Normative Values of Neck Extensor Endurance Test in Adults: An Observational Study

BACKGROUND AND PURPOSE: Endurance of the deep neck extensor muscles is essential for cervical spine stability and function, yet population-specific normative reference values remain limited for middle-aged adults. This study aimed to establish age-, sex-, and activity-specific normative values for the Deep Neck Extensor Endurance Test (NEET) in asymptomatic adults. METHODS: In this observational study, 448 healthy adults (29-60 years) were assessed using the standardized NEET protocol. Endurance holding time was recorded, and participants were stratified by age decade, sex, and physical activity level using the International Physical Activity Questionnaire (IPAQ). RESULTS: The mean ± SD NEET time was 38.42 ± 24.04 s (median [IQR]: 35.82 [16.96] s). Endurance declined progressively with age. Males demonstrated slightly higher endurance than females, although the difference was small. Participants with higher physical activity levels demonstrated greater endurance compared with less active individuals (p < 0.05). While between-group differences were modest, values below the 25th percentile (≈26 s) may indicate clinically relevant reduced endurance. DISCUSSION: This study provides age-, sex-, and activity-specific normative NEET reference values for adults aged 29-60 years. These benchmarks can assist clinicians in identifying reduced cervical extensor endurance, setting rehabilitation targets, and objectively monitoring outcomes. TRAIL REGISTRATION: CTRI/2024/08/072963 (Registered on 23/08/2024) trial registered prospectively.