For most people dealing with neck pain, the real goal isn’t simply to make a pain score go from a 6 to a 2.
It’s to get back to the activities that make life enjoyable.
That might mean riding your bike without your neck tightening after an hour, playing tennis without pain when you turn for the ball, working at a computer without developing a headache, or exercising without numbness, tingling, or loss of strength in your arm or hand.
That changes how we think about neck rehabilitation.
Reducing symptoms matters, but so does rebuilding the neck’s ability to control motion, tolerate load, and continue working as the demands of your sport or daily life increase.
What New Research Tells Us About the Deep Neck Muscles
A new 2026 study by Luk Devorski and colleagues provides an interesting look at one part of that equation: the deep neck flexors, primarily the longus colli and longus capitis.
These relatively small muscles sit deep in the front of the cervical spine and play an important role in segmental stability and control of the neck.
In the study, participants completed a progressive 12-week home endurance program targeting these muscles.
The results were significant.
By six weeks, deep-neck-flexor endurance had increased from an average of 43.4 seconds to 60.2 seconds — approximately a 39% improvement.
By weeks nine and twelve, ultrasound measurements also showed substantial increases in muscle thickness.
In other words, these small stabilizing muscles were trainable. Function improved first, followed by measurable structural changes in the muscles themselves.
But there is an important limitation.
The participants were healthy young adults without neck pain. This study does not prove that making the deep neck flexors stronger or thicker will eliminate neck pain. The authors specifically point out that further research is needed in symptomatic and older populations.
Fortunately, other research helps fill in part of that picture.
Why Deep Neck Flexor Training Matters
A systematic review examining people with chronic neck pain found strong evidence that deep cervical flexor training improves neuromuscular coordination.
However, this type of training was less effective on its own for developing higher-load strength and endurance. The researchers therefore recommended incorporating it into a broader, multimodal exercise program.
Similarly, a randomized clinical trial involving people with neck pain found that adding specific deep-flexor training with biofeedback to a conventional exercise program resulted in greater improvements in pain, disability, and muscular endurance after six weeks compared with conventional exercise alone.
The takeaway isn't that everyone with neck pain simply needs to do more chin tucks.
It's that the smaller stabilizing muscles of the neck appear to matter — but they're only one part of a much larger system.
A Chin Tuck Is Not a Complete Neck Rehabilitation Program
That distinction becomes especially important when your goal is returning to cycling, tennis, skiing, strength training, or another demanding activity.
A chin-tuck exercise by itself is not a complete neck rehabilitation program.
The deep stabilizers of the neck need to coordinate with the larger cervical muscles, shoulder blades, thoracic spine, trunk, eyes, vestibular system, and upper extremities.
Think about what that means in the real world.
A cyclist may need enough cervical endurance to comfortably support the head for several hours while maintaining visual orientation down the road.
A tennis player needs rapid neck and trunk rotation, extension, and force control while serving or tracking a moving ball.
Someone returning to strength training needs to maintain cervical and trunk control while progressively handling heavier loads.
The demands are very different, which means the rehabilitation should eventually be different too.
Treatment may begin with relatively low-load motor-control work and progress into cervical and scapular strengthening, endurance, thoracic mobility, postural control, and ultimately the specific positions and loads required by the activity.
This approach is consistent with clinical-practice guidelines recommending a combination of cervical and scapulothoracic strengthening, endurance, coordination, mobility, and functional exercise rather than relying on a single isolated exercise.
Where Does Hands-On Treatment Fit?
Exercise is an important part of building long-term capacity, but where does manual therapy fit?
The evidence suggests that hands-on treatment can be useful, but it is generally better viewed as part of the rehabilitation process rather than the entire solution.
A 2025 Cochrane review found that manual therapy combined with exercise can improve function and, compared with receiving no treatment, may substantially reduce pain. Comparisons with placebo treatment showed a smaller effect on pain, however, making the evidence more nuanced than simply saying hands-on treatment “fixes” neck pain.
Another systematic review of 22 studies found that combining manual therapy and exercise produced better pain and disability outcomes than exercise alone in several comparisons, although the certainty of much of the evidence was considered low to moderate.
A useful way to think about the relationship is this:
Skilled manual therapy may help restore motion, decrease sensitivity, or make movement easier, while progressive exercise develops your ability to control and use that motion over time.
One can create an opportunity for better movement. The other helps your body build the capacity to keep using it.
Turning Research Into Real-World Rehabilitation
That combination is one reason our approach at Revolutions in Fitness includes both hands-on treatment and specifically prescribed exercise rather than choosing one or the other.
Our physical therapists use an individualized assessment to look at joint and soft-tissue mobility, cervical motor control, strength and endurance, movement patterns, and the demands of the activity you want to return to.
Treatment may include manual therapy, joint and soft-tissue mobilization, strength training, core stabilization, movement retraining, and activity- or sport-specific rehabilitation.
Most importantly, the objective isn't simply to make your neck feel better while you're on the treatment table.
The goal is to progressively give your neck the capacity to do more.
That might mean making the next bike ride longer before your neck starts to fatigue. It could mean turning more comfortably on the tennis court, getting through a workday without developing a headache, returning to strength training, or simply feeling more confident using your body again.
And when neck symptoms include numbness, tingling, or loss of strength in the arm or hand, a proper neurological examination becomes particularly important before assuming that strengthening alone is the answer.
Ultimately, successful rehabilitation isn't just about reducing pain.
It's about rebuilding the mobility, control, strength, endurance, and confidence you need to get back to the activities you love — and stay there.
Research Referenced
Devorski L, Skibski A, Brignola G, VanWert E. Adaptations of the deep neck flexors at the C3 level: muscle thickness changes following a 12-week at-home exercise program. Journal of Bodywork & Movement Therapies, 2026.
Iqbal ZA, Alghadir AH, Anwer S. Efficacy of Deep Cervical Flexor Muscle Training on Neck Pain, Functional Disability, and Muscle Endurance, 2021.
Blomgren J et al. Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain, 2018.
Chacko N et al. Manual therapy with exercise for neck pain. Cochrane Database of Systematic Reviews, 2025.