The cervical spine relies heavily on muscular support, particularly from the deep muscles in the front and back of the neck. Some experts estimate that up to 70% of the stability of the cervical spine arises from these deep neck muscles, particularly those in front of the spine. Studies have demonstrated that the rapid acceleration-deceleration forces that are placed on the neck during a motor vehicle collision can injure these deep neck muscles. Indeed, electromyographic (EMG) testing conducted on WAD patients has shown that those with higher pain intensity also had reduced deep muscle function in both the front and back of the spine. Treatment guidelines for non-specific neck pain recommend incorporating neck-specific exercises into the treatment process. But what about for WAD patients with neck pain?

A 2018 study that involved 26 patients with chronic WAD (symptoms lasting longer than three months) evaluated the role of neck-specific exercises (such as cranio-cervical flexion—tucking in the chin and approximating the chin toward the chest while looking straight ahead without bending the head forward) had in improving muscle performance, disability, and pain intensity over the course of a three-month time frame.

After three months, the researchers used a special type of diagnostic ultrasound to measure function in one large superficial muscle and two deep muscles that all reside in the front of the neck. Investigators observed that the participants in the neck-specific exercises (NSE) group experienced significant improvements with respect to muscle function, disability, and pain intensity that were not observed among those in a “wait list” group who served as controls.

Here’s where it gets more interesting… At the three-month point, the members of the control group were added to the NSE group, and three months later, the researchers observed that these participants experienced the same improvements that they previously noted in the first NSE group! This study supports the need for specific neck exercises to reduce pain and disability and improve function.

When the deep muscles are injured, it’s common for the body to recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue. This helps to explain why exercises are so important in the recovery process from musculoskeletal injuries, especially since there’s research that says that up to half of WAD patients will still experience pain and disability a year after their accident. This underscores the importance of seeking treatment for WAD as soon as possible in order to reduce the risk for chronicity and while the chances for full recovery are greatest.