The Glory 9: Nine Moves to a Stronger, Pain‑Free Neck

Non‑specific neck pain (NSNP) is extremely common – roughly 70 % of people experience it at least once.  It can drag down quality of life and drive up health‑care costs.  Most physiotherapy treatments are conservative and focus on passive techniques, yet the evidence suggests active loading and self‑management are crucial.  To explore how strength work might fit into a manual therapy framework, I developed The Glory 9 programme, a cross‑fit‑inspired set of nine progressive exercises for the neck, shoulders and trunk.  Anna Mengl tested it as part of her master’s thesis, and I (René Bakodi) supervised the project.  We published the findings in MSK – Muskuloskelettale Physiotherapie.
(Mengll A, Bakodi R. Der Effekt des standardisierten ... MSK - Muskuloskelettale Physiotherapie 2025; 29: 295-307 / © 2025 Thieme)

Below I summarise the design and results, mixing personal insight with the data.

Study design at a glance

– Participants: The study enrolled five young adults (three women, two men) aged 18–30 years with non‑specific neck pain.  All were physically active and presented with mild to moderate limitations.  Before starting strength training, each participant went through a 2‑ to 3‑week stabilisation phase: we used Maitland‑style manual therapy, traction and passive accessory mobilisation to calm symptoms, combined with motor‑control drills for the deep neck flexors and scapular stabilisers.

– Intervention: The Glory 9 intervention lasted 8 weeks.  Participants trained three times per week; one session was supervised, the other two were performed independently and recorded in training logs.  Each session included 2–4 exercises drawn from nine movements.  We prescribed 3 sets of 15 repetitions at a 1‑0‑1 tempo with 30–45 s rest.  Loads were initially set below 60 % of estimated one‑rep max, and we increased weight only when more than 20 reps were possible without fatigue, keeping perceived exertion under 7/10.

– Exercises: The nine movements were shoulder circles, bilateral and unilateral strict press, supported and unsupported bent‑over single‑arm rows, bilateral and unilateral push press, thrusters and two variations of the American kettlebell swing.  The programme also emphasised a targeted warm‑up: active mobilisation of the cervical spine in all planes, activation of the deep neck flexors and thoracic extension.

The exercise structure represented a progression in difficulty and load. Only 2-3 exercises were performed each week. If this was possible without discomfort, the level of difficulty was increased in the following week. For example, from strict press to push press and so on.

Pic. 1-9: shoulder circles, bilateral strict press, unilateral strict press, bend over row, bilateral push press, unlateral push press, thrusters, kettlebell swing wit stabilized neck, American kettlebell swing

Table 1: Progression of the 9 exercises over 8 weeks

– Outcome measures: We documented pain on a visual analogue scale (VAS) for both resting and activity‑provoked pain.  Cervical range of motion (CROM) was measured with a digital goniometer.  Endurance tests for deep neck flexors (DNF) and extensors (DCE) provided objective strength data.  The Neck Disability Index (NDI) captured functional impact.  All outcomes were recorded during the stabilisation phase and weekly throughout the intervention to track change over time.

What did the study find?

Pain reduced markedly

Every participant finished the eight weeks with less pain than at baseline.  Resting pain and activity‑provoked pain both declined, and the drops exceeded the minimal clinically important difference of 4.6–21.4 mm on the VAS.  For instance, one participant’s activity‑related pain fell from around 37 mm to 16 mm.  Even the participant with the highest baseline pain recorded meaningful relief.  Taken together, the data show that properly dosed strength work, layered onto a manual therapy foundation, can reduce pain.

Movement range improved for those with restrictions

Mobility gains were modest but clinically relevant.  Participants who started with restrictions improved by 5–26 degrees in at least one direction.  The biggest changes were seen in lateral flexion and rotation in participants 2 and 5.  Those with normal range maintained it, suggesting that progressive loading does not sacrifice mobility.  The preparatory therapy phase with Maitland‑style mobilisation likely helped too.

Neck muscle endurance increased

Endurance improvements were pronounced.  Average hold times for the deep neck flexors increased from 26–93 s at baseline to 47–140 s post‑intervention.  Neck extensor endurance rose from 51–357 s to 86–433 s.  The biggest relative gains came from participants who started weak: one participant tripled flexor endurance (from 26.7 s to 80.8 s) and doubled extensor endurance (from 74 s to 152.3 s).  Not all extensor improvements surpassed the minimal detectable change of 140 s, so some results should be interpreted cautiously.

Functional disability decreased

Daily functioning improved for everyone.  The Neck Disability Index fell by 8–24 percentage points across participants.  One participant’s NDI dropped from 38 % to 13.8 %, moving from moderate to minimal disability.  Although the starting disability scores were low to moderate, the consistent downward trend suggests that strength training complemented manual therapy to make everyday tasks feel easier.

Why should manual therapy physios care?

Active loading complements Maitland techniques

The study deliberately layered manual therapy and active loading.  During the "stabilisation" phase we used Maitland passive accessory techniques (e.g., PAIVMs Grade III–IV) and traction to ease pain, along with motor‑control drills to activate deep neck flexors.  Once symptoms stabilised,The Glory 9 programme introduced progressive strength work.  The sequence shows that hands‑on techniques prepare the tissues and nervous system, while exercises build capacity.  For physiotherapists in the Maitland concept, the takeaway is clear: manual therapy and exercise are partners, not competitors.

A simple, scalable structure promotes adherence

Each training session lasted around 30–45 minutes and required minimal kit – a few dumbbells or kettlebells and some floor space.  Participants performed two sessions on their own and one under supervision every week.  Training logs captured weight used, perceived exertion and pain.  The straightforward format and emphasis on self‑management meant high compliance: everyone completed the eight weeks despite busy schedules.  For clinicians, this illustrates how an organised programme can encourage autonomy.

Objective measurement helps guide treatment

Pain, range of motion, endurance and functional disability were measured with validated instruments.  Regular re‑testing allowed us to track progress and adjust load accordingly.  In practice, using tools like the VAS, digital goniometry and endurance tests can help you and your patients see whether interventions are working.

Limitations and critical appraisal

This pilot was intentionally small.  Five athletic young adults completed the programme; there was no control group and the baseline stabilisation phase was brief.  Results cannot be generalised to older or sedentary patients.  Mobility improvements were difficult to interpret because some participants started with normal range, and extensor endurance gains did not always exceed statistical thresholds.  The programme is cross‑fit inspired and may suit sporty people more than novices.  Future studies should include larger, more diverse samples, compare against other exercise modalities and lengthen the baseline observation period.

Applying the insights in practice

1. Educate and restore control: Start with a phase of manual therapy and motor‑control training.  Teach neutral head positioning, scapular control and ergonomic adjustments.  Don’t add load to early.
2. Introduce graded strength exercises: When symptoms stabilise, move into presses, rows, thrusters and kettlebell swings.  Keep loads light (~60 % 1RM) and use three sets of 15 reps with short rest.
3. Monitor effort and technique: Limit perceived exertion to 7/10 and insist on clean technique.  Increase weight only when more than 20 reps are possible without fatigue.
4. Track objective outcomes: Use tools like the VAS, digital goniometer and endurance tests to document progress.  Regular measurement will inform whether to progress, maintain or regress load.
5. Encourage self‑management: Allow patients to perform most sessions on their own and log their efforts.  Autonomy breeds adherence and empowers patients to take responsibility for their recovery.

Take‑home message

From my perspective as the developer and the supervisor of this pilot, “The Glory 9” programme illustrates how structured strength training can dovetail with manual therapy.  In five young adults it reduced pain, restored or maintained mobility, boosted endurance and lowered disability.  The programme is uncomplicated, scalable and requires little equipment; most of the work can be done at home.  As a manual therapy physiotherapist, remember that passive techniques set the stage for active loading.  Collect objective data so you know when to progress.  Whether “Glory 9” is superior to other active approaches remains to be seen, but its blend of Maitland principles and progressive strength work makes it a practical template.  Ultimately, giving your patients the confidence and capacity to manage their neck pain themselves can be as powerful as any mobilisation technique.

Have you integrated strength exercises into your manual therapy practice? Share your experiences or questions about The Glory 9 in the comments – I’m curious to hear your perspective.

Full article:

The Effect of the Standardized Strength Training Programme

"Glory 9" on Non-Specific Neck Complaints - Clinical Pilot Study

Mengl A, Bakodi R. MSK - Muskuloskelettale Physiotherapie 2025; 29: 295-307 / © 2025 Thieme

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