Neck endurance can be relevant in sport, gym training, contact sports, cycling, desk-based postures, manual work and activities that require repeated head control. The Neck Lateral Flexion Endurance Test provides a simple way to assess how long or how many repetitions a client can maintain a controlled neck side-bending task.
The test can be performed as a hold or repetition-based assessment. It can also be performed left and right to compare side-to-side performance.
The result should not be used alone to diagnose neck pain, determine injury risk or make readiness decisions. It should be interpreted with symptoms, cervical ROM, neck flexion and extension endurance, isometric neck strength, posture, sport or work demands and related shoulder or upper-limb findings.
Test name: Neck Lateral Flexion Endurance Test
Common versions: Left lateral flexion hold, right lateral flexion hold, left/right repetition test
Category: Cervical strength endurance
Primary score: Hold time in seconds or valid repetitions completed
Best use: Side-to-side comparison, baseline testing, retesting and monitoring lateral neck endurance
Key limitation: Published norms are limited and setup differences strongly affect the score
The Neck Lateral Flexion Endurance Test assesses the client’s ability to hold or repeatedly perform controlled lateral flexion of the neck.
Common approaches include:
Side-lying neck lateral flexion hold
Side-lying neck lateral flexion repetitions
Seated resisted lateral flexion hold
Manual or band-resisted lateral flexion repetitions
Isometric lateral flexion endurance against a pad or fixed resistance
The exact setup must be recorded because body position, head support, resistance method, ROM, tempo and stopping criteria all change what the test measures.
The Neck Lateral Flexion Endurance Test may be used to assess:
Lateral neck endurance
Side-to-side differences
Cervical control under fatigue
Baseline and retest change
Response to neck endurance training
Symptom response during side-bending tasks
Fatigue tolerance in sport, work or gym settings
It may also provide useful context when combined with neck flexion endurance, neck extension endurance, isometric neck strength, cervical ROM and symptom monitoring.
The primary score is either valid repetitions completed or time held in seconds, depending on the chosen protocol.
The result may reflect lateral cervical endurance, upper and lower cervical control, side-to-side endurance difference, head and neck position control, fatigue tolerance, shoulder and trunk compensation, pain or symptoms, familiarisation and motivation.
It should not be described as isolated endurance of one muscle unless the protocol and supporting evidence justify that wording.
The test may be useful for contact sport athletes, combat sport athletes, rugby, AFL, football and hockey players, cyclists, desk-based workers, gym and strength-training clients, clients undergoing neck endurance monitoring, professionals comparing left and right sides, and professionals tracking changes over time.
It may not be suitable if the client has high neck irritability, dizziness, neurological symptoms, severe pain, recent trauma, poor tolerance to neck loading or inability to maintain a safe test position.
Mat, bench or flat surface
Stopwatch or Measurz stopwatch
Measurz rep counter for repetition-based testing
Measurz metronome for cadence-controlled protocols
Optional Measurz AR measurement for setup distance or head position reference
Optional inclinometer for neck angle or ROM control
Optional pad, towel or support surface
Optional MAT tools such as Anker or Muscle Meter for related isometric neck strength testing
Measurz platform for side, hold time, reps, symptoms, compensations and retest comparison
For repetition-based testing, the Measurz rep counter and metronome can help standardise counting and tempo. For timed holds, use the Measurz stopwatch. AR measurement or an inclinometer can help document setup and movement range.
The client lies side-lying with the body aligned and the head positioned neutrally at the start.
The tested side is recorded.
The client lifts or holds the head in a controlled lateral flexion position, depending on the protocol.
Start timing once the correct position is achieved.
The client maintains the position without trunk rolling, shoulder elevation or excessive rotation.
Stop when the head drops, position changes, compensation occurs, symptoms become unacceptable or the client chooses to stop.
Record time and reason for stopping.
The client lies side-lying in the selected position.
The tested side is recorded.
The client performs controlled lateral flexion repetitions through the selected ROM.
Use a consistent tempo if comparing over time.
Count valid repetitions until form failure, cadence failure, reduced ROM, symptoms, compensation or voluntary stop.
Test both sides after consistent rest.
The client sits upright with the trunk stable.
A pad, hand, wall or fixed resistance is positioned against the side of the head.
The client gently pushes into lateral flexion against the resistance.
Start timing once the target effort or position is reached.
Stop when the client cannot maintain position or effort, symptoms increase, compensation appears or the client chooses to stop.
Record time, side, resistance method and reason for stopping.
Record the test version, side tested, hold time or repetitions completed, body position, resistance method, head and neck start position, ROM or target position, tempo or cadence, pain or symptoms, compensations, reason for stopping, side-to-side difference and retest date.
A higher score generally suggests greater lateral neck endurance under the chosen protocol, but interpretation should consider setup, position, resistance, fatigue, symptoms and side-to-side difference.
The most useful comparison is usually the client’s own baseline and left-right comparison using the same protocol.
There are no widely accepted universal norms for Neck Lateral Flexion Endurance that apply across all protocols.
Because protocols vary, use practical field bands only when the same setup is repeated:
For hold-based testing:
Strong current tolerance: 40+ seconds
Moderate current tolerance: 20–39 seconds
Developing current tolerance: 10–19 seconds
Low current tolerance: under 10 seconds
For repetition-based testing:
Strong current endurance: 20+ valid repetitions
Moderate current endurance: 10–19 repetitions
Developing current endurance: 5–9 repetitions
Low current endurance: under 5 repetitions
These are practical benchmarks, not universal norms. For stronger interpretation, use the client’s own baseline, side-to-side comparison, exact-protocol research where available and symptom response.
Evidence for clinical neck endurance tests varies by protocol. Neck flexor and neck extensor endurance tests have more published reliability and normative research than lateral flexion endurance tests.
For Neck Lateral Flexion Endurance, reliability depends heavily on consistent setup, head position, resistance method, ROM, tempo, stopping criteria and symptom criteria.
Validity should be interpreted cautiously. The test may provide useful endurance and side-to-side information, but it should not be used alone to diagnose neck pain, identify a specific tissue source or predict injury risk.
Common errors include not recording side tested, not recording body position, allowing trunk rotation, allowing shoulder elevation, allowing head rotation instead of lateral flexion, using inconsistent ROM, changing resistance method, counting poor-quality reps, using inconsistent tempo, testing one side with more rest than the other, ignoring symptoms or dizziness, and using one score to infer injury risk or readiness.
Limitations include limited universal normative data, setup variability, symptom overlap, fatigue effects and potential influence from shoulder or trunk control.
The Neck Lateral Flexion Endurance Test can help professionals monitor lateral neck endurance, compare left and right sides, track response to training, identify fatigue or compensation during side-bending tasks, record symptom response during neck loading, combine findings with neck flexion, extension, rotation, ROM and isometric strength testing, and educate clients using a repeatable endurance measure.
Record test name, version, side tested, score type, body position, resistance method, head position, ROM or target position, tempo or cadence, pain score, symptoms, compensations, reason for stopping, retest date and related strength, ROM and endurance results.
The Measurz stopwatch, rep counter and metronome can support consistent testing. AR measurement and inclinometer tools can help document setup, angle or ROM. MAT tools such as Anker or Muscle Meter can provide related isometric neck strength measures when appropriate.
It measures lateral neck endurance, side-to-side tolerance and cervical control during a side-bending task.
No. Neck lateral flexion involves several cervical and upper-quarter contributors, and the result can be influenced by trunk, shoulder and head-position control.
Yes. Left-right comparison is one of the most useful parts of the test.
There are no universal norms. Use baseline comparison, side-to-side comparison and repeat testing with the same protocol.
Yes. Record pain, tightness, dizziness, headache, fatigue, compensation and reason for stopping.
The Neck Lateral Flexion Endurance Test is best described as a lateral neck endurance assessment.
Side-to-side comparison is often more useful than broad normative comparison.
Setup details such as body position, ROM, resistance and tempo are essential.
The test should not be used alone to diagnose neck pain or infer injury risk.
Measurz can track side, reps, time, symptoms, compensations, setup and retest progress.
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Versteegh, T. H., Beaudet, D. A., Greenbaum, M., Hellyer, L., Tritton, A., & Walton, D. M. (2015). Evaluating the reliability of a novel neck-strength assessment protocol for healthy adults using self-generated resistance with a hand-held dynamometer. Physiotherapy Canada, 67(1), 58–64.
