of the neck called the deep neck flexors (DNF). This will then progress into more traditional strength training that incorporates activating those neck stabilisers while strengthening the large muscle groups of the shoulder girdle. These are the muscles you use when you push and pull stuff.
Take a look at the video above. In it I describe how to perform a DNF exercise. Then we apply the DNF activation to two traditional strength training exercises, the pushup and the row. The beauty of this rehab is that it uses strength training exercises that we should all be incorporating into a typical workout anyway. I am a big fan of this approach. ‘Strength and conditioning’ is rehab and rehab is ‘strength and conditioning’. These worlds are not separate.
The reason we like to use these types of strength training exercises in a good neck injury rehab is not just for the strengthening of relevant musculature, although that is a huge part of it. It’s not just about retraining motor control - or as I like to call it “the skill of beautiful movement”, although that is a big part of it as well!
It’s also in large part about the psychology of reintroducing normal physical activity to your daily routine after injury. It’s our job to sweep away the fear that so often comes with movement after injury. This is a fear which is very real for many people. Fear, while possibly appropriate in the immediate aftermath of an injury, is detrimental in the long term.
Addressing the fear through exposure to movement in the strength training context is an important part of rehab. It’s also fun and, like exercise always does, increases confidence in the exerciser.
Strength training, even in the rehab context should be done with frequency. Research suggests most people rehabbing a neck injury experience best results when training 3 times per week. In my professional experience I suggest more if my clients really want the gold stars!
Another note, muscle soreness after exercise is normal and is not something to be fearful of. Obviously you should discuss the specifics of your pain with your physio for guidance. But exercise induced, delayed onset muscle soreness is part of the package of good quality strength training. When you feel it, consider it a win that you are allowed to feel good about! This type of soreness is typically at its worst 2 days post workout and then gets better, so enjoy it while it lasts.
Of course, when recovering from a neck injury, there is absolutely a place for other clinical interventions including pain management modalities like ultrasound, dry needling, or hands on manual therapy including manipulation of the thoracic and cervical spine. And these are things that you can and should expect from your physiotherapist. But there is a ton of benefit to be had from exercise work like that described in the video above. It really is the meat and potatoes of your rehabilitation. So have fun with it, and enjoy using it to manage your own improvement.
How’s that for a turning of the typical clinical tables - “patient heal thyself”!
Further reading (if you really want to impress your friends)
Booth, J., Moseley, G. L., Schiltenwolf, M., Cashin, A., Davies, M., & Hübscher, M. (2017). Exercise for chronic musculoskeletal pain: a biopsychosocial approach. Musculoskeletal Care.
Bronfort, G., Evans, R., Nelson, B., Aker, P. D., Goldsmith, C. H., & Vernon, H. (2001). A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine, 26(7), 788-797.
Dennison, B., Leal, M. (2015). Chapter 9 in: Fernandez de las Penas, Cleland & Dommerholt. Manual Therapy for Musculoskeletal Pain Syndromes: An evidence- and clinical-informed approach. Elsevier.
Gross, A. R., Paquin, J. P., Dupont, G., Blanchette, S., Lalonde, P., Cristie, T., ... & Goldsmith, C. H. (2016). Exercises for mechanical neck disorders: A Cochrane review update. Manual therapy, 24, 25-45.
O'Riordan, C., Clifford, A., Van De Ven, P., & Nelson, J. (2014). Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle. Archives of physical medicine and rehabilitation, 95(4), 770-783.
Vincent, K., Maigne, J. Y., Fischhoff, C., Lanlo, O., & Dagenais, S. (2013). Systematic review of manual therapies for nonspecific neck pain. Joint Bone Spine, 80(5), 508-515.