Those of us who have "reached a certain age" (i.e. baby boomers, seniors and the elderly) may know well the pain of spinal arthritis. Arthritis (osteoarthritis), a condition in which the cartilage around bones and joints erodes, can be very painful indeed. It also causes joints to stiffen up, making daily activities really difficult to carry out. Osteoarthritis tends to occur mostly with age, repetitive stress or following injury or trauma to your joint(s).
Generally, health providers take a multidisciplinary approach to managing the pain and other symptoms of this condition. For example, your healthcare provider or physical therapist may counsel you on ways you can protect your joints, as well as work on your neck range of motion with simple exercises. And your practitioner may caution you to balance your activity with rest to avoid unnecessary pressure on the spine when your muscles get fatigued. This is in addition to any medication your healthcare provider may prescribe for you.
Exercises You Should Avoid If You Have Neck Arthritis
Exercise for Managing Symptoms
If you're just getting to "that age," you may be looking for the escape button that will enable you to avoid this condition altogether. Most likely such a magic button does not exist, but exercise, particularly arange of motion exercise, is probably your best bet.
And if you're well into your senior years, your healthcare provider may (many times) have strongly suggested that you exercise regularly to address joint stiffness and pain.
Movement is the first line of defense when preventing spinal arthritis and limiting its development in the early stages, says Debbie Turczan, a clinical specialist in Physical Therapy at New York Presbyterian Hospital/Weill Cornell Medical Center in New York. "It's also a good strategy for decreasing the pain," she adds.
While flexibility and range of motion exercises are crucial for managing neck arthritis symptoms, neck strengthening also plays an important role.
Muscle Strengthening Strategy for Relieving Pain
Muscles around the spinal joints are designed to support the neck and back. Along with a range of motion exercises (which should be your first line of defense), managing neck arthritis pain can be greatly enhanced if you strengthen your muscles. This is because when muscles meant to support the spine are too weak to fulfill their responsibility, pressure and compression result. Compression the spine may cause pain and further the development of your arthritis.
A strengthening program to help protect joints and relieve pain associated with neck arthritis targets two muscle groups—both located at the back of the skull and neck, says Hagit Rajter, a physical therapist at the Joint Mobility Center at New York's Hospital for Special Surgery. These muscle groups are called the cervical (cervical means neck), paraspinal (paraspinal refers to next to the spine) and the suboccipital. The suboccipital muscles are those just under the skull in back.
Rajter recommends the following basic neck strengthening exercises.
According to Rajter, the cervical retraction exercise strengthens the muscles (rectus capitis and longus capitus) in front and loosens those in back.
You can either sit or lie down for the cervical retraction exercise. If you’re lying down, put a 2” to 3” rolled towel under your neck for support and comfort. If you sit, make sure it’s with good posture.
Begin with your head upright. Without tilting your chin (up or down), press your head back. The goal is to bring it back to the point where it aligns with your spinal column. You may feel a stretch at the back of your neck. Relax and repeat. or more detailed instructions see:
- Neck exercise for forward head posture can help prepare you to do a mean cervical retraction
- Cervical retraction exercise instructions
Rajter recommends doing 5 reps, 5 times per day, for a total of 20 to 30 reps, but she says the way you break it up is not important. In other words, you can do all 20-30 at once instead of the 5 reps 5 times per day, if that works better for you. The idea is that you need to complete 20-30 per day to make a difference in your neck muscle strength.
Aside from the cervical retraction exercise, strengthening neck muscles involves isometric work. An isometric muscle contraction is one that is static. In other words, this type of contraction produces no visible movement. An example of an isometric contraction is what happens to your bicep muscles (front of the upper arm) when you hold a grocery bag with your elbow bent but without moving your arm or taking the bag anywhere, Rajter says.
Both Turczan and Rajter say isometric exercise is the standard treatment for managing symptoms of neck arthritis. Both therapists generally begin their patients with gentle resistance (which means applying less—about 50% less—pressure than the max).
Turczan progresses her patients with more challenging work when they are ready. Rajter shared specific instructions for basic isometric neck strengtheners with me:
Isometric Neck Flexion and Extension Strengthening
Cervical (meaning neck) flexion occurs when you bend your head forward, and cervical extension occurs when you bend your head back. Although you concentrate on moving your head during the exercise, the flexion and extension actions we’re looking for in occurs in the neck. The muscles affected in this exercise are called the flexors (muscles at the front of the neck) and extensors (muscles at the back of the neck).
Sit or stand. Place the palm of one hand against your forehead and gently press it back, but resist the movement with your head. In other words, as your hand presses into your forehead, your head will be pressed back into your hand. Hold for a count of 5. As with the other exercises, Rajter says doing 20-30 of these is a must but you can break up the sets and reps how you like.
Repeat with your hand on the back of your skull, pressing your hand forward, and your head back into your hand.
Isometric Lateral Neck Muscle Strengthening
Lateral neck flexion means basically to tilt your head to one side. The muscles affected in this exercise are called the lateral flexors.
Place your palm on your right temple and press your left ear toward your left shoulder. Resist the motion of your head with your hand. Hold for a count of 5. Relax back to the start position very slowly. Do several of these (up to the 20-30 recommended by Rajter) and repeat on the other side.
With isometric exercises, Rajter says it’s important to move slowly, especially when you are relaxing the muscle contraction and bringing your head back to the upright position. “The neck is a sensitive area and one where it’s especially important to avoid jolting,” she says. She also cautions against making bouncing motions. This is because bouncing does not result in strengthening, she tells me.
For people who are stronger, Turczan suggests picking up your head when you do strengthening and stretching exercises. For example, while in a plank position, be sure not to let your head drop. “Many people have great form and strength when they do this pose,” she says, “but they let their head sag. This keeps muscles of the neck weak."
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Cleveland Clinic. Osteoarthritis.
Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain.J Phys Ther Sci. 2015;27(3):619–622. doi:10.1589/jpts.27.619
Susko AM, Fitzgerald GK. The pain-relieving qualities of exercise in knee osteoarthritis.Open Access Rheumatol. 2013;5:81–91. doi:10.2147/OARRR.S53974
Cervical Spondylosis (Arthritis of the Neck). American Academy of Orthopedic Surgeons.
Email Interview. Turczan, Debbie, MSPT, Physical Therapist and Yoga teacher. New York City.
Telephone Interview. Rajter, Hagit, PT, MSPT, Schroth Scoliosis Therapist, Cert. McKenzie Therapist, Advanced Clinician Physical Therapist, Joint Mobility Center, Hospital for Special Surgery, New York City.
By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.
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