Strength Endurance Test: Neck Endurance Tests

Did you know the neck can manage almost 30kg worth of force when the head is flexed to 60°? It's little wonder so many people develop postural-related pain or symptoms in this area given that they may not have the strength to deal with such forces.

Neck strength is often a neglected area when it comes to the assessment of physical function but should be a priority in your examination of the people you work with, just like it is a priority for other areas of the body. 

Fortunately, there are some well-established strength assessments that look at all aspects of the neck that you can use to assess the people you work with similar to the trunk endurance tests you have performed previously. Commonly the neck extension tests may not be used due to the amount of time it can take before failure.

Research by Parazza et al 2014 found the following results when looking at neck endurance strength in flexion and extension:

Neck flexion: 44 seconds

Neck extension: 261 seconds

Research by Swanson et al 2020 found the following results when looking at neck endurance strength in lateral flexion:

Males: 122-134 seconds

Females: 94-97 seconds

A side to side ratio of 70% minimum

Procedure - Neck Flexor Endurance Test:

1. The client lies in a supine position and performs a chin tuck movement with hands lying on the abdomen.
2. Ask the client to raise their head approximately 10cm neutral whilst the assessor places a hand underneath the back of the head.
3. The duration that the client can maintain this position is measured until they either touch the assessor's hands or are unwilling to continue.

Procedure - Neck Extensor Endurance Test:

1. The client lies in a prone position, head protruding from the plinth, and performs a chin tuck movement with hands by their side.
2. Ask the client to keep their head in a neutral position, you can use your hand to ask the client to maintain contact with it during the testing process.
3. The duration that the client can maintain this position is measured until they either can't maintain contact with the assessor's hand, can't maintain a chin tuck position or are unwilling to continue.

Procedure - Lateral Neck Flexor Endurance Test:

1. The client lies in a side-lying position on the plinth and performs a chin tuck with the upper arm crossed onto the opposite shoulder.
2. Ask the client to keep their head in a neutral position, you may need to adjust the client's head so there is no rotation, once set place a hand just underneath the client here.
3. The duration that the client can maintain this position is measured until they either touch the assessor's hand, can't maintain a chin tuck position, or are unwilling to continue.

References:

• Sebastian, Deepak, Raghu Chovvath, and Ramesh Malladi. "Cervical extensor endurance test: a reliability study." Journal of bodywork and movement therapies 19.2 (2015): 213-216.
• Harris, Kevin D., et al. "Reliability of a measurement of neck flexor muscle endurance." Physical therapy 85.12 (2005): 1349-1355.
• Domenech, Manuel A., et al. "The deep neck flexor endurance test: normative data scores in healthy adults." PM&R 3.2 (2011): 105-110.