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Woman's neck and hair close up

Ladies neckThere are 20 pairs of muscles in the neck, which can be divided into two main groups: the superficial sleeve and the deep sleeve. To stabilize the head on the body, there needs to be an adequate balance between the two groups. The primary role of the superficial sleeve is to allow movement in all directions to be produced. The deep sleeves role is to wrap around the vertebra of the neck and act as a stabilizer. Without enough activation of the deep sleeve, the contraction of the superficial muscles can cause a buckling action to the vertebra in the neck. Through Postural correction in Pilates and physiotherapy rehabilitation, we can strengthen these deep neck flexors to prevent neck pain and improve the overall spinal position.

Neck Injury

In the last decade, the scientific literature has shown consistent findings of abnormal muscle patterns in people suffering from neck pain. One of the most common patterns seen is the over activation of the superficial sleeve. This limits the neck pain sufferer’s ability to use their deep sleeve for the stability of the spine, which exposes the joints and discs in the neck to further undue pressures. All of this change begins immediately after experiencing neck pain.

When testing people with pain, it has been highlighted that when a prolonged sitting position is used, the painful group allow their neck to drift into a more forward position while allowing their shoulder blades to slide forward on their thorax. This is because of decreased strength and endurance of the deep sleeve of muscles to prevent increase curvature of the neck.

In the last decade, our increased use of technology such as tablet computers has increased the time we spend sitting and reading with a forward head position, predisposing us further to these issues.


Unfortunately, these muscle patterns do not revert back to their efficient function once pain at the neck subsides. This is why appropriate rehabilitation is required to improve muscle control, and then develop their strength and endurance. Training the deep sleeve will cause a relaxation of the superficial muscles such as the Upper Trapezius (UT) and the Sternocleidomastoid (SCM) causing a decrease in pain over time. Most importantly, strengthening the deep flexors will restore your deep stabilization, improve your biomechanics and decrease the likelihood of recurrent neck pain.



Position: Stand with your back against a wall, resting the back of your head gently against it.

Target Movement: Gently nod your head (as if saying yes), without lifting the back of your head off the wall. You should feel the back of your head slide up the wall with your jaw drawing back towards the wall. Hold this position for up to 10seconds and then gently return to the starting, relaxed position.

Palpation: It is vitally important to ensure that the movement is produced by the deep neck flexors in isolation, without turning on the superficial sleeve. This can be monitored by placing two fingers on the SCM muscle located at the front of the neck. If at any time during the above movement you feel this muscle tensing under your fingers, try a slower, gentler or smaller movement.

Dose: Once you have achieved the correct technique, repetition is key. Initially, it is important to be performing at least 10 x 10sec holds 2-5 x daily.

These should be combined with postural correction exercise throughout the day.

Once you have retrained your muscle system to allow you to perform 10 x 10sec contractions effectively with no co-contraction of the superficial palpable muscles, your physiotherapist can guide you through progressions of this exercise to make it as functionally relevant for your limitations and functional demands.

Postural Correction

In addition to your exercises, there are other things you can do to avoid aggravating your neck pain. As discussed, a forward head position is one of the main contributing factors to chronic and recurrent neck pain. Here are a few ways to avoid this posture:

  1. Avoid prolonged sitting – stand up and walk around as frequently as possible, particularly if your pain is acute, also, break up long drives with frequent stops
  2. Avoid hairstyles that promote this position – wearing your hair in a bun or ponytail can prevent you from resting your head back against the head restraint of your car or work chair
  3. Avoid strenuous overhead activity – the superficial neck muscles are often recruited when your hands are carrying large loads