A quick test of neck strength

Here’s a quick, simple and easy to perform test of muscle strength that helps the clinician obtain a baseline measure of sorts: the neck flexor endurance test. It also gives the neck pain sufferer an experience of the confidence they have in their neck and of their willingness to move their neck.

There are a few variations. The version below was first described by Karen Grimmer in 1994 (who in turn had adapted it from Trott 1988).


  • lay supine on a plinth
  • retract chin
  • lifted head 2cm (measured from back of the head to the plinth)
  • the time until the chin begins to ‘thrust’ is measured in seconds
  • chin ‘thrust’ is determined in two ways: by light finger pressure over the point of the subject’s chin, and by observation.
  • average normal-no-neck-pain scores were 15-20 seconds (range 5 -25 seconds).
  • Grimmer (1994) found that scores were stable when re-assessed at one month.
Flexor Endurance Test

In a more recent study Domenech et al (2011) found slightly longer normative times (40 secs for men, 30 secs for women), but with a slightly different methodology to Grimmer’s study. Interestingly Domenech et al (2011) also noted high variability and no correlation between scores on the flexor endurance test and age / activity levels.

Domenech et al (2011) Flexor Endurance Test Times (Normative Data)

Of course – as mentioned above – this test is not just measuring muscle ‘strength’: clearly it’s tapping into confidence and fear of movement plus it offers the neck pain sufferer an experience of the strength of their neck.

Tip 1: It’s worth asking how confident the subject feels during the exercise. 

Tip 2: To help standardise the test use a 2cm thick book and rest the subject’s head on it. You can slide the book out and away from under their head to start the test.

Tip 3: A more challenging test – physically and psychologically – would be to start the test with the subject’s head over the edge of the bed.


Domenech, MA et al. 2011 The Deep Neck Flexor Endurance Test: Normative Data Scores in Healthy Adults, PM&R , Volume 3 , Issue 2 , 105 – 110. Full text here.

Grimmer K 1994 Measuring the endurance capacity of the cervical short flexor muscle group Aust J Physiother 40(4):251-4. Full text here.

Trott PM (1988):Manipulative therapy techniques in the management of some cervical syndtomes. In Grant RE (Ed.): Physical Therapy for the Cervical and Thoracic Spine. Clinics in Physical Therapy (Vol. 17). New York: Churchill Livingstone, pp. 236-237.