Patients with chronic neck pain might be wondering about the safety of exercise for arthritis in the neck and rightly so. Prior to commencing any new stretching or strengthening exercises for neck pain patients are advised to check with their physician or physical therapist to avoid exacerbating neck arthritis problems. Those with rheumatoid arthritis, for example, where atlantoaxial subluxation has occurred or is unstable may exacerbate their condition if engaging in certain movements of the neck. Some neck exercises are beneficial for stabilizing the upper neck however and provide strength and flexibility for patients with chronic neck pain from other conditions.
Do Neck Exercises for Arthritis Work?
A study by Kauppi (et al, 1998) found that exercise for arthritis in the neck could provide benefits as part of active conservative treatment of atlantoaxial subluxation in rheumatoid arthritis patients. Patients in the study continued to practice their neck exercises even after the twelve month follow-up and consistency was thought to accentuate the benefits of the treatment. Cervical pain was significantly reduced and patients also showed evidence of positive changes in subsequent x-rays. Patients were taught to do isometric or only slightly dynamic exercises including flexion, extension, and rotation against compliant resistance, such as a hand or finger. Dynamic flexion and maximal rotation were avoided due to concerns over safety. A ‘pumping’ method was employed where a tension was followed by rest, followed by another tension in both short and long chains around eight seconds or so. The aim of this was to activate all types of muscle cells and patients were also taught to feel and use the deep muscles of the upper neck.
aught to feel and use the small deep muscles of the upper neck in the exercises. Larger neck and shoulder muscle exercises were also performed, taking care to keep these isometric or minimally dynamic and avoiding extreme rotation or dynamic flexion.
The patients were also taught muscle relaxation methods to help reduce chronic pain and muscular cramps and tension and pain was significantly reduced during the first two weeks of treatment. Treatment effects continued for at least twelve months with the authors noting that this was likely due to the initial success in controlling pain symptoms being a significant factor in motivating patients to continue the exercises and control their pain in this fashion. Teaching the patients to avoid situations where maximal subluxation occurs and to enable strengthening of the cervical spinal muscles also appeared to encourage a reduction in atlantoaxial instability.
Rheumatoid Arthritis – Neck Exercises to Avoid
Finnish researchers also conducted a study in 2008 looking at isometric neck exercises for rheumatoid arthritis patients and concluded that submaximal loading of the neck extensors led to a decrease in the width of the cervical spinal canal and should not be recommended for patients with unstable atlantoaxial subluxation (Hakkinen, et al, 2008). This translates to advice for rheumatoid arthritis patients not to conduct a classic strengthening extension neck exercise where the head is pushed back, even in a neutral position, against a forward force as this worsens spinal stenosis and may actually exacerbate pain and nerve damage. Flexion exercises appeared to decrease the atlantoaxial distance in those patients examined and were, therefore, not necessarily contraindicated in patients with rheumatoid arthritis in the neck, unlike in the earlier study by Kauppi, et al.
Ankylosing Spondylitis – Neck Exercises
Those with ankylosing spondylitis are also encouraged to engage in appropriate exercises for arthritis in the neck with a specially devised strengthening and flexibility protocol showing greater results in one Spanish trial in comparison to conventional exercises (Fernández-de-Las-Peñas, et al, 2005). Conventional treatment involved twenty exercises involving motion and flexibility exercises for the neck, thoracic and lumbar spine. Chest expansion exercises, and stretching of shortened muscles were also included in the conventional routine. The experimental routine however was based on the postural affectation of those with ankylosing spondylitis in order to address the shortened muscle chains by using the Global Posture Reeducation (GPR) method.
Targeting these shortened muscle chains during the four-month study period involved weekly, hour-long classes with an experienced physiotherapist. Scores on the BASDAI (The Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (The Bath Ankylosing Spondylitis Functional Index) were improved following both treatments with the experimental group achieving slightly better outcomes on most assessment criteria. Patients with ankylosing spondylitis may wish to check whether a similar approach can be taken in their physiotherapy sessions in order to target the shortened muscle chains indicative of this condition through Global Posture Reeducation.
Exercises for Arthritis in the Neck
Below are several exercises for arthritis in the neck, although patients should consult their physical therapist prior to engaging in such exercises. It is good practice to carry out these exercises in front of a mirror so as to check that the head is not moving, i.e. that the exercise remains isometric rather than dynamic.
With your hands on your forehead push gently against their resistance by tightening the neck muscles, but without actually moving the head forward. Hold for around eight seconds, rest, and repeat. If you cannot raise your hands due to shoulder pain then the exercise can be carried out when lying down by using a pillow underneath the forehead as gentle resistance; be careful not to actually move the head forward however.
Begin by placing your hands against the back of your head then apply slight forward pressure to resist the movement as you push your head back into your hands. Take care not to actually move the head backwards; use a mirror to check your posture during the exercise. Hold the position for five seconds, rest for three seconds, then repeat.
Isometric Lateral Flexion
Use your right hand to apply pressure to the side of your head just above the right ear and resist the pressure by tightening the neck muscles without actually moving your head sideways. Hold the position for five seconds or so, rest for three, then repeat. Do the same number of repetitions for each side of your head.
Isometric Lateral Flexion – Second Exercise
Place your palm against the side of your face in a similar fashion to the earlier exercise, but this time position your hand slightly lower so it is against your chin. Increase the pressure against the side of your face and resist it using your neck muscles as if you were trying to turn your head but without actually turning it. Hold for five seconds or so, rest for three, and then repeat for both sides of the head.
Some patients find that exercise for arthritis in the neck is extremely helpful in managing symptoms of neck pain, but care should be taken to carry out exercises under supervision from qualified physical therapists or physicians.
Hakkinen A, Makinen H, Ylinen J, Hannonen P, Sokka T, Neva M, Kautiainen H, Kauppi M. Stability of the upper neck during isometric neck exercises in rheumatoid arthritis patients with atlantoaxial disorders. Scand J Rheumatol. 2008 Sep-Oct;37(5):343-7.
Kauppi M, Leppänen L, Heikkilä S, Lahtinen T, Kautiainen H. Active conservative treatment of atlantoaxial subluxation in rheumatoid arthritis. Br J Rheumatol. 1998 Apr;37(4):417-20.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Morales-Cabezas M, Miangolarra-Page JC.
Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil. 2005 Jun;84(6):407-19.