Recommended Exercises for Neck Arthritis
For older adults with neck arthritis, implement a progressive exercise program that combines stretching and strengthening exercises focused on the cervical and shoulder-thoracic regions, with strengthening exercises being more effective than stretching alone for reducing pain and improving function.
Exercise Program Components
Strengthening Exercises (Primary Focus)
High-intensity isometric neck strengthening should be the cornerstone of your exercise prescription, as this approach demonstrates superior outcomes compared to endurance training alone 1. Specifically:
- Isometric neck exercises with elastic resistance bands targeting all directions (flexion, extension, rotation, lateral flexion) produce dramatic improvements: 110% increase in flexion strength, 76% in rotation, and 69% in extension over 12 months 1
- Cranio-cervical flexion exercises improve deep neck flexor function, with studies showing 56-point improvements in performance indices after 6 weeks 2
- Progressive resistance training for both cervical and shoulder musculature should be included, as exercises targeting the cervical-shoulder-thoracic region together show moderate evidence of benefit with pooled effect sizes of -0.42 for pain reduction 3
Range of Motion and Stretching
- Active range of motion (AROM) exercises provide limited evidence of short-term pain relief, particularly in acute presentations 3
- Stretching exercises should precede strengthening work and target the cervical, shoulder, and thoracic regions 4
- While stretching alone is less effective than strengthening, it remains an important component when combined with other modalities 1
Endurance Training
- Dynamic neck exercises including head lifts from supine and prone positions show more modest improvements (28% flexion, 29% rotation, 16% extension strength gains) but still significantly outperform no exercise 1
- These should be incorporated but not relied upon as the sole intervention 1
Multimodal Approach
Strong evidence supports combining exercise with manual therapy rather than exercise alone 3:
- Exercise combined with mobilization or manipulation shows strong evidence of benefit for both subacute and chronic neck disorders in short and long-term outcomes 3
- This multimodal approach improves pain, function, and global perceived effect more effectively than exercise alone 3
Proprioceptive Training
- Eye fixation and proprioceptive exercises embedded within a comprehensive program demonstrate moderate evidence of benefit, with pooled effect sizes of -0.72 for pain reduction in chronic neck disorders 3
- These exercises improve both pain and function in short-term outcomes 3
Exercise Frequency and Duration
- Prescribe exercises 3 times weekly as this frequency has been validated in controlled trials 1
- A minimum 6-week intervention period is needed to see meaningful improvements in muscle function 2
- 12-month programs produce sustained benefits in pain reduction and disability improvement 1
Important Clinical Considerations
Exercise is safe for arthritis patients despite historical concerns about joint damage or symptom exacerbation 5. The evidence demonstrates:
- Regular exercise prevents muscle deconditioning, stabilizes joints, improves flexibility, decreases pain, and enhances aerobic fitness 4
- Strengthening and aerobic conditioning are safe for osteoarthritis patients, though improvements may be modest 5
Common pitfall: Prescribing stretching and aerobic exercise alone is significantly less effective than incorporating progressive strengthening exercises 1. Avoid this by making isometric strengthening the primary intervention.