Was hoping to get some suggestions on neck strengthening exercise for a client who is experiencing postural related neck/upper back pain.
Scalenes are quite tight & over-active, and they seem to experience problems when sitting reading/driving car for periods, and when performing abdominal exercises etc. in supine positions (e.g when lifting head).
I am addressing postural issues such as stretches to pec/pec minor, lats, traps, neural mobilizing, and strengthening thoracic extensors, retraining scapular/shoulder position, however are specifically seeking suggestions for appropriate strengthening progressions for the neck.
First of all, and it goes without saying, if there is joint pain present, the individual should be referred to a medical professional. There may very well be a cervical subluxation(s) present that is making stretching and exercise FUTILE. It sounds as if you've really done your homework, good job. You may want to try doing just a couple more neck specific stretches that I noticed you did not list above. Look on the PTontheNET Library of Stretches for the STERNOCLEIDOMASTOID stretch, as well as the LEVATOR SCAPULAE stretch.
You made mention to the fact that you client has trouble: "performing abdominal exercises in the supine position (e.g when lifting head)." Training the rectus abdominus in isolation (i.e. concentric lumbar flexion) may be a "strength" level exercise that you consider "degressing" back to a "stability" level exercise such as a: Supine Knee to Chest, progressing to a Supine Leg Slide. These exercises when properly cued are fairly challenging and are great for emphasizing CORE STABILITY by teaching the primary muscles of the "Inner Unit" to co-contract (i.e. Transverse Abdominis, Internal Obliques, Multifidus, Pelvic Floor, Diaphragm, etc.) Research has shown that lumbar flexion (crunches) performed with chronic regularity in combination with a lack of CORE strength can contribute to Kinetic Chain Dysfunction by way of muscular imbalance. Take a look at the diagram below, it is not hard to see how a shortened Rectus Abdominus due to OVER CRUNCHING can perpetuate and maintain NECK PAIN.
This brings me to my next point. You may want to re-assess your client's posture, particularly at the pelvis. Any exaggerated anterior tilt may be the actual ROOT of the problem. Research has shown that the muscular imbalances that perpetuate an anteriorly tilted pelvis, when left unchecked, can eventually cause segmental shifting up through the kinetic chain manifesting at the upper back, shoulders, and neck. Some muscles at the hip prone to tightness that may require flexibility are: Psoas, Adductors, Hamstrings, TFL, Rectus Femoris, and the Erector Spinae to name a few.
This photo is referenced from Paul Chek's PtontheNET article "The Inner Unit".
- Prone BALL Cervical Retraction(s)
- Prone Ball Cobra
- Shoulder Shrugs (PROPERLY CUED!)
Those regularly performing crunch and sit-up type exercises frequently demonstrate forward head posture (A); note that when head carriage is normal the dotted line through the cheekbone should fall in the same vertical plane as the sternum and pubic symphysis. (B) As the rectus abdominus becomes chronically shortened, it pulls the chest downward, increasing first rib angle; this is commonly associated with shoulder dysfunction and impingement of the nerves feeding the arm as they exit the cervical spine. (C) As the hip flexors strengthen and shorten from chronic exposure to the sit-ups, leg extension and leg lowering exercises commonly used in abdominal workouts the lower abdominal and hamstring muscles are lengthened, frequently demonstrating positional weakness. The postural changes demonstrated here are common among today’s athletes and can be corrected through improved control and strengthening of the inner unit musculature.(1)
REFERENCE & RECOMMENDED READING:
- Chek, Paul. (2001). The Inner Unit. (www.PTontheNET.com)
- Chek, Paul. (2001). Shrug Science Part 1 and Shrug Science Part 2 (www.PTontheNET.com)
- Clark MA. (2001). "Integrated Training for the New Millennium." Thousand Oaks, CA The National Academy of Sports Medicine; (www.nasm.org)
- Clark MA. "Essentials of Integrated Training Series." 2002. Personal Training on the Net, (www.PTontheNET.com)
- Hittner, Noah. (2002). Neck Strength. (www.PTontheNET.com).