This is why improving the neck muscles will help you with neck pain.

Have you been told you have a flat neck?!

Have you been told you have reversed lordosis of your neck?!

Left picture: Normal Cervical Lordosis  Middle picture: Loss of Cervical Lordosis  Right picture: Cervical Kyphosis  Picture courtesy from: Alpayci et al 2016

Left picture: Normal Cervical Lordosis

Middle picture: Loss of Cervical Lordosis

Right picture: Cervical Kyphosis

Picture courtesy from: Alpayci et al 2016

Mild-to-moderate weakness of cervical muscles may lead to an alteration of head–neck posture and lead to reason behind having loss of cervical lordosis or “flattening of the neck”.

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You know what posture can inhibit your neck muscles from firing correctly? Yes, looking down at your phone or computer!

According to Panjabi et al. (1998) the mechanical stability of the cervical spine is provided by the neck musculature (80%) rather than the osseoligamentous system (20%). Therefore, weakness of the cervical muscles may bring about the mechanical instability of cervical spine. We do not yet know if loss of cervical lordosis (i.e. flattening of neck) leads to chronic pain or vice versa.

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However, we do know that there is a correlation between the two and improving the neck muscles with help you more with neck pain than just having manual therapy (chiropractic, massage, etc) without strengthening.

Stability of the spine is that quality by which the vertebral structures maintain their cohesion in all physiological positions of the spine. As physical therapists, we initially examine stability to make sure you do not have true instability, which is very rare. Once this has been ruled out, we examine stability of the neck from a motor control standpoint, meaning, we examine the strength and endurance of the agonistic and antagonistic neck muscles.

PhysioFit of North Carolina. Physical Therapy Wake Forest, NC

PhysioFit of North Carolina. Physical Therapy Wake Forest, NC

It has been found that a balanced co-contraction between agonistic and antagonistic muscles contribute to maintaining spinal stability. The existence of an imbalance between neck extension and flexion strength may have an important negative effect on the stabilization of the cervical spine. Therefore, strengthening neck muscles are likely a good choice if you have a loss of cervical lordosis.

Therefore, even if you are already working on strengthening one aspect of the neck, you may be missing out on the strength and endurance of the opposite muscles.

Additionally, it has been recently found by Kim et al 2018 that fat infiltration in the upper cervical extensor muscles has relevance to the loss of cervical lordosis and fat infiltration in the lower cervical extensor muscles is associated with cervical functional disability. Therefore, we recommend muscle strengthening exercises to prevent fat infiltration of cervical extensor muscles, which could also be effective for relief of neck pain as well as maintenance of cervical lordosis.

Furthermore, Yoon et al 2018 concluded that there is a significant relationship between cervical muscle imbalance, including extensor muscle weakness, and loss of cervical lordosis. An exercise program focusing on cervical extensor muscle strengthening and restoring the balance of flexor and extensor muscles is recommended for patients with loss of cervical lordosis.

That is why we perform our precision rehabilitation and Feel it to Heal it Physio approach to work the appropriate muscles of the neck to help with your pain and improve posture. We find that adding this specific component to an individualized, tailored program yields the best results. Watch videos below to learn more about our approach and contact us to see how we can help you!


Harrison Vaughan is a physical therapist in Wake Forest, NC. Alongside his wife, a vestibular physical therapist, he co-owns PhysioFit of North Carolina. Treatments include pain relieving strategies and specific exercise programs to help multiple areas of pain. They utilize knowledge of the whole body to treat you as a whole versus individualized body parts.