Neck pain exercises, staged

Chin nods in supine, held. Not a crunch, not a chin tuck driven by the superficial flexors — a small nod as though saying yes, with the head still resting. The target is time, not repetitions: build from ten seconds to thirty, five to ten repetitions, once or twice a day.

Deep flexor endurance is the least dramatic part of a neck programme and the part patients abandon first, because nothing about it feels like exercise. Say that out loud when you prescribe it.

Active rotation and side-bending to comfort, slowly, both directions, several times a day. The purpose is not to force range but to remove the guarding that follows an acute episode — which usually moves within a fortnight once the patient stops protecting the neck all day.

Measure rather than guess. Rotation limited on one side by more than about ten degrees is the finding worth acting on, and the cervical norms give the reference to compare against.

Load is what makes the gains hold. A neck that is comfortable at rest and untrained under load reverts the first time the patient carries something heavy up a flight of stairs. The band progression applies here unchanged: range, then reps, then tension.

Posture advice has a poor record as a treatment and a good one as a pacing tool. The useful version is not “sit up straight” but “change position every thirty minutes” — because the provocation most desk-related necks report is duration, not alignment.

The best posture is the next one.

Put the interval on the handout with the exercises, using the programme builder, so it is a prescription rather than advice.