Neck isometric hold

Key points

Studies use two kinds of neck hold: a low-load nod done lying on the back, and an isometric hold, where the muscle works but the joint does not move, against resistance^1,2.
In 10 healthy volunteers, a conventional neck flexion (bending forward) hold produced significantly more activity than the low-load nod in the sternocleidomastoid, a muscle at the front of the neck, and the anterior scalene, another neck muscle^3,4.
A meta-analysis, a study that pools earlier studies, found a large effect of resistance training on isometric neck strength in athletes and healthy people⁵.
Evidence on neck strength and concussion conflicts^6,7. One study of 6704 high school athletes linked weaker necks to concussion, but a review of eight studies found a small, non-significant link, on very low-certainty evidence^6,7.

Movement

The low-load nod

The craniocervical flexion test is a low-load test done lying on the back¹. The person nods the head through five stages that step up, guided by a pressure sensor placed behind the neck¹. It tests the action of the deep cervical flexors, two deep neck muscles called longus capitis and longus colli¹. It measures how well these muscles switch on and keep holding, and how they work with the flexor muscles nearer the skin¹.

Trials have also used the same low-load nod as a training exercise, over six or ten weeks^8,9. Some versions use pressure biofeedback, a pressure reading the person can watch while doing the nod¹⁰.

Holds against resistance

The other kind of hold pushes the head against a force without letting it move^2,11. Studies have used these forms:

Pushing the head back against an investigator’s hand while seated, in 10 women with chronic neck pain².
Hard isometric training against an elastic band, in 180 female office workers with chronic neck pain¹¹.
Maximal and 50-newton isometric efforts in many directions, in three men⁴. A newton is a unit of force.

One meta-analysis of neck strength measured isometric holds in flexion (bending forward), extension (bending back) and lateral flexion, bending to the side¹².

How the holds are measured

A meta-analysis of 31 studies looked at common neck tests in people with and without neck pain¹³. The tests were neck flexor and extensor endurance, the craniocervical flexion test, and strength measured with a handheld dynamometer, a device that measures force¹³. It found moderate to good agreement, both when one tester repeated a test and when two testers compared results¹³.

A systematic review of six neck strength measures in people with chronic neck pain was more cautious¹⁴. Reported reliability ranged from good to excellent, but certainty in the evidence was low or very low¹⁴. The one exception was the measurement error of a handheld dynamometer¹⁴.

What it loads

The deep neck flexors

In 10 volunteers with no known disorder, electrodes on the back wall of the throat recorded these deep muscles¹⁵. Their activity rose in a straight line across the five stages of the test¹⁵.

The muscles at the front of the neck

In 10 healthy volunteers, a conventional neck flexion hold and the low-load nod were compared at full, 50% and 20% effort³. At each effort, the conventional hold produced significantly more activity in the sternocleidomastoid and the anterior scalene³. The sternocleidomastoid is one of the muscles at the front of the neck⁴.

A study of three men recorded neck muscles with fine-wire electrodes, very thin wire sensors placed into the muscle⁴. The two front-of-neck muscles recorded, the sternocleidomastoid and sternohyoid, were most active in similar directions⁴. They also acted together in both dynamic tasks the study tested⁴.

The muscles at the back of the neck

Where the resistance sits changed how strongly the semispinalis cervicis worked relative to the splenius capitis, two muscles at the back of the neck^2,16.

Who was studied	Where the hand pushed	What changed
10 women with chronic neck pain	C2, the second vertebra of the neck, compared with the back of the head or C5, the fifth	More semispinalis cervicis activity relative to splenius capitis with the push at C2²
10 healthy volunteers with electrodes in the muscles	C1 or C4, the first or fourth vertebra of the neck	Semispinalis cervicis about twice as active as splenius capitis at the level just below the push¹⁶

The fine-wire study of three men found the back-of-neck muscles did not act as one group⁴. Most worked together during voluntary movement, but not when the body was jolted on a sled⁴. The splenius capitis did not share their pattern⁴. The authors say their findings suggest that the assumption that all back-of-neck muscles act together as extensors is not reasonable⁴.

In people with neck pain

A review of craniocervical flexion test research compared people with neck pain and people without¹. It reports that people with neck pain showed less deep flexor activity during the nod, and more activity in the flexors nearer the skin¹. Their deep flexors also held for less time¹. In one small study of 10 people with chronic neck pain and 10 without, deep flexor activity was lower in the pain group¹⁷. The gap was significant at the higher stages of the test¹⁷.

How the body adapts

Strength after resisted holds

A meta-analysis of 26 articles on athletes and healthy people found a large effect of resistance training on isometric neck strength⁵. It rated the evidence as high quality⁵. A review of neck strength in sport reports that programmes using isometric or moving actions were generally effective¹⁸. The smallest gains usually came from lighter or less frequent programmes¹⁸. In a meta-analysis of 15 studies with 907 military pilots, exercise raised isometric neck strength in flexion, extension and side bending to each side¹².

Two studies in professional rugby union players measured strength after five weeks, with different results^19,20. In 15 players training twice a week, isometric neck strength rose in flexion, extension and side bending¹⁹. Ten semiprofessional controls showed no significant change¹⁹. In a retrospective look at one squad of 27 players, strength at week five of an isometric programme rose, but not significantly²⁰.

A review of football and rugby found eight studies where neck strengthening raised strength in male rugby players, especially in extension²¹. Evidence for soccer players and female rugby players was limited²¹.

One 12-month randomised trial, which assigns people to groups by chance, took 180 female office workers with chronic neck pain¹¹. It compared hard isometric elastic-band training, endurance training and a control group¹¹:

Group	Flexion	Rotation	Extension
Isometric band training	+110%¹¹	+76%¹¹	+69%¹¹
Endurance training	+28%¹¹	+29%¹¹	+16%¹¹
Control	+10%¹¹	+10%¹¹	+7%¹¹

What the low-load nod changes

In 46 people with chronic neck pain, six weeks of nod training raised deep flexor activity during the test⁸. It also lowered sternocleidomastoid and anterior scalene activity⁸. Strength training did not change deep flexor activity⁸. In a trial of 60 people with chronic neck pain, ten weeks of the nod enlarged the longus colli on ultrasound, a sound-wave scan⁹. Conventional flexion exercise thickened the sternocleidomastoid instead, and pain and disability fell in both groups⁹.

Reviews of this training in people with neck pain describe its effects in different ways^22,23. One review of 12 randomised trials found strong evidence that it improved neuromuscular coordination²². At higher loads, gains in strength and endurance were small or absent²². Another review looked at nine trials in chronic neck pain²³. Eight supported it for deep flexor size, activity, endurance or strength, and one found no difference²³.

Trials in people with neck pain

Trials and reviews in people who already had neck pain or related conditions studied neck exercise programmes^10,11:

In the office worker trial, both the isometric band group and the endurance group reported less pain and disability than controls at 12 months¹¹.
A systematic review of 17 studies in neck pain, pooling 10 of them in a meta-analysis, looked at deep neck flexor training with pressure biofeedback¹⁰. For pain and disability, it was equal to or better than comparison approaches¹⁰. It was slightly more effective than neck strength-endurance training¹⁰.
In 46 women with chronic neck pain, an eight-week neck exercise programme lowered disability scores from 18.2 to 14.1²⁴. The control group did not change²⁴.
A trial took 200 people with cervicogenic headache, a headache that comes from the neck²⁵. Compared with control, a low-load exercise programme reduced how often and how hard headaches came at 12 months²⁵. Manipulative therapy did too, and combining the two was not significantly better than either alone²⁵.

A Cochrane review, a systematic review done to Cochrane’s published standards, looked at 27 randomised trials of exercise for neck pain²⁶. It found no high-quality evidence, leaving the effect of exercise for neck pain uncertain²⁶. It found moderate-quality evidence that neck, shoulder-blade and arm strength training eased pain in adults with chronic neck pain, in the short term²⁶. It found no evidence for recent-onset neck pain²⁶.

A task force defined whiplash as a speeding up and slowing down that passes energy to the neck, as in rear-end or side-impact car crashes²⁷. Whiplash-associated disorders name the problems people have after such an injury²⁸. A pilot trial in 33 people with subacute (between recent and long-lasting) whiplash-associated disorders tried six weeks of device-guided craniocervical muscle training delivered online²⁹. It was linked to larger drops in disability and pain than usual neck exercise or usual care, though the authors call this preliminary²⁹. Across its three groups, 16 mild, short-lived adverse events were reported (27%)²⁹.

A systematic review of 13 trials with 2427 people with long-standing whiplash-associated disorders included a meta-analysis of pain and disability³⁰. It found no difference between neck exercise with and without a behavioural approach³⁰.

Neck strength and concussion

Whether a stronger neck goes with fewer concussions is not settled, and the studies point different ways^6,7. Some findings suggest a link:

In 6704 high school soccer, basketball and lacrosse athletes, weaker neck strength was associated with concussion⁶. Allowing for gender and sport, each extra pound of neck strength went with 5% lower odds of concussion⁶.
A review of 10 studies found two where neck strengthening in male rugby players went with fewer concussions, a risk ratio of 0.55²¹. A risk ratio is how many times more often something happens in one group than in another.

Other findings point the other way, or find too little to judge^5,7:

A systematic review with meta-analysis of eight studies in 7625 team-sport athletes found a small, non-significant link between greater neck strength and lower concussion risk⁷. It rated the evidence very low certainty⁷.
The rugby review found no study showing fewer concussions in soccer players or female rugby players²¹.
A meta-analysis found neck resistance training had no significant effect on how fast the head sped up, in a straight line or in rotation⁵. It rated the evidence low to very low quality⁵. No study it found had tested whether neck resistance training changes how often concussions happen⁵.
A review of neck strength in sport found limited evidence that stronger necks held the head steadier against low forces¹⁸.

Injuries in one rugby squad

A retrospective look at one professional rugby squad of 27 players compared two seasons²⁰. The season with a 26-week isometric neck programme had 2 match injuries against 11²⁰. Injuries to the neck spine, 6 against 8, did not differ significantly, nor did days lost to them²⁰.

Progressive overload

A 2026 position stand describes progressive overload as the need to raise the stimulus on the muscle through a training programme³¹.

Raising the resistance

In the trial of 180 female office workers with chronic neck pain, the strength group trained with an elastic band³². They did one series of 15 repetitions at 80% of their starting maximum isometric strength, three times a week³². That 80% level was checked at the start and again at 2 and 6 months³².

In a randomised trial of 30 healthy adults, one group held the neck at mid-range, chin tucked, lying down and on hands and knees³³. Each hold lasted 12 seconds, for 3 sets, 3 days a week for 6 weeks³³. Participants used body weight for 3 weeks, then an elastic band, aiming for an effort of 4 to 6 out of 10³³. Frequency and rest stayed the same, and those already at that effort kept going without the band³³. Afterwards, isokinetic strength, measured on a machine at a fixed speed, rose 20% in flexion and 25% in extension³³.

Two trials in football-code athletes found different results^34,35:

A pilot randomised trial took 28 under-18 male rugby union players³⁴. Players did 15-second maximal self-resisted neck contractions, pushing against their own resistance, in four directions³⁴. After 8 weeks at three sessions a week, total isometric neck strength rose compared with controls³⁴.
In a randomised trial of 40 elite female soccer and Australian football players, isometric neck exercises were added to usual strength and conditioning³⁵. Done three times a week for 12 weeks, they did not raise neck strength beyond that programme alone³⁵.

Holding for longer

One trial of 60 people with neck pain was included in a systematic review²². Its endurance group trained the craniocervical flexors at 20% of their strongest possible effort for 10 weeks²². The training was progressed by time, and brief holds at 50% were added for 5 weeks²².

Phases and programme length

In one professional rugby union squad of 27 players, the 26-week isometric programme had a 13-week strengthening phase, then a 13-week maintenance phase²⁰. A randomised study of 180 women with chronic neck pain found the largest strength gains in the first 2 months³⁶. Gains went on up to 12 months, and the isometric high-intensity group gained the most at every follow-up³⁶.

What is not yet known

A meta-analysis of 26 articles in athletes and healthy people found that only half described their progression rules adequately⁵. And 62% did not report the starting level⁵. A review of 12 randomised trials of deep cervical flexor training in neck pain found little consistency in the amount of training²². It reports that the best dose is unknown²².

Connections

The muscles it works

Longus capitis and longus colli, the deep cervical flexors that the low-load nod tests^1,15.
The sternocleidomastoid, at the front of the neck, and the anterior scalene, both more active in conventional flexion holds^3,4.
The semispinalis cervicis and splenius capitis, at the back of the neck, in resisted extension holds^2,16.

Device-guided craniocervical muscle training has been tried in a pilot trial in people with subacute (between recent and long-lasting) whiplash²⁹. Neck-specific exercise has also been studied in long-standing whiplash³⁰.