Chapter 16 Corrective Strategies for Cervical Spine Impairments Flashcards
Corrective Strategies
for Cervical Spine Impairments
Learning objectives
Upon completion of this chapter, you will be able to:
- Understand basic functional anatomy for the cervical spine region.
- Understand the mechanisms for cervical spine injuries.
- Determine common risk factors that can lead to cervical spine injury.
- Incorporate a systematic assessment and corrective exercise
- strategy for cervical spine impairments.
Corrective Strategies
for Cervical Spine Impairments
Introduction
According to a survey conducted by the National Institute of Health Statistics (NIHS), neck pain is the third most common type of pain for Americans ( 1 ). Roughly two-thirds of the population will experience neck pain in their lifetime. Its side effects can be mild or severe, and interfere with normal daily functioning such as sitting, turning, and sleeping. Neck pain can be acute (lasts less than 3 months), or chronic (lasts longer than 3 months).
In the NIHS study, the majority of respondents (42%) had suffered neck pain for longer than a year. The survey also showed that women are three times more likely to suffer with this health problem than men and that if you are under severe stress your risk of neck pain increases by one and a half times. However, research has shown that exercise, in the form of neck strengthening, stretching, and proprioceptive exercises, can decrease the risk of neck pain or improve the symptoms of neck pain.
Like other regions of the body, the cervical spine (CS) is a region of the body that has a massive influence on the structures above and below it. The CS has more than 30 muscles that are located in the cervical spine region and shoulder complex. The neck muscle system is intimately related with reflex systems concerned with vestibular function, proprioceptive systems, stabilization of the head and eyes, postural orientation, and stability of the whole body. Thus, dysfunction in this region can lead to many injuries throughout the body.
Cervical Spine
Functional Anatomy
The Neck Region
Looking at the cervical spine region specifically the cervical spine begins at the base of the skull and includes seven vertebrae. The individual cervical vertebrae are abbreviated C1 (atlas), C2 (axis), C3, C4, C5, C6, and C7. Between C2 and each sequential vertebra are the intervening disks.
Cervical Spine
Functional Anatomy
The Neck Region
Typical cervical vertebrae have four facet joints: a right and left superior and inferior facet; and two joints that are called uncovertebral joints Figure.
Collectively, these structures anchor many of the major myofascial tissues that have a functional impact on the arthrokinematics of the structures above and below.
Above the cervical spine is the skull, including the temporal mandibular joint (TMJ). Below the cervical spine are the thoracic and lumbar spines, rib cage, scapula, humerus, and clavicle. These structures in combination make up the cervicothoracic and thoracolumbar junctions of the spine, the scapulothoracic, glenohumeral, acromioclavicular (AC), and sternoclavicular (SC) joints
Cervical Spine
Functional Anatomy
Muscles
Although the CS is a relatively small region of the spine, there are a number of muscles responsible for and contributing to the proper functioning of the CS. The deep neck flexors
(longus colli, longus capitis, rectus capitis anterior and lateralis),
lower trapezius, and serratus anterior form the upper oblique subsystem with the pectorals, upper trapezius, and levator scapula. A
Common Cervical Spine Injuries and
Associated Movement Deficiencies
Common complaints above the CS that may stem from dysfunction in the CS are often seen with symptoms associated with the head, including headaches and dizziness or lightheadedness Table 16. 2 ( 13 ). Common injuries below the CS toward the shoulder include shoulder pain, trapezius-levator scapula dysfunction, AC impingement, scapulothoracic dysfunction, and thoracic outlet dysfunction. At the thoracolumbar spine, low-back pain and sacroiliac joint dysfunction may be seen with various
SYSTEMATIC PROCESS TO DETERMINE CERVICAL SPINE IMPAIRMENTS
The cervical spine is a focus for the investigation of complaints that involve head and upper extremity. Like the other regions of the body, this can be accomplished through the use of static postural assessments, transitional movement assessments, and range of motion assessments.
SYSTEMATIC PROCESS TO DETERMINE CERVICAL SPINE IMPAIRMENTS
STATIC POSTURE
Like the shoulder region, a key static postural distortion syndrome to look for to determine potential movement dysfunction at the CS is the upper crossed postural distortion syndrome. As mentioned in the previous chapter, this is characterized by a rounding of the shoulders and forward head. Every inch of forwarding displacement of the head requires a tenfold increase of muscular effort to support posture.
This position can place large stresses on the muscles and connective tissue associated with the CS, leading to injury.
During the function, the cervical spine also requires a balance between left and right associated musculature to maintain optimal posture. When this does not occur, abnormal asymmetric shifting (lateral flexion, translation, or rotation) can also be seen when assessing one statically. This may be related to an overactive and underactive right and left sternocleidomastoid, scalenes, levator scapulae, and upper trapezius.
SYSTEMATIC PROCESS TO DETERMINE CERVICAL SPINE IMPAIRMENTS
STATIC POSTURE
TRANSITIONAL MOVEMENT ASSESSMENTS
The overhead squat test can be used to assess multiple movement compensations of the CS. During the overhead squat test, the lower CS may become flexed and the cervicocranial junction hyperextended to keep the eyes level. This may lead to (or be caused by) an overactive sternocleidomastoid producing upper cervical extension and mid-lower cervical flexion (forward head). The suboccipital may also become overactive and shortened as a result of this neck posture.
Like the static postural assessment, abnormal asymmetric shifting may also be seen during the descent of the overhead squat. As mentioned earlier, this may
related to an overactive and underactive right and left sternocleidomastoid,
scalenes, levator scapulae, and upper trapezius.
SYSTEMATIC PROCESS TO DETERMINE CERVICAL SPINE IMPAIRMENTS
DYNAMIC MOVEMENT ASSESSMENT
When performing a dynamic movement assessment, (such as walking on a
treadmill), watch for the rounding of the shoulders and a forward head posture
The following table provides a summary of all of the aforementioned CS
compensation and potential overactive and underactive muscles that will need to be addressed in a corrective exercise program.
SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR CERVICAL
SPINE IMPAIRMENTS
FORWARD HEAD
Step 1: Inhibit Key regions to inhibit via foam rolling, self-applied pressure, and
instrument-assisted devices include the thoracic spine, sternocleidomastoid,
levator scapulae, and upper trapezius.
Step 2: Lengthen Key lengthening exercises via static stretching include the sternocleidomastoid, levator scapulae, and upper trapezius.
Step 3: Activate Key activation exercises via isolated strengthening exercises include the deep cervical flexors, cervical-thoracic extensors, and lower trapezius.
SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR CERVICAL
SPINE IMPAIRMENTS
FORWARD HEAD
cont
Step 4: Integration An integration exercise that could be implemented could be a ball combo I while maintaining cervical retraction. Although this exercise can also be considered an activation exercise for the shoulder complex, it could be used as an integration exercise for cervical spine impairments to integrate the use of the cervical spine musculature with the shoulder musculature. Performing this movement on a stability ball also forces one to use these muscles in concert with the core and lower extremity musculature to provide stability throughout one’s overall structure. This movement can be progressed by incorporating other dynamic functional movements involving the lower extremity (e.g., squat to scaption, step-up to scaption, and lunging to scaption) while maintaining proper cervical retraction.
SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR CERVICAL
SPINE IMPAIRMENTS
ASYMMETRIC SHIFT (LATERAL FLEXION, TRANSLATION,
OR ROTATION)
Step 1: Inhibit Key regions to inhibit include the upper trapezius/scalenes (side of shift), levator scapulae (side of shift), and sternocleidomastoid (side of shift for lateral flexion or translation; the opposite side of shift for rotation, i.e., if the chin rotates to the right, inhibit the left SCM). See photos for the forward head impairment for proper execution.
Step 2: Lengthen Key lengthening exercises via static stretching include the sternocleidomastoid, levator scapulae, and upper trapezius.
Step 3: Activate Key activation exercises via isolated strengthening exercises include the deep cervical flexors, cervical-thoracic extensors, and lower trapezius.
SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR CERVICAL
SPINE IMPAIRMENTS
ASYMMETRIC SHIFT (LATERAL FLEXION, TRANSLATION,
OR ROTATION)
Step 4: Integration An integration exercise that could be implemented could be a ball combo I while maintaining cervical retraction. Although this exercise can also be considered an activation exercise for the shoulder complex, it could be used as an integration exercise for cervical spine impairments to integrate the use of the cervical spine musculature with the shoulder musculature. Performing this movement on a stability ball also forces one to use these muscles in concert with the core and lower extremity musculature to provide stability throughout one’s overall structure. This movement can be progressed by incorporating other dynamic functional movements involving the lower extremity (e.g., squat to scaption, step-up to scaption, and lunging to scaption) while maintaining proper cervical retraction.
SUMMARY
As mentioned in the majority of the previous chapters, pain in one region of the body is likely caused by dysfunction in another region of the body. This can be especially true for the cervical spine, dysfunction owing to the compensator chain reaction that can occur during human movement dysfunction. Although the cervical spine is a very complex region of the body, having an understanding of functional anatomy, functional biomechanics, and the overall human movement system will greatly assist the health and fitness professional in being able to understand potential causes for cervical spine dysfunction and key elements that must be addressed to help correct these dysfunctions via the Corrective Exercise Continuum.
