What exercises can help alleviate neck pain, and are there any visual examples?

Exercise Recommendations for Neck Pain

For neck pain, I recommend a structured program of cervical and scapulothoracic strengthening and stretching exercises performed 2-3 times per week, with specific neck strengthening showing superior pain relief compared to general exercise programs. 1

Core Exercise Components

Strengthening Exercises

• Perform cervico-scapulothoracic strengthening exercises focusing on rotator cuff and posterior shoulder girdle muscles, as scapular dysfunction frequently accompanies neck pain 1
• Begin with low resistance (40-60% of 1-repetition maximum) and higher repetitions (10-15 reps), performing 1 set of 8-12 repetitions, 2-3 days per week on non-consecutive days 1
• For chronic neck pain specifically, moderate-quality evidence supports cervico-scapulothoracic and upper extremity strength training, which provides moderate to large pain reduction immediately post-treatment 2

Stretching Exercises

• Include combined cervical, shoulder, and scapulothoracic stretching exercises alongside strengthening, which shows small to large beneficial effects on pain immediately post-treatment and up to long-term follow-up 2
• Stretching alone without strengthening shows no beneficial effects and should not be prescribed as monotherapy 2

Range of Motion Exercises

• Gentle stretching and mobilization techniques should focus on increasing external rotation and abduction to prevent frozen shoulder complications 3
• Active range of motion should be increased gradually while restoring alignment 3

Exercise Execution Guidelines

Proper Technique

• Perform exercises in a rhythmical manner at moderate to slow controlled speed through full range of motion 1
• Exhale during the contraction/exertion phase and inhale during relaxation to prevent Valsalva maneuver 1
• Use pain threshold as intensity guide: discontinue if pain lasts more than one hour after exercise 1

Critical Exercises to AVOID

• Never prescribe overhead pulley exercises, as these encourage uncontrolled abduction and have the highest incidence of developing shoulder pain 3, 1
• Avoid vigorous, repetitive exercises and explosive movements that stress cervical structures 1
• Do not prescribe aggressive passive range-of-motion exercises, as these can cause more harm than benefit 3, 1

Adjunctive Modalities

Heat Application

• Apply local heat before exercise to improve tissue elasticity and reduce pain 3, 1
• Heat application has a higher strength of recommendation compared to ultrasound 3, 1

Additional Modalities

• Ice, heat, and soft tissue massage can be used as adjunctive modalities to reduce pain/swelling 3
• Functional electrical stimulation (FES) may improve shoulder lateral rotation and reduce pain, though evidence shows no significant change in overall pain intensity 3

Evidence-Based Exercise Programs by Duration

For Recent-Onset Neck Pain (0-3 months)

• Offer range-of-motion home exercises for grades I-II neck pain 4
• For grade III neck pain, provide supervised graded strengthening exercise 4

For Persistent Neck Pain (>3 months)

• Offer supervised strengthening exercises or home exercises for grades I-II neck pain 4
• Supervised group exercise or supervised yoga are effective alternatives 4
• High-dose massage combined with manipulation and soft tissue therapy shows benefit 4
• For workers with persistent neck and shoulder pain, mixed supervised and unsupervised high-intensity strength training is supported 4

Multimodal Approach

A multimodal approach combining manual therapy, self-management advice, and exercise is the most effective treatment strategy for both recent-onset and persistent neck pain 4. This approach should include:

• Manipulation or mobilization 4
• Supervised exercise programs 4
• Self-management education focusing on activation rather than passive strategies 5

Home Exercise Program Design

• Provide education on strategies for reducing load on the shoulder during daily activities and proper positioning 1
• Cognitive behavioral therapy, distraction, mindfulness, relaxation, and guided imagery can be incorporated as adjunctive psychological interventions 1

Clinical Outcomes

Adding aerobic exercise to neck-specific exercises demonstrates significant improvements: 77.4% of patients reported successful outcomes at six months versus 40% in control groups, with pain reduction from 6.73 to 1.89 on VAS scale 6. This combination also significantly reduces neck disability index scores and fear-avoidance beliefs 6.