The cervical spine is the neck: seven vertebrae, C1 to C7, that hold up the head and let it nod, turn and tilt. It is the most mobile part of the spine, which is why it is good at moving and why it complains when held in one position for hours. Neck pain is very common, but the link between neck posture and pain is weaker than most people think, and muscle endurance is something you can train.
How the neck is built
- C1 (atlas) and C2 (axis): special top vertebrae that carry the skull and allow about half of the neck’s turning.
- C3 to C7: the typical neck vertebrae, with discs and facet joints between them. C7 is the bump you can feel at the base of the neck.
- Nerve roots leave at each level and supply the shoulders, arms and hands. See spinal nerves.
- Muscles: deep neck flexors at the front hold the head steady; extensors at the back hold it up against gravity. See deep neck flexors.
Why the neck gets sore
The further the head moves forward of the shoulders, the harder the muscles at the back of the neck work to hold it. Hours of screens and phones keep it there. In adults, a forward head is associated with somewhat more neck pain, though not in adolescents, and studies are mostly snapshots.1 In women with chronic neck pain, a forward head came with lower endurance of the neck extensor muscles.2 See forward head posture and text neck.
Neck pain is common worldwide: about 203 million people had it in 2020.3 See neck pain.
What training does
A systematic review of 12 trials found that training the deep neck flexors improved coordination of the neck muscles and head posture, with pain and disability falling about as much as with other neck exercise.4
The neck responds to training. Exercises that build control and endurance improve head posture, and a mix of exercise types works best for pain.4
Practical starting points: the chin tuck, neck isometrics and upper back work such as scapular retraction.
When to see a clinician
Neck pain after an injury, with arm weakness or numbness, problems with balance or walking, or fever with a stiff neck needs prompt assessment. See red flags.
Footnotes
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The relationship between forward head posture and neck pain: a systematic review and meta-analysis. 2019. ↩
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The impact of forward head posture on neck muscle endurance and thickness in women with chronic neck pain. 2025. ↩
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Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. 2024. ↩
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Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. 2018. ↩
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