Neck flexor endurance is important for head and neck control during sport, work, posture, driving, cycling, contact preparation and general upper-body movement. The Neck Flexion Endurance Test provides a simple field-based way to assess how long or how many repetitions a client can maintain a controlled neck flexion task.
The test can be performed as a timed hold or repetition-based assessment. The most common clinical version is a supine chin-tuck and head-lift hold.
The result should not be used alone to diagnose neck pain, identify the exact muscle source of symptoms, determine concussion risk or make return-to-sport decisions. It should be interpreted with symptoms, cervical ROM, neck extension endurance, lateral flexion endurance, isometric strength, posture, training history and functional demands.
Test name: Neck Flexion Endurance Test
Common versions: Supine chin-tuck hold, head-lift hold, repetition-based neck flexion test
Category: Cervical flexor strength endurance
Primary score: Hold time in seconds or valid repetitions completed
Best use: Baseline testing, retesting, symptom monitoring and tracking cervical flexor endurance
Key limitation: The result is protocol-specific and should not be described as isolated deep neck flexor endurance without caution
The Neck Flexion Endurance Test assesses the client’s ability to hold or repeatedly perform controlled cervical flexion.
Common approaches include:
Supine chin-tuck and head-lift hold
Supine neck flexion repetitions
Head-lift hold with consistent chin position
Cervical flexion endurance against light resistance
Other standardised flexion endurance setups
The exact setup must be recorded because head-lift height, chin-tuck quality, shoulder position, breathing, tempo and stopping criteria all change what the test measures.
The Neck Flexion Endurance Test may be used to assess cervical flexor endurance, neck fatigue tolerance, baseline and retest change, response to neck endurance training, symptom response during neck flexion loading, postural endurance context and cervical control during sport, gym or work tasks.
It may also provide useful context when combined with cervical ROM, neck extension endurance, lateral flexion endurance, isometric neck strength and symptom monitoring.
The primary score is valid hold time in seconds or valid repetitions completed, depending on the chosen protocol.
The result may reflect cervical flexor endurance, deep and superficial neck flexor contribution, chin-tuck control, head-lift tolerance, fatigue tolerance, breathing and bracing strategy, pain or symptoms, familiarisation and motivation.
It should not be described as isolated deep neck flexor endurance unless the exact protocol and evidence support that wording.
The test may be useful for clients with neck pain or fatigue, contact sport athletes, combat sport athletes, cyclists, desk-based workers, gym and strength-training clients, clients undergoing neck endurance monitoring, professionals tracking changes over time, and professionals comparing flexion and extension endurance profiles.
It may not be suitable if the client has acute trauma, high irritability, dizziness, neurological symptoms, severe pain, recent surgery, poor tolerance to supine head lift or inability to follow the test position safely.
Mat or flat surface
Stopwatch or Measurz stopwatch
Measurz rep counter for repetition-based testing
Measurz metronome for cadence-controlled protocols
Optional folded towel or low support if standardised
Optional Measurz AR measurement or inclinometer for head-lift or angle consistency
Optional MAT tools such as Anker or Muscle Meter for related isometric neck flexion strength testing
Measurz platform for 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.
The client lies supine with the head resting on the surface.
The client gently performs a chin tuck.
The client lifts the head slightly from the surface while maintaining the chin-tuck position.
Start timing once the correct position is achieved.
The client maintains the position without losing chin tuck, holding breath excessively, shaking beyond tolerance or lifting the head too high.
Stop when chin position is lost, head drops, symptoms become unacceptable, compensation occurs or the client chooses to stop.
Record hold time and reason for stopping.
The client lies supine in the selected start position.
The client performs controlled chin-tuck and head-lift repetitions.
Use a consistent tempo if comparing over time.
Count valid repetitions until form failure, cadence failure, symptom increase, compensation or voluntary stop.
Record repetitions, tempo and reason for stopping.
The client sits or lies in the selected position.
A pad, hand or fixed resistance is placed against the forehead.
The client maintains gentle flexion pressure or performs controlled repetitions.
Stop when position, effort, symptoms or form criteria are no longer maintained.
Record time or repetitions, resistance method and reason for stopping.
Record the version, hold time or repetitions completed, body position, head-lift height or target position, chin-tuck quality, tempo or cadence, pain or symptoms, breathing strategy, compensations, reason for stopping and retest date.
A higher score generally suggests greater neck flexion endurance under the chosen protocol, but interpretation should consider setup, symptom response, fatigue, motivation and test familiarity.
The most useful comparison is usually the client’s own baseline using the same protocol.
The deep neck flexor endurance test has published normative and reliability research, but values vary across protocol, age, sex, sample and testing method. For this reason, broad universal values should be used cautiously.
As practical field-use bands only, and only when the same protocol is used:
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 versions:
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 values are practical benchmarks, not universal norms. For stronger evidence-backed benchmarking, use exact-protocol studies, internal Measurz group data, symptom response, baseline comparison and retesting.
The deep neck flexor endurance test has been studied for reliability and normative values in healthy adults. Published research supports its use as a practical clinical endurance test, but results are influenced by protocol details and population.
Reliability depends on consistent chin-tuck position, head-lift height, stopping criteria, verbal instructions, breathing, examiner observation and retesting conditions.
Validity should be interpreted cautiously. The test may provide useful cervical flexor endurance information, but it should not be used alone to diagnose neck pain, determine injury risk or isolate deep neck flexor performance.
Common errors include lifting the head too high, losing chin tuck, holding the breath, allowing jaw tension to dominate, counting poor-quality repetitions, using inconsistent tempo, failing to record symptoms, continuing after form failure, comparing different protocols and using one score to infer injury risk or readiness.
Limitations include protocol variability, symptom irritability, fatigue, familiarisation, motivation and contribution from both deep and superficial neck flexors.
The Neck Flexion Endurance Test can help professionals monitor cervical flexor endurance, track response to neck endurance training, record fatigue tolerance, document symptom response, compare with neck extension endurance, combine findings with cervical ROM and isometric neck strength, and educate clients using a simple repeatable endurance measure.
Record test name, version, score type, body position, head-lift height or target position, chin-tuck quality, tempo or cadence, pain score, symptoms, breathing or compensation notes, 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 or position if needed. MAT tools such as Anker or Muscle Meter can provide related isometric neck flexion strength measures when appropriate.
It measures cervical flexor endurance and the ability to maintain controlled neck flexion under the chosen protocol.
No. It may involve deep neck flexors, superficial flexors, breathing strategy, effort and task control.
Published values vary by protocol and population. For practical use, compare the client with their own baseline and use the same setup for retesting.
Yes. Record pain, tightness, dizziness, headache, fatigue, compensation and reason for stopping.
It can provide useful endurance information, but it should be interpreted with symptoms, ROM, strength, posture and functional findings.
The Neck Flexion Endurance Test is best described as a cervical flexor endurance assessment.
Published evidence supports clinical use, but protocol consistency is essential.
The test should not be described as isolated deep neck flexor performance without caution.
Setup details such as chin-tuck position, head-lift height and stopping criteria are essential.
Measurz can track reps, time, symptoms, compensations, setup and retest progress.
Domenech, M. A., Sizer, P. S., Dedrick, G. S., McGalliard, M. K., & Brismée, J. M. (2011). The deep neck flexor endurance test: Normative data scores in healthy adults. PM&R, 3(2), 105–110. https://doi.org/10.1016/j.pmrj.2010.10.023
Harris, K. D., Heer, D. M., Roy, T. C., Santos, D. M., Whitman, J. M., & Wainner, R. S. (2005). Reliability of a measurement of neck flexor muscle endurance. Physical Therapy, 85(12), 1349–1355.
Olson, L. E., Millar, A. L., Dunker, J., Hicks, J., & Glanz, D. (2006). Reliability of a clinical test for deep cervical flexor endurance. Journal of Manipulative and Physiological Therapeutics, 29(2), 134–138.
