Safe Posture Training After TBI: Neck Stretches, Seated Marching, and Balance Drills

 

Posture exercises after a traumatic brain injury (TBI) need to be gentle, slow, and carefully supervised. The goal is to help your neck, spine, and balance systems work together again—not to “push through” symptoms.

This article explains:

• Why posture problems are common after TBI

• How to start neck, core, and balance exercises safely

• How integrative chiropractic care and nurse practitioners work together to support recovery

Throughout, remember:

Always get clearance from a healthcare professional before starting or changing any exercise program. Stop if you feel sharp pain, severe dizziness, or new neurological symptoms (like weakness or vision changes). CDC+1

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Why TBI Affects Posture, Neck, and Balance

After a concussion or TBI, many people notice that:

• Their neck feels tight or painful

• Their head juts forward (forward head posture)

• Their balance feels “off” when standing, walking, or turning quickly

The U.S. military’s Traumatic Brain Injury Center of Excellence notes that neck pain often appears along with headaches after a concussion, and managing neck tension is part of recovery. Military Health System+1

Research on forward head posture (FHP) shows that when the head moves forward, the neck muscles and joints bear much greater loads, leading to pain, stiffness, headaches, and balance changes. Wikipedia+3Healthline+3Medical News Today+3

Dr. Alexander Jimenez, DC, APRN, FNP-BC, has observed in his El Paso clinics that many TBI patients develop:

• Guarded, stiff neck movement

• Forward head posture and rounded shoulders

• Subtle balance shifts, especially on soft surfaces or in busy visual environments El Paso Sciatica Clinic+3El Paso, TX Doctor Of Chiropractic+3El Paso Injury Doctors+3

His clinical approach combines gentle spinal care, posture retraining, vestibular and balance drills, and lifestyle changes to slowly normalize alignment and reduce neck-driven dizziness and headaches. El Paso, TX Doctor Of Chiropractic+3El Paso, TX Doctor Of Chiropractic+3ChiroMed+3

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Safety First: Rules Before Any Posture Exercise

Before starting neck or posture work after TBI:

• Get medical clearance

  • From a physician, nurse practitioner, or other licensed provider familiar with your injury. Ivy Rehab+3Mayo Clinic+3Biaia+3

• Start low, go slow

  • Begin with small ranges of motion and short sessions (5–10 minutes).

• Use a “symptom stop rule”

  • Stop immediately if you feel:

    • Sharp or increasing pain

    • Spinning dizziness or strong nausea

    • Sudden vision changes

    • New weakness, numbness, or trouble speaking

• Avoid high-speed or jerky neck moves

• Exercise in a safe environment

  • Use a stable chair and a sturdy surface, and have a caregiver nearby if your balance is poor.

• Don’t exercise alone if you have a history of severe TBI, fainting, or strong dizziness. Ivy Rehab+2CDC+2

Sheltering Arms, Flint Rehab, and Ivy Rehab all stress that concussion/TBI exercises should be gradually progressed and ideally supervised by trained professionals. Ivy Rehab+3Flint Rehab+3Flint Rehab+3

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Gentle Neck Stretches After TBI

Neck stretches should relax tight muscles and reduce forward head posture, not strain your joints. Many rehab and posture guides support using simple chin tucks and slow side bends when done correctly. Ivy Rehab+3Healthline+3Spine-health+3

General neck stretching tips

• Sit upright with your feet flat and back supported.

• Keep movements slow and controlled.

• Work within a mild stretch, not pain.

• Breathe normally—do not hold your breath.

1. Chin tuck (small range)

This exercise gently strengthens deep neck flexor muscles and helps bring the head back over the shoulders.

• Sit or stand tall.

• Look straight ahead.

• Gently slide your chin straight back, as if making a “double chin,” without looking up or down.

• Hold for 3–5 seconds, then relax.

• Repeat 5–10 times, 1–2 times per day, as tolerated. Spine-health+2Scribd+2

Stop if you feel sharp pain, strong dizziness, or radiating symptoms down the arms.

2. Lateral neck stretch (side bend)

• Sit tall.

• Gently tilt your right ear toward your right shoulder (do not shrug the shoulder up).

• Hold for 10–20 seconds, then return to neutral.

• Repeat on the left.

• Do 2–3 times on each side.

You can place the same-side hand lightly on top of the head to support, not force, the stretch.

3. Gentle neck rotation

• Sit upright.

• Slowly turn your head to the right as if looking over your shoulder.

• Go only to a comfortable range.

• Hold for 5 seconds, and return to the center.

• Repeat to the left.

• Do 5 times in each direction.

4. Shoulder rolls and scapular squeezes

Because forward head posture often comes with rounded shoulders, shoulder and upper-back drills help support better alignment. Healthline+2El Paso, TX Doctor Of Chiropractic+2

• Roll your shoulders up, back, and down 10 times.

• Then gently squeeze shoulder blades together and hold 5–10 seconds; repeat 10 times.

These movements can reduce tension through the upper trapezius and support a more upright posture.

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Core and Trunk Exercises to Support Posture

Early after TBI, many patients are safer in seated positions. Seated core and trunk exercises help build a stable base for the neck and head. Rehab programs commonly use seated marching, trunk flexion/extension, and lateral reaching to retrain posture in a safe way. El Paso, TX Doctor Of Chiropractic+5Zao Rehab+5Flint Rehab+5

General rules for trunk exercises

• Use a stable chair with a back if you need support.

• Keep feet flat and hip-width apart.

• Maintain an upright posture as best you can.

• Use a caregiver or therapist nearby if your balance is limited.

1. Seated marching

• Sit tall with your hands resting on your thighs or the sides of your chair.

• Slowly lift one knee a few inches toward your chest, then set it down.

• Alternate legs in a gentle marching pattern.

• Start with 10–20 marches, rest if symptoms rise. Zao Rehab+2Flint Rehab+2

This helps activate the hip flexors, core, and lower trunk while you stay safely seated.

2. Seated lateral trunk flexion (side reaching)

• Sit tall.

• Slide your right hand down toward the side of the chair or knee, allowing your trunk to bend slightly to the right.

• Use your side muscles to return to an upright position.

• Repeat to the left.

• Start with 5–10 repetitions on each side. Flint Rehab+2El Paso Back Clinic+2

3. Seated trunk extension (“sit tall” drill)

• Sit near the front of the chair with your hands clasped in front of you.

• Gently lean your trunk forward, then use your back muscles to bring your chest tall again.

• Keep movements small and controlled.

• Repeat 5–10 times. Flint Rehab+2El Paso Back Clinic+2

4. Seated weight shifts for balance

• Sit tall with feet flat.

• Gently shift your weight to the right hip, then return to the center.

• Then shift to the left and return to the center.

• Do 10–20 shifts, as tolerated. Flint Rehab+2Flint Rehab+2

These weight shifts retrain your body’s sense of midline and balance, which is often changed after TBI.

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Standing Balance and Posture Exercises (When Ready)

Once your provider says it is safe, you may be cleared for supported standing work. Balance and posture exercises often focus on small weight shifts, stance progressions, and safe walking drills. El Paso, TX Doctor Of Chiropractic+6Flint Rehab+6Flint Rehab+6

Always use:

• A stable surface (countertop, heavy chair, or rail)

• A caregiver or therapist is nearby if you are unsteady

Beginner standing posture routine

• Stand with feet hip-width apart, lightly holding a counter.

• Gently tuck your chin and lengthen the back of your neck.

• Imagine a string lifting the top of your head toward the ceiling.

• Softly activate your core by drawing your belly button slightly inward. Bone Health & Osteoporosis Foundation+2Mayo Clinic Health System+2

Weight shifts while standing

• From your tall standing posture, gently shift weight toward your right foot without lifting your left.

• Hold 3–5 seconds, then move back to the center and over to the left.

• Repeat 10–20 times as tolerated. El Paso Back Clinic+3Flint Rehab+3Flint Rehab+3

As you progress, your rehab team might introduce:

• Narrow stance or tandem stance (one foot partly in front of the other)

• Soft surfaces (like a foam pad) under supervision

• Turning the head slowly while keeping balance steady El Paso, TX Doctor Of Chiropractic+3ScienceDirect+3Flint Rehab+3

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How Integrative Chiropractic Care Helps Posture After TBI

Integrative chiropractic care looks beyond just a single spinal adjustment. It often combines:

• Gentle spinal and cervical adjustments

• Soft tissue work for tight muscles

• Posture and breathing drills

• Vestibular and balance exercises

• Lifestyle and ergonomic coaching Aurora Health Care+3Calibration Brain & Body+3Calibration Brain & Body+3

Clinics that focus on TBI recovery report that chiropractic care can help:

• Reduce neck pain and cervicogenic headaches

• Improve cervical alignment and forward head posture

• Decrease dizziness linked to neck dysfunction

• Support better nervous system communication and balance Pinnacle Health Chiropractic+3Aurora Chiropractic+3Pinnacle Health Chiropractic+3

Dr. Alexander Jimenez’s clinical articles describe a dual-scope approach as both chiropractor and nurse practitioner. In TBI and posture cases, he often: El Paso Chiropractor Blog+5El Paso, TX Doctor Of Chiropractic+5ChiroMed+5

• Screens for red-flag neurological signs and orders imaging when needed

• Uses gentle cervical and upper thoracic adjustments to reduce neck-driven symptoms

• Pairs spine care with vestibular and sensory-motor retraining, such as gaze stabilization and balance drills

• Teaches posture and breathing strategies for sitting, standing, and driving

• Coordinates with physical therapists, occupational therapists, and other specialists

These strategies line up with broader evidence on brain rehabilitation, which shows that combining multiple therapies—movement, balance, and education—supports better functional recovery after brain injury. Ivy Rehab+3Mayo Clinic+3Biaia+3

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The Nurse Practitioner’s Role in TBI Posture Rehabilitation

Nurse practitioners (NPs) play a central role in the TBI care pathway. Articles on neurotrauma note that NPs often act as the “consistent thread” in trauma teams, coordinating communication, education, and follow-up care. NursingCenter+2SciSpace+2

In TBI and posture-focused care, a nurse practitioner can:

• Perform comprehensive assessments

  • Review injury history, symptoms, and risk factors

  • Screen for mood changes, sleep problems, and cognitive issues

• Coordinate referrals

  • To chiropractic care, physical therapy, occupational therapy, speech therapy, and neuropsychology

• Optimize medication and symptom management

  • For headaches, sleep, mood, spasticity, or pain

• Provide patient and family education

  • Activity pacing, safe exercise, and warning signs that need urgent care

• Monitor recovery over time

  • Adjusting the plan as symptoms improve or new challenges appear ScienceON+4Mayo Clinic+4Biaia+4

When an NP is also trained in integrative or functional medicine—or, like Dr. Jimenez, holds dual credentials in chiropractic and family practice—they can blend:

• Medical screening and imaging

• Manual therapy and posture-based rehab

• Nutrition, sleep, and stress management strategies

This whole-person view is important because posture, balance, mood, sleep, and pain all interact after TBI.

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Putting It Together: A Sample Beginner Posture Routine (With Approval)

The following is a general example of what an early-phase routine might look like after you have been cleared by your provider. It is not a personalized prescription.

Warm-up (3–5 minutes)

• Easy diaphragmatic breathing in sitting

• Gentle shoulder rolls and scapula squeezes

Neck and posture (5–10 minutes)

• Chin tucks: 5–10 gentle reps

• Lateral neck stretches: 2–3 holds each side (10–20 seconds)

• Gentle neck rotations: 5 reps each way

Seated trunk and balance (5–10 minutes)

• Seated marching: 10–20 marches

• Seated lateral trunk flexion: 5–10 reps each side

• Seated weight shifts: 10–20 shifts side-to-side

Optional standing work (if approved)

• Tall standing posture practice at countertop: 30–60 seconds

• Standing weight shifts: 10–20 shifts each way

Keep total time short at first (10–20 minutes), and stop earlier if your symptoms increase. Many TBI programs recommend a “sub-symptom threshold” approach—working below the level that noticeably flares symptoms. Cognitive FX+2Ivy Rehab+2

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When to Stop Immediately and Seek Medical Care

Contact emergency services or your doctor right away if, during or after exercise, you notice:

• Sudden severe headache or “worst headache of life”

• New weakness, numbness, or clumsiness

• Slurred speech, confusion, or loss of consciousness

• New seizure activity

• Sudden vision loss or double vision

• Chest pain, shortness of breath, or heart palpitations

These can signal serious complications that need urgent attention.

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Lifestyle Posture Tips After TBI

Posture recovery is not only about exercise time. It also includes how you sit, stand, and move all day.

Health and rehabilitation sources highlight that good posture and varied movement patterns reduce pain and prevent joint and muscle overload. Harvard Health+4Bone Health & Osteoporosis Foundation+4Mayo Clinic Health System+4

Simple daily posture habits

• Screen setup

  • Raise screens so your eyes are level with the top third of the screen.

  • Keep the monitor about an arm’s length away.

• Sitting breaks

  • Stand or walk for a few minutes every 30–60 minutes.

• Head position

  • Think “ears over shoulders,” not chin-forward, when standing or sitting.

• Support the neck when reading or using a phone

  • Bring the device up to eye level instead of dropping your head.

• Sleep posture

  • Use a pillow that keeps your neck in a neutral position, neither flexed nor extended.

Dr. Jimenez’s posture and TBI content also highlight the value of breathing mechanics, rib cage alignment, and rib–pelvis positioning to support spinal health, balance, and energy. El Paso, TX Doctor Of Chiropractic+5El Paso, TX Doctor Of Chiropractic+5El Paso, TX Doctor Of Chiropractic+5

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Final Thoughts

Posture exercises after TBI are powerful but must be handled with care:

• Gentle neck stretches (like chin tucks and lateral bends) help reduce muscle tension and forward head posture.

• Seated core and trunk exercises (seated marching, trunk flexion/extension, and weight shifts) build a stable base for your neck and head.

• Progressive standing balance work supports safer walking and daily activities.

• Integrative chiropractic care can improve alignment, reduce neck-driven dizziness and headaches, and support nervous system function.

• Nurse practitioners help coordinate the big picture—screening, education, medications, referrals, and long-term follow-up.

Working with a team that understands both brain injury and spine mechanics—like an integrative chiropractor-nurse practitioner model—can make your posture plan safer, more personalized, and more effective over time. SciSpace+5Calibration Brain & Body+5Pinnacle Health Chiropractic+5

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References

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https://health.mil/Reference-Center/Fact-Sheets/2020/07/30/Neck-Pain-Following-ConcussionmTBI-Fact-Sheet

Flint Rehab. (2022). Traumatic brain injury recovery exercises: 20 best TBI exercises.
https://www.flintrehab.com/exercises-for-brain-injury-recovery/

Flint Rehab. (2023). Balance exercises for brain injury patients of all levels.
https://www.flintrehab.com/balance-exercise-after-brain-injury/

Flint Rehab. (2024). Core exercises for stroke patients to help improve balance.
https://www.flintrehab.com/core-exercises-for-stroke-patients/

Ivy Rehab. (2025). 8 concussion rehab exercises.
https://ivyrehab.com/health-resources/athletes/concussion-rehab-exercises/

Sheltering Arms Institute. (n.d.). Concussion treatment exercises you can do at home.
https://shelteringarmsinstitute.com/rehablogs/concussion-treatment-exercises-you-can-do-at-home/

Mayo Clinic. (2018). Brain rehabilitation.
https://www.mayoclinic.org/tests-procedures/brain-rehabilitation/about/pac-20393150

Mayo Clinic. (2018). Understanding brain injury: A guide for the family.
https://biaia.org/wp-content/uploads/2018/01/Mayo-Clinics-Understanding-Brain-Injury-A-Guide-for-the-Family.pdf

Centers for Disease Control and Prevention. (2024). Recovering from a mild traumatic brain injury or concussion.
https://www.cdc.gov/traumatic-brain-injury/media/pdfs/2024/05/patient_discharge_instructions_ENG-508.pdf

Healthline. (2020). Forward head posture: Exercises and stretches to try.
https://www.healthline.com/health/bone-health/forward-head-posture

BackIntelligence. (n.d.). Latest BackIntelligence FWD head exercises.
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Pinnacle Health Chiropractic. (2025). Six ways chiropractic care supports healing after TBI.
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