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Broadgate spine & joint clinic news

by Alan Jordan

Neck pain is the most prevalent musculoskeletal complaint in office workers (Blangsted et al, 2008), and research shows that people with neck pain are more likely to experience other musculoskeletal pain in association with neck pain (Hagen et al, 2006; Juul-Kristensen et al, 2006) likely due to increased pain sensitivity  (Arendt-Nielsen and Graven-Nielsen, 2008).

A common thread emerging in medical research is that people experiencing neck pain present with impaired activation of deep flexor muscles (Jul et al, 2009). This is in line with our clinical findings and highlights the need for an effective neck rehabilitation program, to retrain and improve their activation.

Evidence shows that low load training of the deep neck muscles is effective even in the early stages of rehabilitation (Cagnie et al, 2008) and that the combination of manual therapy (manipulation or mobilisation) and exercise (as used at Broadgate) is the most effective. It has a greater long-term improvement in pain and global perceived effect when compared to no treatment for chronic neck pain, subacute/chronic neck pain with cervicogenic headache, and chronic neck pain with or without radicular findings (Miller et al, 2010).

It is important that exercise is done correctly – at Broadgate Spine & Joint Clinic we use biofeedback tools to give our patients confidence that they can successfully activate the right muscle patterns, when strengthening the deep neck muscles. It also gives us a benchmark upon which to measure success.

Follow the links to the videos below to see a couple of exercises that have been shown to effectively improve the activation patterns of these muscles.

Activating the deep neck flexor with biofeedback device

Deep neck flexor – Longus Colli strengthening level 1

Deep neck flexor – Longus Colli strengthening level 2


Arendt-Nielsen L, Graven-Nielsen T (2008). Muscle pain: sensory implications and interaction with motor control. Clin J Pain 2008;24:291–8.

Blangsted AK, Sogaard K, Hansen EA, Hannerz H, Sjogaard G. (2008) One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. Scand J Work Environ Health; 34:55–65.

Cagnie B, Dickx N, Peeters I, Tuytens J, Achten E, Cambier D, et al. (2008) The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises. Journal of Applied Physiology;104:230–5.

Hagen EM, Svensen E, Eriksen HR, Ihlebaek CM, Ursin H. (2006) Comorbid subjective health complaints in low back pain. Spine;31:1491–5.

Juul-Kristensen B, Kadefors R, Hansen K, Bystrom P, Sandsjo L, Sjogaard G.(2006) Clinical signs and physical function in neck and upper extremities among elderly female computer users: the NEW study. Eur J Appl Physiol ;96:136–45.

Jull, G.A. Falla D., Vicenzino, B. Hodges P.W. (2009) The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Manual Therapy Vol. 14,6, 696-701.

Jordan Miller, Anita Grossa,b, Jonathan D’Sylva, Stephen J. Burnie , Charles H. Goldsmith,  Nadine Grahama , Ted Haines , Gert Brønfort, Jan L. Hoving (2010) Manual therapy and exercise for neck pain: A systematic review. Manual Therapy (15)4, 334-354.

Lars L. Andersen, Karl Bang Christensen, Andreas Holtermann, Otto M. Poulsen, et al. (2010) Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: A one-year randomized controlled trial Manual Therapy Vol. 15, (1), 100-104.

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