By Jonathan Chu, MD

Interventional Pain Medicine

PM&R

So in today’s modern society, with everyone addicted to their smartphones and all other forms of digital screens, there has also been an explosion of a problem known as “tech neck,” due to everyone spending hours upon hours each day in terrible postures, and thus putting a tremendous amount of repetitive stress on their necks and shoulders.

Now of course, though neck pain has really been surging in the last one or two decades, it certainly isn’t a new problem, as poor posture and repetitive strain on the neck have been problematic for humankind since pretty much forever.

Now, why are these types of postures bad for your neck? To summarize it quickly, spending many hours hunched over with your neck in flexion and protraction places considerable stress on the intervertebral discs of the cervical spine, which are the cartilage pads in between each of the vertebral bones of your neck. Poor posture also places a lot of chronic stress on the ligamentous structures and musculature of the neck.

So today, I’m going to talk about the king of neck exercises, which is the chin tuck, which is designed to reverse the damage done by the chronic poor posture, which unfortunately seems to be becoming a feature of modern life.

But before we go into detail on this exercise, I want to first talk about the anatomy, so you can understand everything that’s happening in your neck. As I always say, when it comes to pain medicine, knowing the anatomy is half the battle.

The part of your spine in your neck is known as the cervical spine, and is made up of seven bones called vertebrae, which are stacked on top of each other, almost like building blocks. The cervical vertebrae are the smallest of the spine, which partially accounts for the propensity of the cervical spine to develop pain problems, as all of the structures are relatively narrow and tight.

Now, located in-between each of these vertebral bones are cartilage pads called the intervertebral discs, which allow your neck to bend and twist, and also act as shock absorbers. Looking more closely at the discs, it is made up of two parts, the nucleus pulposus and the annulus fibrosus. The repetitive stress of chronic poor posture can often have quite a damaging effect on these discs, leading to accelerated degeneration, and potentially even disc bulging or herniation over time.

There are also extremely  important ligaments that are put under repetitive stress with chronic poor posture as well, and this most notably includes the anterior longitudinal ligament that runs in the front of the vertebrae, and the posterior longitudinal ligament that runs along the back of the vertebral bodies, and really function to hold the vertebral bones and discs in proper alignment.

Of course, tech neck also involves multiple layers of muscles as well, and if you’re watching this video, you are most likely experiencing significant painful spasms in these muscle groups, unfortunately.

When studying the back of your neck, the most superficial muscle is the trapezius, which is flat and diamond-shaped, and attaches to your neck and shoulders. The trapezius is probably the most well-known of the neck muscles, not only because it is the most superficial and it’s usually the muscle your rub when your neck hurts, but also because bodybuilders will often talk about working this muscle. Now, just below the trapezius, or deep the trapezius as we would say as medical professionals, there are another set of important muscles: the splenius capitus, the semispinalis capitis, and the levator scapulae, which all function to help extend the neck, among other functions. At the deepest layer there are muscles known as the rotatores cervicis muscles and the spinalis cervicis muscle; also, at the base of the skull, there are the suboccipital muscles, which can be especially problematic, as they can often trigger headaches if they are in spasm.

All of these muscles I described are extremely important for moving your neck throughout the day and also just to supporting your neck and maintaining an upright posture. Obviously, when someone spends many hours per day in poor posture, it will greatly overwork these muscles, contributing to chronic and painful muscle spasms.

Now let’s take a closer look at the mechanics of the neck. When your neck is in a normal, upright, neutral posture, as it was designed to be in the majority of the time, then the vertebrae and discs will be stacked up properly, there will a normal lordotic curvature which help the neck absorb shock, and the muscles really won’t have to work too hard to maintain the position, almost like scaffolding on a tower.

Now, when someone is hunched over their phone, you can see that the position places a tremendous amount of excess stress on the intervertebral discs, the ligaments, and all of the layers of muscles of the neck. Of course, flexing and protracting your neck for a few minutes here and there is no big deal; however, in the modern era, it’s been found that the average person spends 3 hours and 15 minutes each day looking down at their phones, which is really just too much, and places excessive load on the structures of the neck over time.

To help further expound on the concept, think of a typical dumbbell weight. If you hold it close to the body, it’s pretty easy to do so for a long period of time. However, if you extend the weight away from your body, it’s going to put tremendous strain on your arm and shoulder, and you aren’t going to be able to sustain the position for very long at all. When you’re looking down at your phone in a forward flexion position, you’re putting a similar type of mechanical stress on your neck.

Now for most people, tech neck will manifest as muscle spasms, deep aching pains, and fatigue of the neck. If it becomes more serious and actually involves injury to the discs, these intervertebral discs can actually bulge outward and press on the spinal nerves that exit the spine, causing pain that shoots down the arm, which is known as radiculopathy.

So now, let’s finally talk about what I consider to be one of the very best exercises for reversing the damage caused by tech neck, which is the chin tuck. I do apologize that it took me a little while to get here, but I really want you understand your own anatomy and what’s happening in your neck, as I believe that it will help you to do the exercise properly, and also, I believe that knowing the rationale will help you stick with the exercise more consistently.

So let me walk you through the chin tuck exercise, step by step:

1. You should sit or stand in a neutral upright posture with your shoulders relaxed, facing straight ahead.

2. Next, I want you to glide your chin straight back. It is a small and controlled movement, and you’ll feel the activation of the deep muscles in the front of your cervical spine, in addition to the muscles in the back of your neck, to a lesser degree. You should not tilt your head up or down or side to side during this movement. I want you to hold this position for 10 seconds, before you relax and go back to neutral. When you’re starting off you can also put two fingers on your chin to help guide you through the movement, but this is optional.

3. You should do this for anywhere from 5 to 10 reps, depending on what you can tolerate.

4. You can either do this for multiple sets during one exercise session, or what many patients prefer is to actually stop their work for a few quick breaks during the day, and during each of these breaks they take some time to do a set of chin tucks. This is an easy and convenient way for you to get your reps in, and also a way for you to change up your daily routine so you’re not spending the entire day sitting in one position.

Now going back to the anatomy, I want you to visualize your spine again, and how this exercise helps to reverse the repetitive stress that you’re putting on your neck all day. Oftentimes when you do this exercise, you can feel it in the deeper structures of the spine and in the muscles that we discussed earlier in the video.

Now if you feel up to it, you can add to this exercise and make it a little more challenging and increase the degree of stretch. This is actually how I personally like to do the chin tuck in my own exercise program.

1. First, I want you to clasp your hands together, and then draw your shoulder blades back together by tightening your rhomboid muscles.

2. Then, I want you to extend your neck ever so slightly.

3. Then, I want you to glide your head back in the chin tuck movement. I want you to hold this position for about 10 seconds before relaxing.

When you do this, you’re really going to feel it at the base of your neck and between your shoulder blades, and you may even feel a gentle and soothing pressure at the back of your intervertebral discs, and you should thus feel what it’s like for your body to do the opposite of what it’s doing throughout most of the day.

In general, I would say that you need to do these exercises consistently over the long-term to really maximize the therapeutic benefit. However, if you do the chin tucks properly, you can often get some degree of relief almost immediately. This was actually demonstrated by a study that came out of Japan in 2023, done by Takasaki and Yamasaki, and this showed that neck retraction exercises produced immediate hypoalgesic effects, or pain-decreasing effects, in a small cohort of young patients.

So that really concludes all of the fundamentals you need to know about both tech neck and the chin tuck exercise. There are actually a lot more variations of the chin tuck I can hopefully go over in a future video, if you guys are interested.

This is Dr, Chu with 360 Pain Academy, thanks so much watching; if you found the video valuable, feel free to like and subscribe to the channel, and also check out the 360 Pan Academy website for a ton of free articles and educational resources, link in the description below. Take care until the next video.

References:

Benzon, H. T., et al. (2018). Essentials of pain medicine (4th ed.). Elsevier.

Braddom, R. L. (Ed.). (2010). Physical medicine and rehabilitation (4th ed.). Saunders/Elsevier.

Cuccurullo, S. J. (2004). Physical medicine and rehabilitation board review. Demos Medical Publishing.

Liebenson, C. (Ed.). (2007). Rehabilitation of the spine: A practitioner's manual (2nd ed.). Lippincott Williams & Wilkins.

Morrone, M. (2008). Overcoming back and neck pain. Harvest House Publishers.

Netter, F. H. (2006). Atlas of human anatomy (4th ed.). Saunders/Elsevier.

Takasaki, H., & Yamasaki, C. (2023). Immediate neck hypoalgesic effects of craniocervical flexion exercises and cervical retraction exercises among individuals with non-acute neck pain and a directional preference for retraction or extension: Preliminary pretest-posttest randomized experimental design. Journal of Manual & Manipulative Therapy, 31(5), 368–375.