Incorporating asymmetrical tonic neck responses into your rehab program

You may have heard about primitive reflexes. You may also have been taught that they don’t persist into adulthood, however, we can assure you, they persist into adulthood (1) and are modulated by both eye movement and muscular activity (2). When there is neurological compromise (think about physiological lesions, or shorts in the nervous system, not just anatomical lesions), the reflex can be more prevalent. They appear to arise from the joint mechanoreceptors in the neck and take advantage of the connection to the reticular formation of the brainstem (3), and may also be related to the cervicoocular reflex. It may modulate blood flow and cardiovascular activity too (4). 


The asymmetrical tonic neck reflex was 1st described by Magnus and de Kleyn in 1912 (5). Like in the picture above, when the head is rotated to one side, there is ipsilateral extension of the upper and lower extremity on that side, and flexion of the contralateral (the side AWAY from where you are rotating) upper and lower extremity. Take a few minutes to see the subtleness of the reflex in the pictures above. Now think about how this occurs in your clients/patients.  Don’t believe us, take an egg needle and put it into on of the upper or lower extremity extensors and rotate the head to the same side and watch the increased activity in that extremity.


So, how can we take advantage of this? We could follow in the footsteps of Berta Bobath (6) and incorporate these into our rehabilitation programs, which we have done, quite successfully. But rather than read a whole book, lets talk about how you could incorporate this into your stretching and exercise program. 

Let’s say you want to stretch the right hamstring:

  • actively rotating the head to the right (see reference 3) facilitates the right tricep and right quadricep AND facilitates the left bicep and left hamstring. You could easily incorporate this into your gait and exercise programs, using the same principal

  • through reciprocal inhibition, this would inhibit the right bicep and hamstring AND left tricep and left quadricep

  • To get a little more out of the stretch, you could actively contract the right tricep and quadricep (MORE reciprocal inhibition), amplifying the effect

We encourage you to try this, both on yourself and your clients. It really works!

Dr Ivo Waerlop, one of The Gait Guys

#gait #gaitanalysis #TNR #tonicneckresponse #tonicneckreflex #rehabilitationexercise #rehabexercises

  1. Le Pellec A1, Maton B. Influence of tonic neck reflexes on the upper limb stretch reflex in man. J Electromyogr Kinesiol. 1996 Jun;6(2):73-82.

  2. Michael D. Ellis, Justin Drogos, Carolina Carmona, Thierry Keller, Julius P. A. Dewal Neck rotation modulates flexion synergy torques, indicating an ipsilateral reticulospinal source for impairment in stroke Journal of NeurophysiologyDec 2012,108(11)3096-3104;DOI: 10.1152/jn.01030.2011


  4. Hervé Normand, Olivier Etard and Pierre Denise Otolithic and tonic neck receptors control of limb blood flow in humans J Appl Physiol  82:1734-1738, 1997. Bruijn SM1, Massaad FMaclellan MJVan Gestel LIvanenko YPDuysens J.

  5. Are effects of the symmetric and asymmetric tonic neck reflexes still visible in healthy adults?Neurosci Lett.2013 Nov 27;556:89-92. doi: 10.1016/j.neulet.2013.10.028. Epub 2013 Oct

  6. Berta BobathChartered Society of Physiotherapy (Great Britain)  Abnormal postural reflex activity caused by brain lesions Aspen Systems Corp. Rockville, MD, 1985 -