Neck Flexion Test

This tests are to evaluate the use/performance of the Deep Neck Flexors (DNF) in comparison to the SternoCleidoMastoids (SCM).


  1. Prominence of SCM at mid to distal insertion.
  2. Forward head posture.
  3. Increased angle between chin and neck (>90′ usually indicates involvement of supra hyoids).
  4. Impaired respiration.
  5. Jaw clenching

The patient is in the supine position and is asked to perform a sit up. Careful observation will show whether the patient keeps their chin tucked, or if it juts forward making more use of the SCMs for neck stabilisation and movement.

This movement is considered pathological for a number of reasons. Firstly, observation of a child will show how they first initiate this movement by craniocervical flexion to stabilise the head on the neck and the anterior structures via contraction of the Rectus Capitis Anterior/Lateralis, the Longus Capitus and Longus Colli.

Secondly, dominance of the SCM translates the head forward, placing the lower cervical vertebrae into an anterior sheared position, and upper into hyperextension (A). This position strains the cervical tissues and is also a compromised position for additional movement such as rotation.


If you want to test for endurance… instruct the patient to tuck their chin in and raise their head from the table 1 inch. Average readings are approximately 40 seconds for males and 30 seconds for females. Patients with neck pain are commonly found to have values around 20 seconds.