Anterolateral Neck Flexors Strength Test

The Anterolateral Neck Flexors Strength Test is a clinical assessment that evaluates the strength of the anterolateral neck flexor muscles. Specifically, the primarily the sternocleidomastoid (SCM) and anterior scalene groups. This test is important for clients with neck pain, postural dysfunction (especially forward head posture), or after trauma.

How the Test is Performed

  • Client position: Supine (lying on their back), head in a neutral position.

  • The client rotates their head away from the side being tested (e.g., if testing the right side, rotate to the left).

  • The therapist stabilizes the side being tested to prevent lateral movement.

  • The client is then asked to lift their head into slight flexion (chin toward the chest and slightly diagonally toward the opposite side) and hold it against gentle resistance from the therapist’s hand on the forehead.

  • The therapist observes for the ability to maintain position, onset of fatigue, or compensatory movement.

Interpretation

  • Normal result: The client can hold the head up against resistance for several seconds with minimal compensation.

  • Weakness: The head drops quickly, or the client shows excessive shaking, fatigue, or muscle substitution (like using upper traps or contralateral SCM).

Clinical Significance

  • Weakness of the anterolateral neck flexors is commonly seen in those with chronic neck pain, whiplash injuries, forward head posture, and cervical instability.

  • This test can help differentiate between global (superficial) and deep muscle dysfunction, and may inform specific rehabilitation strategies.

  • May also reveal asymmetry between sides, guiding individualized treatment and corrective exercise planning.

Assessment

  • Use this test for clients with neck pain, forward head posture, headaches, or impaired cervical function.

  • Carefully document side-to-side differences, compensations, pain, or fatigue observed during testing.

  • Note any inability to hold the position, tremor, or quick onset of fatigue as indicators for targeted intervention.

Treatment

  • If positive for weakness:

    • Incorporate targeted strengthening and motor control retraining for the anterolateral neck flexors (SCM, anterior scalene), starting with gentle isometric exercises and progressing as able.

    • Pair strengthening work with soft tissue release of compensating muscles (upper trapezius, suboccipitals, scalenes).

    • Address postural education, focusing on head and neck alignment in daily activities to reduce overuse of superficial flexors.

    • Educate the client on at-home exercises and postural habits that optimize recovery.

Safety and Referral

  • If severe weakness, significant asymmetry, or neurological symptoms are observed, consider referral for physiotherapy or medical evaluation for further investigation.

  • Always screen for acute injury or contraindications before strengthening, especially after trauma.