One Simple Approach to Exercise

In our last article, we discussed a couple of different methods of cervical extension traction for the rehabilitation of cervical lordosis.  In this article, we will discuss extension exercise in the context of rehabilitation of cervical lordosis. Loss of cervical lordosis and loss of cervical motion have both been associated with cervicogenic headaches.1,2   Cervical extension traction and cervical extension exercises are two methods that may be employed in rehabilitation of the normal lordotic curve of the neck with associated headache.

There are two simple ways to perform cervical extension exercises.  The easiest and the cheapest method is to simply have the patient perform the motion of cervical extension in the prone position with the weight of the head serving as resistance.  The advantages of this exercise are obvious:  You always have the equipment with you and it’s free. Typically, the patient would perform multiple sets of 10-20 repetitions of this exercise, taking approximately 1 second for the concentric phase (head extension) and 1 second for the eccentric phase (return to the prone position).

A second method is to use a device that can apply varying resistance for the extension exercise.  An example of such a device appears below.

The Noodle™ (patent pending) is about the most versatile tool we know about. If you’re stranded on a desert island with only one simple exercise device, then this is at the top of our list, as it allows exercise for just about every body area. It can also be employed in-office or the patient can purchase it for use at home.  Below, it is shown with a patient performing active, resistive cervical extension exercise.  In the office setting, the exercise is performed in sets of twenty repetitions to build endurance of the postural muscles.  Commonly, a patient would start with 1-2 sets per office visit, working toward the goal of performing five sets at each session.

Of course, like everything else, you need to make sure you know how to use it properly and that there are no contraindications for its use before you begin using it with your patients. It comes with a pretty comprehensive product brochure to provide you with this type of information.

Now, you have two different exercise tools for cervical extension exercises to aid you in improving cervical motion and strengthening the cervical musculature.  These two methods are attractive because they work and are low cost and simple. So, let’s see how we can put together the things we discussed here and in our previous article to treat a fictional case of cervicogenic headache:

Mrs. Jones enters your office complaining of headaches that you determine to be cervicogenic in nature.  She has a lot of the findings that are common in this type of condition, including neck pain, loss of cervical motion, and loss of the cervical curve. For those of you that want a more complete review of cervicogenic headache, we really like an article by Howard Vernon.1

Some of the things that you have at your disposal to work with these findings are adjustments, traction and exercise. In this case, you decide to do all three.

The combination of these techniques can be used to address the neck pain, the loss of cervical motion and the loss of cervical lordosis.  You can combine them in the way you think is best.  In this case, everything goes according to plan and the case responds and you got what you always wanted:  Simple straightforward care, happy doctor and happy patient.

As we said from the start, we think rehab is usually pretty straightforward and that’s our approach. We tend to favor simple methods over the complex, if both methods work.

Note: This information in not intended as healthcare advice. The determination of the risk and usability of information rests entirely with the attending doctor of chiropractic.


1. Vernon H, Steiman I, Hagino C.  Cervicogenic dysfunction in muscle contraction headache and migraine:  A descriptive study.  JMPT  1992;15:418-429.
2. Nagasawa A, Sakakibara T, Takahashi A.  Roentgenographic findings of the cervical spine in tension-type headache.  Headache  1993;33:90-95.

Dr. Roger R. Coleman is a 1974 graduate of Palmer College of Chiropractic, practicing in Othello, WA.  He is a member of the Adjunct Research Faculty at Life Chiropractic College West, and on the postgraduate faculty of National University of Health Sciences

Dr. Stephan J. Troyanovich is a 1987 graduate of Palmer College of Chiropractic, practicing in Normal, IL, and a member of the Adjunct Research Faculty, Dept. of Research, at Life Chiropractic College West.  He may be reached at 309-454-5556.

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