Post whiplash, 2 muscle groups in the neck that are otherwise difficult to isolate (deep neck flexors and extensors), need special attention. A chin tuck, where you drop the chin to the chest without flexing the head forward, is highly recommended. It can be done lying doing or upright; you can also add resistance with your fingers behind the neck and increase range by slowly moving your head.
Whiplash, or “Whiplash Associated Disorders” (WAD), results from a sudden jarring motion, often from a car crash that occurs too fast for someone to voluntarily “brace” themselves. This is because the whole “whiplash cycle” is over within 300 ms and we cannot contract a muscle faster than 700-800 ms.
Common Injury Factors Include
- Type and angle of the crash
- Size of the involved vehicles
- Absorption of the crash by crushing metal (or lack thereof)
- Size of the person (and gender)
- Angle of the seat back and it’s “stiffness”
- Position of the head rest
- Slipperiness of the road
All these factors help determine:
- The possibility of an injury, and
- The degree of the injury.
There is so much published about neck pain resulting from whiplash that it is confusing (to say the least) about which exercises are best for the whiplash patient. Rather, each patient needs to be assessed and managed based on his/her unique situation.
In regards to neck pain, an exercise program must have three goals that include Stretching, Strengthening and Stabilizing. All three goals work towards a common purpose: to restore function.
Initially, when pain factors are high, patients perform active movement within reasonable pain boundaries to improve their cervical range of motion. Once movement is fairly well tolerated, it is time to focus on strengthening exercises.
Whiplash Exercises To Target Deep Neck Flexors And Extensors
There are certain muscles that can “hide” behind larger, stronger muscles and are more difficult to isolate and very often, remain weak — despite strengthening exercises. One very important muscle group called ”Deep neck flexors”, ‘hide behind’ the stronger, more superficial neck flexing muscle called the Sternocleidomastoid (SCM).
To trick the SCM into NOT contracting (so we can engage and exercise the deep neck flexors), we drop the chin to the chest without flexing the head forwards (like the downward motion when nodding “yes”).
You should feel “the pull” or a stretch in the muscles in the back of your neck. This is referred to as “craniocervical flexion”, but we will call it a “chin tuck.” Try it!
Deep Neck Flexors: Lying Down Chin Tuck
- Perform the above “chin tuck” by lying on your back, chin tuck and press your neck down into the bench or floor.
- Hold for 3 to 5 seconds and then release the chin tuck slowly (two times slower than the initial downward movement).
- If you can’t get your neck to flatten out, repeat this with a small rolled up towel placed behind the neck.
- Start with 3 to 5 repetitions and gradually increase the reps and sets.
- To make this more “portable” so you can do this during the day, see Procedure 2.
Deep Neck Flexors: Sitting or Standing Chin Tuck
- In a seated or standing position, place your finger tips behind your neck and push your neck into your fingers gradually increasing the pressure as you apply the “chin tuck.”
- Do this slowly, applying gradual pressure into your finger tips and then (most importantly), release the pressure slowly (again, two times slower than the initial “push”).
- Repeat three-to-five times for one session and do multiple sessions during the day. Set the timer for two or three hours to remind you to do these multiple times a day.
Since the 1990s, the deep neck flexors have been getting most of the attention as being the “missing link” in rehab of the neck after whiplash. As important as the deep neck flexors are, the deep neck extensors cannot be ignored. In fact, both the deep neck flexors and extensors have to work in concert to control segmental movement!
A 2013 study reported the deep neck extensors can become quite de-conditioned and weak in patients with neck pain. Recent studies confirm that neck pain patients typically display reduced activation and a less defined activation pattern in the deep neck extensors.
The amount of weakness and poor activation is proportional to the amount of pain present (i.e., the higher the pain level, the worse the activity response).
Chin Tuck – Prone Neck Extensors
- Lying on your stomach, arms at your sides, palms facing outwards, tuck in the chin without looking down.
- Lift your head and chest off the floor and hold the position for ten seconds or as long as can be tolerated.
- Remember, stay within “reasonable boundaries of pain” (that only you can define) and gradually add repetitions over time.
Chin Tuck – Neck Extensor Isometrics
- Sitting or standing, tuck in your chin without looking down.
- Extend the head back slightly and place one hand behind the head.
- Slowly push the head back into your fingers at about 10% of maximum force and gradually use a greater amount of force over time.
- Once you feel you have good motor control and are tolerating the exercise well, vary the amount of resistance from 10% to 90%, gradually increasing then decreasing the resistance slowly (crescendo and decrescendo the resistance)!
Chin Tuck – Neck Extensor Isotonics
- Same as above, but this time the head moves while applying a steady light (10-25% of max.) resistance from full extension into full flexion. Repeat this for three to five slow repetitions through the full range.
- Keep your chin tucked while moving the head into your hand.
- The object is to smoothly move your head into and out of flexion/extension slowly through as much of the range as possible (remember you define the pain boundaries)!