A common question that comes up in the clinic is whether physical therapy for low back pain can actually work if an MRI or X ray shows positive findings. This concern makes sense. Traditional thinking often suggests that if something looks abnormal on imaging, that must be the source of pain. Not quite. In many cases, imaging findings only matter when they clearly match very specific symptoms. More often, they serve as a sign rather than the true root cause of pain. Relying too heavily on imaging can cause you to overlook deeper movement based issues that are actually driving your symptoms. A typical MRI or X ray for someone with low back pain may show disc degeneration, disc bulges or herniations, bone spurs, stenosis, loss of disc height, spondylosis, or spondylolisthesis. Some of these findings are completely normal age related changes. Others, such as disc herniations, do reflect structural damage. Even so, that does not automatically mean they are the source of your pain. Structural Damage Does Not Equal Pain One of the most important concepts to understand with back pain is that damage does not equal pain. Pain is one of the most complex processes in the human body. It is influenced by biomechanics, the nervous system, hormones, stress levels, and psychological factors. Because of this complexity, there is rarely a one to one relationship between structural damage and pain. Research consistently shows that many people with no back pain at all have disc degeneration or even disc herniations on MRI. At the same time, others experience severe pain despite having no significant findings on imaging. This disconnect is one of the biggest reasons imaging alone rarely provides a complete answer. Your Symptoms May Not be Related to Imaging Findings  Imaging results should always be considered alongside your clinical symptoms. Pain that is primarily driven by structural damage tends to be constant, unrelenting, and often accompanied by nerve related symptoms such as numbness, tingling, or burning. Sciatica caused by nerve compression is a classic example. On the other hand, signs that your pain may not be directly related to imaging findings include symptoms that come and go, pain that only shows up with very specific movements, or the absence of nerve related symptoms. If you have had back pain for a long time, there is also a strong chance that any initial structural damage has already healed. The body is remarkably adaptable. Research shows that disc herniations often heal within six to twelve months. In fact, larger herniations frequently heal faster than smaller ones. If pain persists well beyond that timeframe, it is often related to an underlying movement dysfunction that may have contributed to the injury in the first place. What the Root Cause of the Pain is Even when imaging findings are not the direct cause of pain, they can still provide clues. Disc herniations commonly occur due to weakening of the back portion of the disc. As the disc weakens, it becomes more vulnerable to injury. Often the final trigger is something minor like bending over or sneezing. This weakening process is frequently linked to reduced blood flow, which is essential for disc health. Blood flow to the disc decreases when the back side of the spine stays compressed for long periods of time. That compression often happens in positions that bias spinal extension, such as excessive arching or bending backward. If your body is stuck in postures or movement patterns that consistently load the spine this way, the disc becomes more vulnerable over time. These patterns are often influenced by stress, habits, and repetitive activities. The solution is not fixating on the disc damage itself, but identifying and correcting the movement patterns that led to both the damage and the ongoing pain. Understanding this bigger picture is often the missing piece in resolving persistent back pain when imaging alone does not give clear answers.

The inversion ankle sprain is the most common injury in the world. Walking down the stairs and missing a step. Getting bumped in the air during a layup and landing on the outside of the foot. In an instant, force is applied through the outside of the foot and ankle at a speed the ligaments and surrounding tissues cannot rebound from, as shown in Image 1 below. [caption id="" align="aligncenter" width="894"] Image 1: An inversion ankle sprain in the NBA.[/caption] Like most acute injuries, damage to the bones, muscles, ligaments, and tendons triggers inflammation. This response helps clear damaged tissue and initiate healing. Swelling follows as part of this process and gradually decreases as the acute phase of injury resolves. Once ankle and foot range of motion is restored, one of the most commonly prescribed interventions is unstable surface training. This usually involves standing on a foam pad, wobble board, or BOSU ball while maintaining balance and foot contact. The idea behind this approach is that standing on an unpredictable surface forces the ankle and center of gravity to adjust continuously. This is thought to retrain body awareness and reduce the tendency to place force through the outside of the foot, which could lead to another ankle sprain. [caption id="" align="aligncenter" width="929"] Figure 2: Single Leg Stance Balance Retraining on a Bosu Ball[/caption] There is nothing inherently wrong with this concept. For athletes and active individuals, the ability to respond to unexpected perturbations and regain control is important. The issue lies in how well this type of training transfers to real world movement and sport demands. Most sports are performed on solid surfaces such as hardwood courts, turf, grass, asphalt, or concrete. These surfaces do not yield the way unstable surfaces do. The yielding nature of unstable surfaces makes it difficult to place the ankle, foot, and rest of the body into positions that are optimal for producing force to slow down, absorb load, and change direction safely. Clinically, individuals with recurrent ankle sprains often struggle to control internal rotation through the foot, ankle, and hip. Internal rotation represents the ability to drive force down into the ground beneath the body. To slow down effectively during landing, the body must apply force into the ground over time. To redirect movement, it must quickly produce force again to push away from the surface. If you attempt to produce downward force while the foot and limb remain oriented toward external rotation, force continues to be directed toward the outside of the foot instead of directly beneath the body. This limits your ability to reduce sprain risk. In the example referenced above, notice how the foot may be on the unstable surface, but the shin remains oriented outward relative to the body. This brings up an important question. How do we retrain the ability to produce force directly beneath the body rather than outside of it? The first step is developing coordination in a low demand position, such as the supine cross connect shown in Video 1. [embed]https://youtu.be/TcsiqnDrd0g[/embed]  Video 1: Supine Cross Connect  This exercise helps align the foot, knee, hip, and rib cage while pressing into a fixed surface. The wall simulates the ground, allowing you to learn proper force direction without the complexity of standing balance. Progression: Low Step Up Cable Chop Once this pattern is solid, the next step is transferring it to a standing position. [embed]https://youtu.be/mGzNekn1g3o[/embed] Video 2: Low Step Up Cable Chop  In this exercise, the stance leg is positioned directly under the body while the cable or band chop helps guide force into the inside portion of the foot. This reinforces proper alignment and force production during upright movement. These exercises are just two examples of how to retrain the ability to absorb and generate force without directing bodyweight toward the outside of the foot. To be truly prepared for sport or high level activity, these principles must eventually be trained at higher speeds, under greater loads, and repeatedly without fatigue altering mechanics. If you have tried unstable surface training and still feel that your ankle does not function the way you expect after an injury, this approach may be worth exploring. If you have questions, feel free to reach out and continue the conversation.

For something as small as a toe, it can be surprising how much influence the big toe has on the rest of the body. With every step we take, the big toe helps us sense the ground and plays a major role in how we push off from one foot to the next. When big toe extension is limited, especially the motion needed to rise up onto the toes, walking mechanics can change significantly. Those changes often lead to compensations that do not stop at the foot. Over time, they can affect the knees, hips, low back, and even travel upward into the upper back, shoulders, and neck. Basics of Walking:  To understand why the big toe is so important, we first need to review some basic anatomy and the gait cycle, or how we walk. The big toe is designed to extend backward roughly 70 degrees, creating nearly a right angle with the bottom of the foot. This extension can become limited for several reasons, but two of the most common contributors are altered joint positioning and tightness in the muscles that flex or curl the toe downward. Changes in joint position can occur for many reasons and are best identified during a full evaluation with a physical therapist. Factors such as high or low arches, excessive pronation or supination, or pushing off the outside of the foot instead of the big toe can all alter how the bones of the foot align. When alignment changes at the big toe joint, the available motion is often reduced. The important takeaway is that these changes are often modifiable. With the right interventions and exercises that address the root cause, big toe position and movement can frequently be improved. The second contributor is tightness in the muscles that hold the toe in a flexed or curled position. It is important to understand that muscle tightness is usually a response, not the original problem. Muscles typically become tight due to the positions they are placed in or the demands repeatedly placed on them. It is uncommon for someone to be born with muscles that are simply too tight. More often, tightness develops as a reaction to how the foot is functioning. That is why identifying and addressing the underlying cause is essential for long term improvement. Gait Cycle: Push Off To further highlight the role of the big toe, we need to look at the terminal stance and toe off phases of the gait cycle. During this phase, the heel lifts off the ground and the body moves forward over the big toe. This motion requires adequate extension at the big toe joint. Because we take thousands of steps each day, even small impairments in this phase can add up over time. Diagram: Phases of the normal gait cycle, including heel strike, loading response, mid stance, terminal stance, pre swing, toe off, mid swing, and terminal swing. When the big toe cannot extend properly, people often compensate by rolling toward the pinky side of the foot during push off. Another common compensation is the development of a bunion, which occurs when force is driven through the inside edge of the toe instead of allowing the toe to extend backward at the joint. Both of these compensations can lead to pain in the toe or foot itself. They can also increase stress on the knees, hips, low back, and other areas as the body adapts to keep walking smoothly despite the limitation. Whether you are dealing with foot pain, pain elsewhere in the body, or are concerned about a developing bunion, the big toe is often an overlooked but critical piece of the puzzle. If you have been focusing only on the location of your pain without success, it may be time to zoom out and look at the entire body, quite literally from head to toe. A thorough assessment by a physical therapist can help identify movement limitations, compensations, and how they may be contributing to ongoing pain.

Training in martial arts can be an intense and rewarding pursuit. Competing for both pride and the occasional small trophy is part of the process for many athletes. Studying multiple styles is common, but for some, Judo becomes the primary focus. There is something deeply satisfying about getting inside an opponent’s head and navigating every move and counter move. It often feels like chess, but with physical combat and no getting punched in the face. This article is not about a love for throwing people. It is about repeatedly dealing with ankle sprains every few months. One wrong step. One moment of lost focus. Suddenly, an athlete can be off the mat and out of the gym for two to four weeks. This frustrating cycle prevents consistent progress in strength and skill development and can leave people feeling fragile. It raises an important question: what is the point of training so hard if something so simple can take you out so easily and so often? Many people no longer deal with this problem, but if any of this sounds familiar, keep reading. Understanding Ankle Sprains There are several types of ankle sprains, but this article focuses on inversion sprains since they are the most common. An inversion sprain occurs when the heel rolls inward and the outside of the foot collapses toward the ground. This usually happens for one of two main reasons. Either the center of mass shifts outside of the base of support, or the peroneal muscles on the outside of the lower leg do not activate quickly enough as the ankle begins to roll. The peroneal muscles work to evert the foot and ankle, essentially resisting the exact mechanism that causes an inversion sprain. These muscles play a critical role in protecting the ankle. For the purpose of this article, the primary focus will be on delayed muscle activation. The term sprain means damage to a ligament. Ligaments are connective tissues that attach one bone to another. When it comes to inversion ankle sprains, the ligaments most commonly involved are the anterior talofibular ligament and the calcaneofibular ligament. Unlike muscles, ligaments do not contract and they do not have their own direct blood supply. Because of this, they heal more slowly and they cannot actively change their length once healing has occurred. Here is an important and often overlooked fact. The number one predictor of a future ankle sprain is a previous ankle sprain. Let’s unpack why that matters. Why Ankle Sprains Keep Coming Back Ligaments are often described as the structures that hold the body together, but that is only partially true. Ligaments are not especially strong. Muscles are what truly stabilize the body and allow it to move through the world. Ligaments do have an important role though. They are loaded with mechanoreceptors, which are sensory structures that help the brain understand where the body is in space. As joints move, ligaments stretch and send signals to the brain, providing constant updates about joint position. This sense of body awareness is called proprioception. Without proprioception, movement would be clumsy and uncoordinated. When a ligament is sprained, it is forcibly stretched and partially torn. As it heals, it does so at a slightly longer length than before. Ligaments cannot shorten themselves after healing. This means that after an ankle sprain, the ligaments are slightly looser than they used to be. Because these ligaments help provide positional feedback to the brain, the signals they send are now slightly delayed. The delay may only be fractions of a second, but during high speed or high intensity movement, that delay matters. Here is the good news. Muscles also contain mechanoreceptors. By retraining the muscles of the foot and lower leg, especially those on the outside of the ankle, it is possible to help make up for the lost feedback from the injured ligaments. This is why proper rehabilitation is not just about strength. It is about timing, awareness, and control. What Comes Next Now you understand why ankle sprains tend to repeat themselves and why simply resting until the pain goes away is not enough. In Part 2 of this series, Next Level Physical Therapy will walk through a few foundational exercises that are considered mandatory in a complete ankle rehabilitation program. These drills are designed to restore confidence, improve control, and help stop the cycle of repeatedly rolling the ankle. Stay tuned.

You are reading this because either you, or someone you care about, has been dealing with a persistent burning or aching pain on the bottom of the foot. Maybe it only hurts when walking. Maybe it hurts all the time. Maybe it is in the middle of the arch or closer to the heel. Either way, chances are a podiatrist or orthopedist has told you that it is plantar fasciitis. Here are three things they probably did not tell you. There is typically nothing wrong with the foot itself Typical solutions do not address the root of the problem Exercise is the only way to truly eliminate it Let’s get into it. There is Typically Nothing Wrong With the Foot Itself Plantar fasciitis is classified as an inflammatory condition, but inflammation itself is not the problem. Inflammation often gets a bad reputation, but it is actually a critical part of the healing process. When tissue damage occurs, even at a mild level, inflammation shows up to start repair. Think of a car accident on the highway where a guardrail is damaged. Police arrive to secure the area, tow trucks remove vehicles, street cleaners clear debris, and construction crews rebuild the rail. Inflammation serves a similar purpose in the body. It clears debris and delivers materials needed for healing. Inflammation only becomes an issue when it never resolves. If inflammation represents the first step in healing, then chronic inflammation means the body is constantly trying to repair damage but never catching up. This is the definition of an overuse injury. With plantar fasciitis specifically, the pain in the foot is usually the result of a problem, not the problem itself. Flat feet, high arches, or family history are rarely the primary cause. If the structure of your foot were the issue, pain would have shown up much earlier in life. Typical Solutions Don’t Address the Root of the Problem Common treatments include rest, boots, stretching, massage, cortisone injections, and orthotics. While these can help reduce pain, they often miss the bigger picture when used alone. The goal of early treatment is to reduce stress on the plantar fascia so healing can occur. A boot, night splint, or rest period lowers overall load. Pain decreases and things feel better for a while. Then the boot comes off, life returns to normal, and weeks later the pain slowly creeps back in. That is not bad luck. The strain did not happen randomly. You felt better because support and reduced activity offloaded stress. Once normal movement and load returned, the same stresses were placed on the same tissues. Stretching and massage often follow next. Rolling the foot on a frozen water bottle and stretching the calves can feel great temporarily. Relief lasts an hour, then symptoms return, so the cycle repeats. Temporary relief is mistaken for progress. Cortisone injections often come next. They can dramatically reduce pain by suppressing inflammation. The problem is that inflammation is not the root issue. Removing the warning signal does not eliminate the stress causing the problem. All of these approaches treat symptoms, not causes. They can create a window of opportunity to do the real work, but they are rarely sufficient on their own. Exercise is the Only Way to Truly Eliminate It If most treatments focus on reducing pain, then exercise must address why the pain exists in the first place. That usually means strengthening the foot and improving how forces move through the body. Strengthening is straightforward. Strong tissues tolerate more stress before breaking down. This allows you to do more without accumulating overuse. Unfortunately, seated calf raises and toe curls only take you so far. To truly change capacity, exercises like walking, farmer carries, step ups, step downs, split squats, lunges, and light plyometrics must be part of the plan. The other major factor is motor variance. For this discussion, motor variance means how many movement options you can access and control. The more positions your foot, ankle, and lower leg can move through, the less wear any single tissue experiences. Think of it like shoes. If you wore the same pair every day, they would break down quickly. Rotating through several pairs spreads the stress. Stretching and massage temporarily improve range of motion, but range of motion is driven by muscle activity. If stiffness keeps returning, those muscles are doing a job. The key is figuring out why. That often means looking above the foot. What if plantar fasciitis pain is influenced by your upper back? The position of your center of mass has a major impact on your feet. If the upper back, lower back, or hips are stiff, they can push your body weight forward. As your weight shifts forward, your calves and feet must work harder to keep you upright. You push your toes into the ground to prevent falling forward, which increases stress through the plantar fascia, calves, and Achilles. Muscles tighten to protect you from tipping. Suddenly foot pain is not just a foot problem. This is why any approach to plantar fasciitis that ignores center of mass is incomplete. If you have been dealing with foot pain for a long time and nothing seems to work, widen your lens. Do not stare at one tree so closely that you miss the forest.

Do you find yourself turning your entire body just to look over your shoulder while driving? Or maybe you notice your neck doing most of the work during an ab workout. If so, you are likely dealing with a restricted and overactive neck. This is extremely common in a stress driven world where many people spend hours each day on computers and cell phones. Unfortunately, many suggested solutions fail to address the real cause of restricted neck mobility. Instead, they rely on passive stretching that acts as a temporary band aid for symptoms. Others avoid stretching altogether and are told to fix their posture or perform strengthening exercises like face pulls. Neither approach consistently solves the underlying issue and in some cases can make symptoms worse. Below are five exercises designed to target the most common contributors to restricted neck mobility, which tend to be faulty breathing patterns, limited rib cage movement, and repetitive movement habits. For best results, these exercises should be performed in the order listed. #1. Zercher band Breathing  [embed]https://www.youtube.com/watch?v=3CtDqIZnC_U[/embed] You might wonder why improving neck mobility starts with breathing and upper back expansion. There are two important reasons. First, the muscles that extend your neck and resist rotation attach all the way down into the middle of your upper back. If upper back mobility is limited, neck mobility will almost always suffer. Second, many muscles on the front and back of the neck act as accessory breathing muscles. This means they help move the rib cage to allow the lungs to expand. If the rib cage is stiff and cannot expand properly, these neck muscles are forced to work harder than they should. Over time, this leads to increased tension and overactivity. Zercher band breathing helps improve rib cage mobility and encourages expansion of the mid and upper back. Perform: 3 to 5 sets of 5 breaths #2. Staggered Stance DB Curls [embed]https://www.youtube.com/watch?v=o16wXhnkCs4[/embed] Biceps curls for neck pain might sound strange, but there is a method behind it. The arm position mirrors the previous exercise, and curling the weight encourages the shoulder to move down and away from the ear. Adding slight neck rotation introduces much needed movement while maintaining rib cage expansion. This position also places the upper trapezius, a common contributor to neck tightness, into a lengthened state. Breathing during the movement reinforces this position and helps reduce excess tension. Perform: 2 to 3 sets of 10 reps on the restricted sideBoth sides can be trained if needed #3. Lower Body Rolling [embed]https://www.youtube.com/watch?v=ZeugF67eiFw[/embed] The human spine is made up of 33 segments, with 26 capable of movement. Healthy motion depends on segmental movement, meaning each segment can move independently rather than the spine moving as one rigid unit. When segmental motion is lost, movement becomes stiff and robotic. This often shows up as turning your entire body instead of simply turning your neck. Lower body rolling teaches segmental movement from the bottom up. The motion starts at the hips and pelvis and finishes with the neck. An inhale at the end of the roll reinforces upper back and neck rotation. Perform: 2 to 3 sets of 6 rolls on the restricted sideBoth sides can be trained if needed #4. Rolling Arm Bar  [embed]https://www.youtube.com/watch?v=rfuEzHjiGro[/embed] Once you are comfortable with more passive or controlled neck movement, it is time to introduce more active motion. The rolling arm bar is an excellent tool for restoring and maintaining neck mobility. The kettlebell encourages shoulder reach, which helps maintain upper back expansion. This exercise uses the same bottom up segmental movement pattern as lower body rolling. Keeping your eyes on the kettlebell teaches the body to actively rotate the neck through a full range of motion. Neck fatigue is common at first, as you are retraining proper movement patterns. Most people notice improved baseline neck motion after performing this exercise. Perform: 2 to 3 sets of 6 rolls on the restricted sideBoth sides can be trained if needed #5. Turkish Get Up  [embed]https://www.youtube.com/watch?v=vPUD-Lqh6w0[/embed] Overhead shoulder movement is closely linked to movement of the lower cervical spine. This is why weightlifters often jut their head forward when pressing overhead. It helps maintain the relationship between shoulder and neck mechanics. The Turkish get up trains this relationship effectively. The kettlebell encourages shoulder reach and upper back expansion while keeping the neck moving in coordination with the shoulder. Maintaining your gaze on the kettlebell reinforces proper neck and shoulder mechanics. Looking upward also places the muscles on the front of the neck in a lengthened position. This movement ties together all of the mechanics addressed in the previous four exercises. Perform: 2 to 3 sets of 3 reps on the restricted sideBoth sides can be trained if needed Try this five exercise sequence to help restore neck mobility and reduce pain. If pain prevents you from performing these movements or symptoms persist, it may be time to be evaluated by a licensed professional. Reach out to Next Level Physical Therapy to schedule a free in person or virtual Discovery session.

In this article, we are going to discuss what other movements to consider if you are dealing with movement related neck discomfort and chin tucks have not helped. If you are not sure what a chin tuck is or whether it might be useful for you, refer back to the previous article in this series to see if your neck pain solution might be that simple. At the end of Part 1, we discussed how chin tucks are an exercise that extend the lower cervical spine while expanding the back side of the upper cervical spine. This relationship is shown in Picture 1. [caption id="attachment_1580" align="aligncenter" width="790"] Picture 1: The orientations of the two regions of the neck in a chin tuck position, live in action.[/caption] A key concept introduced earlier is that this position is not harmful. In fact, it is commonly used by individuals who are producing large amounts of force. When the goal is to be strong or generate force, the body often limits available movement to improve output. Think about the last time you helped someone move a couch. If you tightened your body and lifted straight up and down, the task likely felt easier. If you lost tension, twisted, or had to reposition yourself mid lift, your strength and leverage were reduced. When the body moves away from positions that limit rotation, it becomes harder to generate force efficiently. This is why strength athletes such as powerlifters compress certain regions of their body during lifts like the bench press. They pinch their shoulder blades together and extend the lower back to reduce unnecessary movement and improve force production. For them, this is a performance adaptation. Over time, however, this adaptation can contribute to a reduced ability to rotate or turn the head. To move into any position, the body must be able to expand into that space. Chin tucks extend or compress the lower neck. To turn your head to the right, the right side of the lower neck must expand while the left side compresses. The opposite must occur to turn left. If your head and neck naturally sit in a chin tucked position even when you are not lifting or producing force, and you struggle to turn your head in either direction, chin tucks are unlikely to improve your neck mobility. In these cases, exercises that promote expansion of the lower neck are often a better starting point. An Alternative: The Alternating Frog Crawl A great movement to begin restoring this ability is the alternating frog crawl, shown below. A video of the alternating frog crawl exercise. This exercise offers several benefits for individuals who have difficulty turning their head or who have experienced neck pain for an extended period of time. First, it teaches you how to create pressure through the ground to expand the space between your shoulder blades and the base of your neck. Second, it challenges you to maintain that expanded position against gravity, which helps build endurance in the muscles that support your neck and head. As you step one arm and the opposite leg forward, one side of the neck experiences compression while the other side expands. These are the exact biomechanical demands required to rotate the head side to side. Key Takeaways There is nothing inherently wrong with the chin tuck position. It can be helpful in specific situations, but it is not a universal solution for neck pain. The goal is to have a neck that can move into positions that resist motion when strength is required and positions that allow movement when rotation and flexibility are needed. If you have been relying on chin tucks without improvement and still feel limited by neck stiffness, it may be time to try a different approach. Focus on exercises that restore your ability to expand, rotate, and adapt so your neck can move freely again.

Chin tucks, a common exercise that involves drawing the head straight back as if creating a double chin, are frequently prescribed for people experiencing neck related symptoms. Video 1 above demonstrates one of our physical therapists performing the movement. Video 1: The “Chin Tuck” exercise. Chin tucks can be effective for symptom relief in individuals with neck pain, neck pain that travels into the arm, headaches, or general aching in the back of the neck. Some people notice improved neck motion and a reduction or complete resolution of pain when performing chin tucks. At the same time, we regularly meet patients who have been doing chin tucks for years and are still seeking help for ongoing neck discomfort. The goal of this article is to make sure your time and effort are spent on strategies that actually move you forward. So let’s get into it. When is doing chin tucks useful?  There are a few key heuristics we use to determine when chin tucks are likely to be a good investment of time. 1. You Have a Directional Preference for Your Neck or Arm Pain Many individuals with neck pain also experience symptoms that travel into the arm or hand. A directional preference means that moving your neck in one direction makes symptoms worse, while moving it in the opposite direction makes symptoms better. For example, looking forward or down may increase neck or arm pain, while moving the head backward reduces it. If performing chin tucks and holding the end position for a few seconds improves your symptoms, that is a good sign. Continue performing them and monitor whether your discomfort decreases and your neck movement improves over time. Even if chin tucks do not reduce neck pain directly but lessen arm or hand symptoms, that is still a positive response. This phenomenon is known as centralization and is strongly associated with improved outcomes in neck pain. 2. Your Neck Endurance Needs Improvement When neck pain has been present for a long time, it is common for people to move their neck less. Over time, this leads to reduced capacity and endurance in the muscles that support the neck. The Neck Flexor Endurance Test, shown above in Video 2, is a tool sometimes used to assess how well someone can maintain a specific neck position. [embed]https://www.youtube.com/watch?v=0JEWM_McBmM[/embed] Video 2: The Neck Flexor Endurance Test  If a person struggles to hold this position for less than 30 seconds, or especially less than 10 seconds, it is often worthwhile to focus on building endurance of the deep neck flexor muscles. In these cases, chin tucks can be a helpful way to improve local neck strength and endurance. However, if someone does not demonstrate a directional preference and performs well on both neck flexor and extensor endurance tests, chin tucks are unlikely to significantly move them closer to their goals. When is doing chin tucks not useful?  I frequently see individuals who already hold their neck in a chin tucked position during standing or other upright activities. They often resemble the position shown in the image above. [caption id="" align="aligncenter" width="681"] Graphic 1: Doing more chin tucks won’t be useful here.[/caption] The lifter shown above is already performing a chin tuck due to the demands of the bench press. If this same neck position shows up during daily life and the individual also has neck pain, reinforcing that position with more chin tucks is unlikely to change the outcome. In these cases, the more important question becomes why high force activities like the bench press drive the neck into this position in the first place. We will dive deeper into that topic in the next part of this series. Key Takeaways Chin tucks are not a magic exercise. They are simply a tool that moves the body toward a specific position. They can be helpful if you have a directional preference that improves neck or arm symptoms when moving into a chin tucked position. They can also be useful if you have poor endurance of the deep neck flexors and need to rebuild local capacity. The most important takeaway is understanding your unique starting point and matching the intervention to that presentation. In Part 2, we will discuss when chin tucks are unlikely to be the answer and what to consider instead.

In today’s world of technology and working from home, posture has become a buzzword with a largely negative reputation. We are constantly surrounded by messages about what makes posture good or bad and why it is supposedly the root cause of all aches and pains. You have probably heard it all. Pull your shoulders back. Stand up tall. Stop looking down at your phone. Or the personal favorite, posture correctors that promise to fix everything by doing the work of your muscles for you. Have neck or back pain? It must be your posture. Fix your posture and the problem goes away. With so much information floating around, it can be difficult to separate what actually helps from what does not. You can spend hours researching neck pain and still walk away without a clear solution. The truth is that the body is far more complex than finding one perfect posture to solve every issue. We are built to move, adapt, and function dynamically. Everything in the body is designed to work together. Because of that, the solution to neck pain is rarely as simple as just having better posture. Take a look at picture 1 above. Every time you move your shoulder, your shoulder blade, also known as the scapula, must move as well. If we look at the muscles that surround the scapula, particularly the levator scapulae and upper trapezius, we can see that they attach on one end to the scapula and on the other end to the cervical spine. This means that every time you move your shoulders and use these muscles, you are also influencing your neck. If you are dealing with neck pain, pause for a moment and consider a few questions. Do you feel stressed and notice that you hold tension by keeping your shoulders shrugged? Do you spend hours typing at a keyboard that is positioned too high, forcing your shoulders upward all day? Do you feel limited when trying to reach overhead or behind your back? If any of this sounds familiar, the true contributor to your neck pain may be the position of your shoulders and the constant tension in those surrounding muscles. The second picture above shows the muscles of the neck from the front. This includes the sternocleidomastoid muscles, the scalene muscles, and again the upper trapezius. In addition to helping move your neck, these muscles also assist with breathing. Before diving deeper into this, it is important to understand what normal breathing should look like. Ideally, during an inhale, the rib cage should move outward and upward. During an exhale, it should move downward and inward. When breathing with the diaphragm, there should be noticeable rib cage movement with each breath. Sometimes this breathing pattern becomes inefficient. The rib cage no longer moves as it should, and the diaphragm is not used effectively. When this happens, the body often relies on the neck accessory muscles to help drive breathing instead. These muscles are relatively small and not designed to handle high demand. If they are asked to assist with roughly twenty two thousand breaths per day, they will struggle to keep up. Over time, this leads to increased tension in the neck and upper shoulder region and eventually pain. While bad posture is an easy explanation for neck pain, it is often an incomplete one. The body is far more interconnected than posture alone. Many muscles attach different regions of the body together, meaning dysfunction in one area can show up as pain somewhere else. Understanding this makes it clear why neck pain is rarely as simple as it is often presented. If you are dealing with chronic neck pain, it is important to zoom out and look beyond posture alone. You may listen to the advice to pull your shoulders back, but if your rib cage mechanics or breathing patterns are contributing to your pain, that solution will fall short. If this sounds like you, consider being evaluated by a licensed professional who can assess how your entire body is moving and help identify the true root cause of your neck pain.