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Longus coli, longus capitis, rectus capitis anterior and rectus capitis lateralis exercises for improving movement dysfunction, chronic neck pain, shoulder impingement, forward head, whiplash syndrome, and sports performance. Great chin tucks activations for the deep cervical flexors.

Deep Neck Flexor Exercises (Activation)

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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This course describes neck exercise for the deep neck flexor muscles; the longus coli, longus capitis, rectus capitis anterior and rectus capitis lateralis exercise (a.k.a. deep cervical flexor activation, deep cervical flexor training, or deep neck flexor activation). Performing retraction, which is a combination of upper cervical flexion and lower cervical and upper thoracic extension, may aid in targeting the deep neck flexors, as well as inhibit the superficial neck flexors (e.g. sternocleidomastoid). Further, cues to aid in posterior tipping and depression of the scapula, may aid in reducing activity of the superficial cervical extensors (e.g. levator scapulae and upper trapezius).

The longus coli, longus capitis, rectus capitis anterior and rectus capitis lateralis are the only neck muscles that can perform neck flexion without upper neck extension, resulting in their unique role in preventing poor posture and stabilizing the neck (cervical spine). However, these muscles are prone to inhibition (under-activity, hypotonicity, weakness). It is common to include these exercises in a program designed to address forward head posture (poor posture); however, these exercises may also be recommended for shoulder pain, shoulder dysfunction, scapula dyskinesis, and thoracic kyphosis. Addressing these signs has been correlated with improving and reducing the risk of acute neck injury, chronic neck pain, whiplash, cervicogenic headache, upper thoracic pain, scapular pain, shoulder impingement pain, and improving sports performance. Movement professionals (personal trainers, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should consider adding these exercises to their repertoire with the intent of improving patient/client outcomes from their integrated exercise programs and therapeutic (rehabilitation) interventions.

Standing Isolated Activation of Deep Cervical Flexors: 

Deep Cervical Flexor Activation and External Rotator Activation

Deep Cervical Flexor Stability Ball Pass and Catch

Last, it is important to integrate the increase in deep cervical flexor activity into functional exercise. The Brookbush Institute accomplishes this with intrinsic stabilization subsystem integration. Some example movements for these purposes include:

Quadruped with Deep Cervical Flexor Combination (ISS)

Dr. Brent Brookbush demonstrating a deep neck flexor exercise

Course Description: Deep Cervical Flexor Exercises (Activation)

Introduction to the Deep Neck Flexor Exercises (Activation) Study Guide

Study Guide: Deep Neck Flexor Exercises (Activation)

Introduction

Deep Cervical Flexors In Postural Dysfunction And Movement Impairment

The longus coli, longus capitis, rectus capitis anterior, and rectus capitis lateralis have a propensity to become inhibited and under-active (relatively weak during activity). This reduces their ability to eccentrically decelerate cervical extension and rotation and maintain head/neck alignment during daily activity and sport. This impaired function may result in dyskinesis (movement dysfunction) of the head/neck and scapula, and is often paired with over-activity of the sternocleidomastoid (SCM), scalenes, 

 Deep cervical flexor inhibition may reduce performance, increase the risk of future injury and dysfunction, and is correlated with pain and dysfunction of the cervical spine, thoracic spine, lumbar spine, scapula, and upper extremity.

Signs of Under-Activity and a Maladaptive Increase in Length

An image of forward head position, which is a common position for an inhibited deep cervical flexor complex

Signs of Under-Activity & Length in Weak Deep Cervical Flexor Muscles

Introduction to Deep Cervical Flexor Exercises

Overactive Synergists

Muscles that commonly become synergistically dominant when the deep cervical flexors are inhibited. Release and stretch prior to activation and cue joint motion to reciprocally inhibit these muscles during activation exercise.

A demonstration on how to find the SCM muscle for static manual release

Note: The SCM and scalenes often become over-active (synergistically dominant) when the deep cervical flexors exhibit signs of inhibition. Unfortunately, from a practical standpoint, self-administered techniques for the SCM and Scalenes are not recommended due to their proximity to delicate vessels and nerves in the neck. This is not to say that self-administered intervention is ineffective for cervical dysfunction, in fact, it is often very effective to address the structures that can be affected by self-administered techniques. For example, release the 

, cervical extensors, and potentially the 

; along with activation of the deep cervical flexors. Improving cervical mechanics is imperative to optimal function of the scapular stabilizers (3), implying that cervical function and shoulder girdle function are intimately related (Cervical Dysfunction and 

Optimizing Motion (Order Matters)

Research Corner

There is a growing body of research on deep cervical flexor (DCF) activity and intervention; thanks in large part to one group of researchers (Jull, Hodges, Falla et al. (4 - 13)). DCF dysfunction appears to be consistent and predictable, resulting in DCF under-activity and dominance of superficial flexors (e.g. sternocleidomastoid and anterior scalenes). This behavior has been correlated with cervical spine loss of ROM, chronic neck pain, whiplash, acute neck injury, and cervicogenic headache - each resulting in the same altered muscle activity (4-9).

Although the cervical flexion test described by Kendal et al. (1) would not aid in differentiating between a DCF and superficial flexor weakness, assessments like the Deep Cervical Flexor endurance test are commonly used and have high reliability (2, 3, 11)

Several studies have noted the effectiveness of cervical retraction exercises (like those described below) for the treatment of chronic neck pain, whiplash, cervicogenic headache, and postural dysfunction (10 - 14). It should be noted that the exercises performed in these studies more closely resemble the supine progressions as well as the Lewit Cervical Retraction exercise described below. They do not include the progressions in standing, those that integrate range of motion (ROM) activities, or those that integrate other upper body activation exercises. With that being said, the Brookbush Institute has noted the best clinical outcomes with the latter.

 be limited to those with cervical dysfunction. Maladaptive changes in cervical muscle activity and head/neck posture have been correlated with altered scapular mechanics and activity of the 

 muscles (15-19). Adding a single DCF activation exercise to a routine intended to correct 

, only adds a couple of minutes to a program and may aid in optimal recruitment of scapular muscles.

Dr. Brent Brookbush demonstrating a deep cervical flexor and external rotator activation exercise

Standing Isolated Activation of Deep Cervical Flexors

Stabilization Progression for Deep Cervical Flexors

Deep Cervical Flexor Activation Progressions for Range of Motion

Stabilization Progressions for Deep Cervical Flexors

Stabilization Progressions 2 for Deep Cervical Flexors

Lewit Deep Cervical Flexor Activation

Combined Activation Techniques

Cobra with Cervical Retraction

Best Exercises for Deep Cervical Flexor Isolated Activation

Deep Cervical Flexor Explosive Chest Pass

Reactive Activation

Note: There is no effective means of taping for the facilitation of the deep cervical flexors; however, it is possible to facilitate lower cervical and upper thoracic extension using the taping technique above. Although no research is available at this time, clinical outcomes have been very positive.

Lower Cervical Extensor Facilitation Taping

Sample Activation Circuit

Perform each exercise for 10-20 reps with a weight that is challenging, but ensures that ideal form will be maintained. Perform in a circuit (without rest between exercises) 1-3 times through.

Release and stretch short/over-active structures first:

ROM Progression while Performing Chest Out/Thumbs Out against a mirror

Quadruped with Stability Ball Resisted Cervical Retraction

Deep Cervical Flexor Reactive Activation Integration

Note: The cervical spine is notoriously sensitive to the volume of therapy/exercise. Please keep in mind that the number of exercises performed is a progression unto itself. Although the sample activation circuit may be effective, it is only effective if the client/patient is progressed to the volume and intensity of these exercises carefully. For example, the circuit above may represent a goal for week 6 of a rehabilitation intervention, whereas week 1 only included the first exercise.

Sample Activation Circuit: Deep Cervical Flexor Exercises

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

Peolsson, A. L., Peolsson, M. N., & Jull, G. A. (2013). Cervical muscle activity during loaded arm lifts in patients 10 years postsurgery for cervical disc disease. 

Journal of manipulative and physiological therapeutics

Falla, D., Jull, G., & Hodges, P. W. (2004). Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. 

(1), 43-48. (Delayed onset of DCF with arm movement)

Jull, G. A. (2000). Deep cervical flexor muscle dysfunction in whiplash. 

Jull, G., Barrett, C., Magee, R., & Hodges, P. (1999). Further clinical clarification of the muscle dysfunction in cervical headache. 

(3), 179-185. (Decreased activity of deep cervical flexors)

Jull, G., Kristjansson, E., & Dall’Alba, P. (2004). Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. 

Falla, D., O'Leary, S., Farina, D., & Jull, G. (2011). Association between intensity of pain and impairment in onset and activation of the deep cervical flexors in patients with persistent neck pain. 

Falla, D., O’Leary, S., Fagan, A., & Jull, G. (2007). Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. 

Jull, G.A., Falla, D., Vicenzino, B., Hodges, P.W. (2009). The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Manual Therapy. 14: 696-701.

Jull, G., Trott, P., Potter, H., Zito, G., Niere, K., Shirley, D., … & Richardson, C. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. 

Van Ettekoven, H., & Lucas, C. (2006). Efficacy of physiotherapy including a craniocervical training programme for tension‐type headache; a randomized clinical trial. 

Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. 

Helgadottir, H., Kristjansson, E., Einarsson, E., Karduna, A., & Jonsson, H. (2011). Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. 

Journal of electromyography and kinesiology

Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N. (2010). Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. 

Journal of Electromyography and Kinesiology

Moustafa, I. M., & Diab, A. A. (2015). The Effect of Adding Forward Head Posture Corrective Exercises in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Study. 

Cools, A.M., Witvrouw, E.E., Declercq, G.A., Danneels, L.A., Cambier, D.C. (2003) Scapular muscle recruitment patterns: Trapezius muscle latency with and without impingement symptoms. 

Bibliography

Questions, comments, and criticisms are welcomed and encouraged

Deep Neck Flexor Exercises (Activation)

Related Courses:

Course Description: Deep Cervical Flexor Exercises (Activation)

Study Guide: Deep Neck Flexor Exercises (Activation)

Introduction to Deep Cervical Flexor Exercises
1 Sub Section

Overactive Synergists
1 Sub Section

Research Corner

Best Exercises for Deep Cervical Flexor Isolated Activation
7 Sub Sections

Reactive Activation
1 Sub Section

Lower Cervical Extensor Facilitation Taping

Sample Activation Circuit: Deep Cervical Flexor Exercises

Bibliography

Related Courses:

Comments

Guest

Deep Neck Flexor Exercises (Activation)

Related Courses:

Course Description: Deep Cervical Flexor Exercises (Activation)

Study Guide: Deep Neck Flexor Exercises (Activation)

Introduction to Deep Cervical Flexor Exercises1 Sub Section

Overactive Synergists1 Sub Section

Research Corner

Best Exercises for Deep Cervical Flexor Isolated Activation7 Sub Sections

Reactive Activation1 Sub Section

Lower Cervical Extensor Facilitation Taping

Sample Activation Circuit: Deep Cervical Flexor Exercises

Bibliography

Related Courses:

Comments

Guest

Introduction to Deep Cervical Flexor Exercises
1 Sub Section

Overactive Synergists
1 Sub Section

Best Exercises for Deep Cervical Flexor Isolated Activation
7 Sub Sections

Reactive Activation
1 Sub Section