Welcome to the Norse universe

The nine realms of the Norse universe offer a great potential for new experiences and stories for people with neck pain and its related disorders.

Gallery of Upcoming Games

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Mission Statement

Neck Orchestra

Neck Wobble Board

The Three Horns of Odin

Gallery of Upcoming Games

Mission Statement

Initially, the overarching goal is to treat clinical instability in the neck, defined as functional instability and/or minor mechanical segmental hypermobility of the neck*. Clinical instability is approached from different angles in the exergames, addressing clinical instability from all three biological pillars: the bony (passive subsystem), muscular (active subsystem) and different motor control perspectives (control subsystem).

Various exercises therefore target distinct aspects of clinical instability, while some other exergames create favorable conditions for its effective treatment (e.g., Fly Fishing).

Later, treatment for visual, balance and cognitive disturbances will be added into the Norse universe.

*Minor mechanical segmental hypermobility, potentially associated with clinically meaningful pathology, is not detectable by contemporary imaging modalities such as plain X-rays, CTs, and MRIs.

Neck Orchestra

New

Neck Orchestra

An exergame designed for people with impaired movement control of the head-neck muscles.

What does Neck Orchestra do?

Neck Orchestra initially activates and coordinates the deep neck muscles, and as the orchestra progresses, trains the deep and superficial muscles to work in sync, through precise timing during active movements.

The exergame unfolds across three of the nine realms of Norse mythology. Its orchestral theme helps patients to understand and to visualize what movement control training entails: Odin represents the central nervous system (CNS) and the peripheral nervous system (PNS), and conducts the ‘symphony of neck muscles’. Each of the 46 neck muscles—23 on each side—acts as an instrument. Well-coordinated movements produce beautiful music, while poorly coordinated movements create less harmonious music.

Patients receive auditory feedback by listening to the same piece of music performed at four different levels: beautiful; good; bad; ugly. As the auditory feedback is an integration of proprioceptive, visual and vestibular cues – the “orchestration” of neck function – it helps patients to correct their movements and relearn efficient movement control.

Short-term benefits, long-term consequences

When the cervical sensorimotor system is disrupted, for example, following trauma, the central nervous system (CNS) may reorganize its muscle recruitment strategy.

Research has identified several common adaptations: impaired movement sense, resulting in deficient movement control; reduced or delayed activation of the deep stabilizing neck muscles; increased reliance on the superficial neck muscles; greater muscle co-contraction and protective guarding; less efficient movement, leading to increased energy expenditure.

Although these adaptations may initially protect the neck, their persistence can contribute to ongoing pain, fatigue, stiffness, and repeated micro injuries. Vicious circles develop.

How Neck Orchestra helps

Neck Orchestra trains the nervous systems to prioritize the quality of movement rather than simply reaching an end position.

Specifically, it trains the CNS to reduce unnecessary muscle guarding through continuous recruitment and relaxation of muscles, to improve adaptability by adjusting muscle force moment by moment, and to explore multiple movement solutions while precisely regulating joint stiffness.

CNS must continuously answer the following questions: Where is my head relative to the rest of my body? How fast is it moving? Which muscles need to be activated, and by how much, at this exact moment? The continuous need to answer these questions strengthens neck sensorimotor control by improving the integration of proprioceptive, visual, and vestibular information. Over time, this promotes more accurate movement control, more efficient muscle coordination, and greater adaptability during everyday activities and athletic performance.

Read about the Clutter Test →

NECK ORCHESTRA

GAMEPLAY: PROGRESSION THROUGH THE NORSE REALMS

Participants begin with a score-free warm-up, facing Odin, who sits on his high seat, Hlidskjalf. This introductory phase helps them become familiar with the exercise experience and learn to respond to feedback without the pressure to perform. Participants then progress through four increasingly difficult training levels set across three realms of the Norse universe.

01 / 04

NIFLHEIM

FOUNDATIONAL TRAINING

Located at one of the three roots of Yggdrasil, the World Tree, Niflheim provides foundational training. It is intended for participants with the lowest Clutter Test results. Before training begins, participants visit Valhalla to preview the achievement associated with improved performance.

Neck Wobble Board

New

Neck Wobble Board

Players respond to external perturbations created by a ball upon the head in VR. Using subtle head-neck movements, they steer the ball through obstacles implemented in varied landscapes. The goal is progressive training of the deep neck muscles to stabilize the neck with the superficial muscles coactivated or not.

Neck Orchestra →

WHAT IS TRAINED?

The Board targets the neck muscles to detect small external perturbations and coordinate precise responses, much like balance-board training after an ankle sprain. In the VR Neck Wobble Board, patients use subtle head - neck movements to steer a ball through a variety of tasks and obstacles in different landscape scenarios.

Clinical rationale

Research indicates that unstable tasks produce greater activity in the deep neck muscles than stable tasks, regardless of task difficulty¹. In contrast, activity in the superficial torque-producing muscles increases progressively as the task becomes more challenging¹.

These findings are consistent with research on lumbopelvic core stability, which emphasizes coordinated activation of the transversus abdominis, the deep fibers of the multifidus, the diaphragm, and the pelvic floor muscles^{2, 9}. This suggests that the central nervous system uses different strategies to control the deep and superficial muscle layers in people with chronic axial pain syndromes^{1, 3}. Emerging evidence also highlights the importance of training the deep neck muscles and the lumbopelvic core muscles concurrently⁵.

This combined approach addresses: coordinated neuromotor coupling^{2, 4, 5}; neuromotor disruption in patients in pain^{6, 7, 8}; the “light switch” phenomenon and the importance of motor control exercises after the initial pain episode has resolved^{9, 10, 11}. This helps prevent dysfunctions across the cervical, lumbar, and pelvic regions and reduce the recurrence of pain and disability. According to the Neck Pain Task Force, recurrence of pain is one of the most common characteristics of neck pain¹².

Clinical messages

Progression should be slow and carefully monitored, particularly for people with suspected ligamentous and/or upper cervical instability. Short sessions are built into the gameplay, but their duration can be adjusted from the main menu.

Because this exercise regimen is unfamiliar, all patients begin at the Light – Warm-Up Stage described below. Transient adverse effects, such as fatigue, discomfort, and post-exercise soreness, may occur and may be acceptable if they remain mild and short-lived. Multiple difficulty stages are built into the gameplay to support gradual progression.

During the initial stages, the aim is to activate the deep neck muscles while minimizing recruitment of the superficial torque-producing muscles, which are often overactive. In short: Avoid rigid responses. Surface EMG-biofeedback can help monitor superficial muscle activity. Later, once superficial muscle hyperactivity and persistent shortening and/or contracture of the muscles and fascias have been addressed with ‘hands-on’ treatments, the superficial muscles are progressively recruited to coactivate with the deep neck muscles through increasingly challenging gameplay stages.

The neck-wobble-board training is performed in sitting and/or in standing positions and coactivation of the core muscles of the lumbar-pelvic region is recommended – with normal diaphragm breathing.

Scenarios, tasks, obstacles and feedback vary across different difficulty levels.

Familiarization with the gameplay and warm-up before the more difficult stages. Clutter Test results inform how long the player stays at this stage. The setting is Víti crater in Askja, Iceland, whose name translates to “Hell”; it was formed during a large explosive eruption sequence of the Askja volcano in early 1875. The player keeps the virtual ball still on the virtual platform at the crater’s center, for progressively longer holds within session and across sessions.

Concept illustration: a player in a VR headset looks at a floating island platform with obstacles, a ring and a light beam above a dark sea — Concept illustration of the player’s VR view at the Moderate–Difficult stage.

RESEARCH REFERENCES

References

Sources cited in the clinical rationale above. They concern core stability in neck pain, in low back - pelvic pain and core stability in general.

Röijezon U, Jull G, Djupsjöbacka M, Salomoni SE, Hodges PW. Deep and superficial cervical muscles respond differently to unstable motor skill tasks. Hum Mov Sci. 2021;80:102893. doi:10.1016/j.humov.2021.102893
Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42.
Baydogan Tan BG, Tan S, Karatas L, Karaoglan B. Altered transversus abdominis and internal oblique muscle activation during cervical motor control tasks in individuals with chronic neck pain: A surface EMG-based analysis. J Back Musculoskelet Rehabil. 2026 Jul;39(4):1428-1437. Epub 2026 Feb 18. PMID: 41707670; PMCID: PMC13291376.
Hodges PW, Gandevia SC. Activation of the human diaphragm during a repetitive postural task. J Physiol. 2000;522(1):165-175.
Milosevic M, Masani K, Erickson-Davis C. Transcutaneous spinal cord stimulation of the cervical cord modulates lumbar networks. J Neurophysiol. 2019;122(6):2483-2491.
Hodges PW, Moseley GL. Pain and motor control: From the laboratory to rehabilitation. J Electromyogr Kinesiol. 2003;13(4):361-370.
Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008;131(8):2161-2171.
van Dieën JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol. 2003;13(4):333-35.
Hides JA, Jull GA, Richardson CA. Long-term effects of medical exercise therapy in acute low back pain patients: A 3-year follow-up. Spine. 2001;26(11):E243-E248.
Macedo LG, Maher CG, Latimer J, McAuley JH. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys Ther. 2009;89(1):9-25.
Tsao H, Galea MP, Hodges PW. Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain. 2010;14(8):832-838.
Guzman J, Hurwitz E, Carroll L, Haldeman S, Côté P, et al. Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders. Spine. 2008;33(4S):S1-S220.

Founder’s research

Founder’s own references in this field.

Kristjansson E, Gislason M. Women with late whiplash syndrome have greatly reduced load bearing of the cervical spine. In vivo biomechanical, cross-sectional, lateral radiographic study. Eur J Phys Rehabil Med. 2018; 54 (1): 22–33.
Kristjansson E. Reliability of ultrasonography for the cervical multifidus muscle in asymptomatic and symptomatic subjects. Manual Therapy. 2004; 9: 83–88.
Jull G, Kristjansson E, Dall'Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain. Manual Therapy. 2004; 9: 89–94.
Kristjansson E, Leivseth G, Frobin W, Brinckmann P. Increased sagittal plane segmental motion of the lower cervical spine in women with chronic WAD, grades I-II. A case-control study using a new measurement protocol. Spine. 2003; 28: 2215–2221.
Kristjansson E, Jonsson Jr. H. Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment. Journal of Manipulative and Physiological Therapeutics. 2002; 25: 550–555.
Kristjansson E. The Vertebral Column: An Equilibrium Organ in Imbalance. The Journal of the Icelandic Physiotherapy Association. 1995; 22: 9–12.

The three horns

New

The Three Horns of Odin

You become a winner with discipline

The Horns encourage patients to train efficiently toward the goals set for each recovery milestone. Because people with head and neck injuries may tolerate only limited exercise, the program emphasizes short, frequent gameplay sessions throughout the day.

Patients are encouraged to train in Odin two or three times daily, with the duration and frequency of all sessions contributing to their daily total. Each time the patient exercises in Odin, the three Horns fill with fluid one at a time. When all three Horns are filled within the same day, the patient has reached the daily VR training dosage and receives a reward from Odin. The clinician or patient can select either the Standard or Optional fill-up setting in the Odin VR menu.

The clinician can remotely adjust the relationship between training dosage—the duration and frequency of exercise—and how quickly the Horns fill, in consultation with the patient for each exergame period.

For example, the first period may last two weeks and provide access to one, two, or a maximum of three exergames. Horn fill sensitivity can be set on a scale from 0 to 5. A setting of 0 allows the Horns to fill relatively quickly based on the time spent training and may be suitable during the initial phase, such as the first two weeks. The clinician can then adjust the sensitivity according to how the patient responds to the prescribed training duration.

The Optional Option in Odin is based on principles of motor control and learning. When other factors remain constant, more practice generally leads to greater skill improvement.

However, the task difficulty must be matched to each patient’s ability so that the exercise is challenging without being too difficult or too easy. This principle is described in the challenge point framework¹. The optimal challenge point is the level of task difficulty that best supports learning for a person with a particular skill level¹. As the patient’s ability changes, the task difficulty can be adjusted to maintain the optimal challenge point¹. Clutter identifies each patient’s level of impairment, allowing exergames to begin at an appropriate difficulty level and progress gradually as motor control improves. These deficits may be trained in Neck Orchestra, Neck Wobble Board, and upcoming exergames.

Reference

Guadagnoli M, Lee T. Challenge point: a framework for conceptualizing the effects of various practice conditions in motor learning. J Mot Behav 2004; 36:212–24.

Some upcoming games

New

Gallery of Upcoming Games

The gallery advances automatically. Click a slide, or press pause, to keep it still for longer reading.

Upcoming

Status: Upcoming

ODIN’S HEADING GAME

Advanced Level of Neck Orchestra

Animated scene: a virtual soccer-heading task at Ullevål Stadion in Oslo, with Odin, Thor and Loki.

“Odin’s spear, Gungnir, never misses its mark.”

ODIN’S HEADING GAME is the fourth and most advanced level of Neck Orchestra, with its own progressive difficulty levels. It is intended for professional and amateur soccer players, and for highly motivated people with neck injuries who have completed the final stage of rehabilitation.

Participants perform virtual soccer-heading tasks with Odin, Thor and Loki, developing smooth and accurate head–neck movements without the physical impact of a ball. Odin’s Heading Game is a stand-alone exergame.

Upcoming

Status: Upcoming

Mimir’s Well

Head/Neck Relocation Accuracy

Animated scene: Mimir’s head upon Mimir’s Well, with Odin’s bright left eye positioned above Mimir’s head on a dark background.

“Largely avoids stimulation of the hair cells in the inner ear and reliance on memory.”

In Norse mythology, Mimir’s Well (Mímisbrunnr) lies beneath one of the three roots of the world tree, Yggdrasil. This root extends into Jotunheim, the realm of the giants. Known as the Well of Wisdom, it is said to contain immense knowledge and insight. The well is guarded by the wise Mimir, and Odin famously sacrificed his left eye in exchange for a single drink from its waters. In exchange, Odin gained profound wisdom.

Inspired by this story, Head/Neck Relocation Accuracy and Precision Training takes place at Mimir’s Well. The training is guided by the results of the Revised Joint Position Sense Error (JPSE) Test, performed in Clutter. Unlike the conventional JPSE test, the revised version has a stronger construct validity because it minimizes input from the hair cells in the vestibule of the inner ear and reduces reliance on memory. This provides a more specific assessment of neck position sense—one of several components of cervical sensorimotor function.

Upcoming

Status: Upcoming

Fly Fishing

Increasing Neck Range of Motion

Animated scene: Tyr is the angler at Norway’s famous Gaula River—a dream destination for fly fishers.

“Maintains achieved ranges while gradually pushing the limits to increase neck mobility.”

The 153-kilometre-long Gaula River is recreated in virtual reality through a series of animated regions of increasing difficulty. Each region features short-, medium-, and long-distance casting, along with progressively stronger waterfalls that add greater physical and visual challenges.

An artificial fly, generated by the software, lands in the river while salmon swims upstream and attempts to strike the fly. The patient controls the salmon’s head/mouth through his/her head-neck movements detected by the VR sensors, encouraging greater ranges of movements throughout the exergame. Various, positive and negative, feedback is given during the game.

To advance to more challenging regions of the river, the angler must apply for a virtual Fishing Permission License. Access to each new level is granted by the software under the supervision of the clinician, ensuring that progression matches the user’s range of motion rehabilitation goals.

Upcoming

Status: Upcoming

Neck Slalom

Dynamic Neck Stabilization

Animated scene: Sif skis a slalom course at Kvitfjell Ski Resort, Norway.

“Training the deep transversospinal neck muscles during movement.”

The exergame trains the deep transversospinal muscles of the cervical spine, particularly in the upper and mid-cervical regions, which are the areas most affected by clinical instability after neck injuries. These muscles are activated by controlled neck movements within the available range of motion. Dynamic stabilization is trained by performing small rotational movements during continuous forward and backward bending of the head-neck.

The alpine skier navigates a series of slalom courses with incremental difficulty. The software automatically adjusts the challenges by varying the within-gate distances and the between-gate distances (longitudinally), as well as the steepness of the slopes, and by reducing the time available to complete each course.

The players control the skier by moving their head and neck. These movements are detected by sensors in the virtual reality headset, allowing the skier to pass through the gates using precise and coordinated neck movements. Various feedback is given during the exergame.

Upcoming

Status: Upcoming

Ice Rock Balance

Postural Control

Scene: Training postural control and balance at Jökulsárlón, Vatnajökull National Park, Iceland.

“Training postural control and balance at Jökulsárlón, Iceland.”

Balance training begins in a safe environment, either at home or in the clinic. Exercises are first performed with the eyes open and then with the eyes closed. Balancing on small, unstable ice rocks is especially challenging because the support surface is narrow, uneven, and constantly moving. To stay upright, the peripheral and central nervous systems must rapidly combine sensory information from the soles of the feet, the muscles and joints of the lower limbs, the vestibular system in the inner ear, vision, and other mechanoreceptors throughout the body. The nervous system must continuously adjust muscle activities to maintain balance. Evidence shows that training on unstable surfaces improves postural control, dynamic balance, lower-limb strength, and overall neuromuscular efficiency.

The VR exercises at Jökulsárlón become progressively more challenging. Users step between floating ice rocks placed increasingly farther apart, pause to balance on each rock, and respond when the rocks gently tilt or drift. Diverse visual challenges are added to the more advanced levels in the exergame.

Game 1 of 5: ODIN’S HEADING GAME. Slideshow playing.

The next step

Discuss Odin Neck Games with our team

Contact the clinical team to discuss guided rehabilitation with Odin Neck Games and how it connects with Clutter assessment.

Contact the clinical team

Clutter

Welcome to the Norse universe

Mission Statement

Neck Orchestra

What does Neck Orchestra do?

Short-term benefits, long-term consequences

How Neck Orchestra helps

GAMEPLAY: PROGRESSION THROUGH THE NORSE REALMS

FOUNDATIONAL TRAINING

Neck Wobble Board

WHAT IS TRAINED?

Clinical rationale

Clinical messages

01STAGE 1LIGHT / WARM-UP

02STAGE 2 · EASY · MEDIUM · DIFFICULTMODERATE

03STAGE 3INTENSE

04STAGE 4ULTRA

RESEARCH REFERENCES

References

Founder’s research

The Three Horns of Odin

01How the Horns work

02OPTIONAL – RECOMMENDED

03The Optimal Challenge Point

Gallery of Upcoming Games

ODIN’S HEADING GAME

Discuss Odin Neck Games with our team