WELCOME TO. Spinal isolation, restriction & rehabilitation

Transcription

1 WELCOME TO Spinal isolation, restriction & rehabilitation

2 2 P a g e Contents Introduction pg. 3 Anatomy pg. 4-6 What affect spinal mobility? pg. 7 The structure of the vertebra pg. 8 Intervertebral discs and fusions pg. 8 Precautionary measures for disc pathology pg Spinal fusions pg. 11 Spinal mobility and breathing pg. 13 Spinal isolation and movement pg Common cheats during training the back extensors pg. 18 Thoracic spine pg Spinal isolation and pelvic tilts pg The deep neck flexors pg Bibliography: pg. 23

3 3 P a g e There are many factors that influence the mobility and range of the spine i.e. hereditary restrictions or merely due to negative spinal mechanics and everyday activities. The spine forms a bridge between our extremities and has a superior bond with the pelvis. Therefore it is extremely important to know when enough is enough. First and foremost it is important to understand the anatomy of the spine including the muscular system. There are many factors that come into play when mobilizing or strengthening the spine and these need to be considered to avoid permanent injury. Anatomy Concentric contraction: Shortening of the muscle against high or low load which will decrease the joint angle Eccentric work: Controlling a joint as the muscle lengthens against high resistance. Eccentric control: Controlling a joint as the muscle lengthens against low resistance. When looking at the anatomy of the spine, remember that a muscle works and controls both eccentrically and works under high or low load concentrically. Therefore a muscle could be weaker concentrically but stronger eccentrically depending on the activities and load that you expect it to endure on a daily basis. However this does not mean that the muscle is strong, it just means that there is more effort exerted from the muscle in an eccentric or concentric position on a daily basis. What is muscle strength? A group of muscles may have a great ability to contract but the amount of load and repetitions that the group can handle will indicate the amount of strength that the group has. Therefore in order to obtain strength, we need to add resistance and additional repetitions. Hence, through postural assessment we cannot conclude that muscles are strong or weak until we physically test them. Are you ready to delve into the spine?

4 4 P a g e The muscles involved are: Erector Spinae Spinalis (Concentrically) Attachments: spinous to spinous process (interspinalis); Transverse (T5/6 ) to Spinous process (C2-C5) Movements: spinal stability segmental spinal extension; bilateral spinal extension; spinal rotation toward opposite side; localized spinal lateral flexion to that side (cervical area & intertransversarii) Longissimus:(Concentrically) Attachment: originate and insert at various points along the transverse processes of the entire spine Movement/s: bilateral spinal extension; lateral spinal flexion to same side Iliocostalis: (Concentrically) Attachments: along the sacrum, lumbar spinous proceses, sacrospinalis aponeurosis and illium to the ribs above and transverse process of cervical vertebrae Movements: extension in thoracic & lower cervical regions; stabilizes, extends and laterally flexes thoracic spine to same side as it assists by depressing the ribs Notes: These are our main global spinal extensors that also control flexion of the spine in a standing position as in a roll down. It is important to note that the attachments of the spinals is noticeably different compared to the longissimus and iliocostalis. Therefore the spinalis is capable of performing segmental extension. Due to this function, it plays a vital role in spinal isolation where we would need to isolate areas of the spine in order to improve postures. What would the antagonists be to the erector spinae?

5 5 P a g e Quadratus Lumborum Attachments: Illiac crest, transverse processes of lumbar vertebrae, last rib (12 th rib) Movements: Aids in depressing the ribs during breathing Holds the 12 th rib down as we inhale and as we exhale the ribs come down, it will move into a slightly shorter position; unilaterally flexes the spine to the same side; elevates the hip unilaterally; extends the LUMBAR spine; pulls the pelvis into an anterior tilt; rotation of the spine to the same side. What would the QL s antagonists be? Multifidus: (Concentrically) Multifidus Attachments: the feathered muscle in lumbar, thoracic and cervical regions. Spanning 2 4 vertebrae runs from sacrum and transverse processes to the 2 nd or 4 th superior spinous process above it and continues to C2 Movements: the main function is spinal stabilization; however some literature has mentioned that the multifidus would assist with spinal extension and rotation toward the opposite direction What would the QL s antagonists be?

6 6 P a g e Rotatores: (Concentrically) Rotatores Attachments: transverse process of vertebra and base of spinous process of vertebra above Movements: spinal extension, rotation and lateral flexion on a smaller scale. Due to their size, the rotators are less likely to work intensely in these movements and will therefore be synergists to the movements mentioned. They also assist in stabilizing the pelvis but have a strong sensory component where they play a role in proprioreception of the vertebrae as they move. What would the Rotatores antagonists be? Attempt to visualise the layers of muscles surrounding the spine Superficial layers include the Erector Spinae group (except Spinalis) and Splenius (cervical) group. Oblique layers consist of the Scalenes (anterior, medius,posterior). Deeper layers involve Longis Capitis and Longis Colli (central/ anterior deep neck flexors). The deeper back extensors involve the Quadratus Lumborum and deeper Spinalis groups (first layer), Multifidus (second layer) and the Rotatores being the deepest (third layer). Interspinalis and intertransvesarii are right along the spine. Scalenes Longus Colli Longus capitis

7 7 P a g e A quick overview Muscle Movement Concentrically Antagonists Moves Lumbar spine into flexion/extension? Abdominals Spinal flexion and rotation Back extensors, hip flexors Flexion Hip Flexors Hip flexion Abdominals, hip extensors Extension Gluteus Maximus Hip extension, abduction and lateral rotation Hip flexors, back extensors Flexion if you squeeze but extension if you hyperextend the hip Hamstrings Hip extension, knee flexion and slight knee rotation Hip flexors, back extensors Flexion if you squeeze but extension if you hyperextend the hip What else affects spinal mobility Spinal cord: this runs through the vertebral foramen and can therefore be affected through movement of the spine. This should always be taken into consideration, especially if a client feels a neural pull, tingling or a sharp pain during any exercise. Not only can we irritate the spinal cord or nerves through movements but the irritation is exasperated if it is performed with an existing spinal pathology where the spinal cord is compressed. Anterior Posterior Posterior and anterior longitudinal ligaments: these are the ligaments of the bodies of vertebra and protect the spine from flexing or extending too far. Due to the fact that these are ligaments, they are restricted in their flexibility and therefore the spine should not be forced to enable a client to get more flexibility if the restriction lies within these ligaments. In this case you will normally find that it is hereditary. Forcing large ranges of mobility can cause direct complications with the intervertebral discs. If the client is not required to do large ranges of motion in their spine in their everyday lives then this is better left as is. Many instructors do not consider the influence that the ligaments of the spine have on mobility and always diagnose it down to the muscles of the back. Remember, joints can be affected by muscles, ligaments and their general structure.

8 8 P a g e A quick look at a vertebra s structure Intervertebral discs and fusions: It is very important to be aware of these conditions as certain conditions have movements that are contraindicated to them. Therefore if they are put into the contraindicated position, the condition could worsen. Remember that as the spinal cord is running through the vertebrae, it could be affected by the vertebrae s movement or changes. Nerve roots radiate out of each vertebra which may also be affected through the movement of the spine. NB: MOVEMENT OF THE SPINE IN MEDIUM TO LARGE RANGES IS AVOIDED WITH DISC PROBLEMS. DO NOT: Load the spine Create traction in the spine e.g. prone hanging over a ball Excessively flex or extend the spine Combine flexion or extension WITH rotation Ranges should be kept to no more than 20% of the NORMAL range ALWAYS: Ask for a thorough report from the health care professional which states; diagnosis, their suggestions of program and contraindications. Ask client for constant feedback and follow up with them the next day to see how they felt after the session. Keep a record of each and every program that you offer them.

9 9 P a g e Precautionary measures for disc pathology Posterior bulging disc: The disc will be bulging towards the spinal cord and this could cause neural pain in various areas depending on the disc that is bulging. Flexion of the spine is avoided as it will protrude more towards the spinal cord creating various symptoms. Flexion and extension with rotation is also avoided. 4 movements that you would avoid with this condition: 1. A standing roll down where the spine experiences traction due to the weight of the torso and gravity 2. Crunches or chest lifts where you round the part of the spine where the disc is bulging 3. Any spinal articulation in flexion i.e. pelvic curl, tower, long spine, short spine 4. Any heavily loaded exercises for the spine e.g. deep squats with HEAVY weights SUGGESTED PROGRAM We suggest lower load exercises on the spine where the spine is held in neutral i.e. spinal hinges sitting pelvic bridges without rolling through the spine upright low load spinal twist NB: The spine has 24 vertebrae, therefore these movements are avoided only in the areas of the pathology, however, if the movement is performed in another area but the area of the pathology is affected then please refrain from the movement all together. Neutral spine against the wall with theraband (closed chain) Abdominal hinge with theraband resistance Controlled squat with medium resistance Basic back extension prone on a long bench Ensure that you maintain neutral pelvis to ensure that they do not posteriorly tilt their pelvis as this will aggravate the disc condition. Remember that the response of muscles changes depending on whether you are sitting, standing or prone. If you are unsure of an exercise, please take a photo and send it to us and we will assist you as far as possible. It must never hurt!

10 10 P a g e Anterior bulging disc: The disc will be bulging towards the abdominal area and therefore extension of the spine is avoided to ensure that it does not increase the bulge as well as extension and flexion with rotation. 4 movements that you would avoid with this condition: 1. Any exercise lying prone (on the tummy) 2. Any hip extension prone as this will increase the extension in the spine 3. Any hip extension standing or sitting where the spine goes into extension 4. Standing roll downs as mentioned in the posterior bulging disc SUGGESTED PROGRAM We suggest lower load exercises on the spine where the spine is held in neutral i.e. spinal hinges sitting pelvic bridges with small low load ranges where the client rolls through the spine NB: The spine has 24 vertebrae, therefore these movements are avoided only in the areas of the pathology, however, if the movement is performed in another area but the area of the pathology is affected then please refrain from the movement all together. upright low load spinal twist Neutral spine against the wall with theraband (closed chain) Sitting oblique work in neutral spine Controlled squat with medium resistance Also make sure that the client does not to shorten the one side of the torso as they exercise. Lateral bulging disc: The disc would be bulging towards the left or right hand side. This is commonly seen together with a posterior or anterior bulge. Lateral flexion of the spine away from the bulge is avoided as this will cause the disc to bulge further laterally. Extension and flexion with rotation is also avoided. If the disc is bulging anteriorly or posteriorly then you will follow the precautionary measures as seen above, 4 movements that you would avoid with this condition: 1. Sides / oblique work where you flex the spine against low or high load 2. Spinal rotation until you get the go ahead from the health care professional 3. Side plank as the spine is vulnerable in lateral work especially under load 4. Side or oblique stretches where the spine is in lateral flexion

11 11 P a g e SUGGESTED PROGRAM We suggest lower load exercises on the spine where the spine is held in neutral i.e. spinal hinges sitting pelvic bridges with small low load ranges where the client rolls through the spine upright low load spinal twist NB: The spine has 24 vertebrae, therefore these movements are avoided only in the areas of the pathology, however, if the movement is performed in another area but the area of the pathology is affected then please refrain from the movement all together. Neutral spine against the wall with theraband (closed chain) Gentle spinal press into a 65cm ball sitting Seated low load abdominal hinge Controlled squat with medium resistance Ensure that you maintain neutral pelvis to ensure that they do not anteriorly tilt their pelvis as this will aggravate the disc condition. Spinal Fusions: The vertebrae are fixed to one another through surgery or they join naturally due to injury and therefore offer no mobility in the area of the fusion. Excessive mobilization is avoided due to the restricted mobility in the area of the fusion. Therefore the vertebrae above and below the fusion are placed under stress in excessive spinal mobilization due to the fact that they have to take more load and mobility during a movement. 4 movements that you would avoid with this condition: 1. Deep spinal flexion loaded 2. Deep spinal extension loaded 3. Excessive spinal rotation loaded 4. Any rolling on a mat especially when the spine thuds on the mat due to the area of the fusion that appears flat

12 12 P a g e SUGGESTED PROGRAM We suggest lower load exercises on the spine but you are able to perform flexion, extension and rotation of the spine in a small range (20% of the original range) i.e. spinal hinges sitting pelvic bridges with small low load ranges where the client rolls through the spine pelvic curl (do not expect articulation in the area of the fusion) Chest lift or abdominal work (do not flex neck if the fusion in near C7 or overload the spine at the area of the fusion) upright low load spinal twist, neutral spine against the wall with theraband (closed chain) NB: The spine has 24 vertebrae, therefore these movements are avoided only in the areas of the pathology, however, if the movement is performed in another area but the area of the pathology is affected then please refrain from the movement all together. gentle spinal press into a 65cm ball sitting seated low load abdominal hinge controlled squat with medium resistance spinal extension i.e. basic back extension, swimming Ensure that you maintain a comfortable pelvis as they often appear to be posteriorly tilted when they have had a lumbar fusion. If this is the case then maintain a comfortable, small lumbar flexion (posterior tilt). If you force the spine into neutral and it is fused in slight flexion, you will strain the vertebra above and below the fusion. Spondylolisthesis Conditions such as Spondylolisthesis would be treated similarly to an anterior bulging disc as there is discomfort when extension is done. Spondiloysthesis is where there is a shift in the vertebral body which could be due to a fracture in the vertebra. Due to this there is an instability and the vertebra has the ability to shift. The shift is usually anteriorly and therefore extension is avoided as this would exasperate the condition. Please refer to precautionary measure for anterior and posterior discs!

13 13 P a g e Spinal mobility and breathing Breathing plays a vital role in spinal isolation and mobility. A certain amount of tension is created in the torso (especially on exhalation) when we breathe and therefore releasing in the vertebrae becomes more challenging. The mobility and free movement of the spine is also affected when we have an insufficient breathing pattern. It restricts the mobility of the thoracic spine and due to this we are not able to maintain a reasonable thoracic spine position. The outcome is that thoracic spinal extension is limited. (It is important to take additional time when teaching your client breathing.) WHEN IS ENOUGH, ENOUGH? We are often not sure what causes the restriction in the back. Often the client has not consulted a health care professional as there are no symptoms, only stiffness. We can narrow it down to it either being due to bad habits or hereditary. (This is easier to see if you have another family member training at your facility.) The 3 factors that affect the spinal mobility are: 1. Muscles: this can usually be improved through constant stretching and mobilization of joints. However, you need to realize that it could take a long period to see considerable improvement. Efficient stretching is vital. Ask if they are feeling a muscular stretch. Keep the body in alignment from insertion to origin as well as from joint to joint Be aware of a neural sensation when they stretch as this may not be held for longer than 3 5 seconds 2. Ligaments: the improvement here will be minimal, however, remember that if the ligaments are stiff then that would directly affect the amount of movement and flexibility that occurs in the muscles of the back. Therefore, the muscles can improve but they will reach a limit due to the ligamentous properties. Any forced stretching of the spine can cause other pathology if the spine is restricted through its ligaments. 3. Fascia: this is usually released through manual massage and should be done by a health care professional who understands the positioning and composition of the fascia. It is therefore important to do the first assessment as this gives you a base to work from. It is also far easier to keep track of improvements as the program progresses. Remember that if there is a restriction in the spine, the muscles that were discussed earlier will also be affected. (Refer to page 4 6)

14 14 P a g e Which muscles will be inhibited if the spine is restricted from achieving flexion? Abdominals Which muscles will be inhibited if the spine is restricted from achieving Extension? Back extensors Which muscles will be inhibited if the spine is restricted from achieving Rotation? Obliques & spinal rotators A quick reminder Spinal isolation and movement Rotation: (Remember that the spine is able to do 30 of rotation) We should never underestimate the importance of spinal rotation as we have specific muscles that are responsible for this movement. They are: Obliques, rotatores, serratus posterior inferior, Quadratus lumborum & assisting spinal rotators Many clients tend to rotate from the feet, knees and hips in order to facilitate rotation and this is only necessary once the spine has reached it maximum range of motion in rotation (30 ). However, if they do not have mobility in the muscles mentioned above then the compensation would be to rotate from the hip, knees and feet. This also does not allow for the development of the rotating muscles. Due to this, it is common that the spine is injured when loaded pure rotation is performed as the spine is not accustomed to this movement. So what movements do we want to enable the spine to do? We know that the vertebrae are able to articulate or they should be. This however is not the case in many clients. When looking at spinal isolation or segmental extension and flexion, we are directly referring to the spinalis and the smaller spinal extensors. The positioning of these muscles enables the spine to do segmental extension and control flexion segmentally. It is usually easier to teach this to a client that is less active as the larger Erector Spinae are usually predominant in an active person. We want the spine to: 1. Flex and extend in the cervical, thoracic and lumbar spine. 2. Rotate from left to right with a stable and fixed section. Be that the shoulders or pelvis. Mainly rotation occurs at the lower thoracic vertebrae and therefore we have a higher concentration of the rotatores muscles in this area. 3. Isolate areas of the spine; here we want the spine to flex or extend the thoracic with no change in the lumbar spine and visa versa. This is a movement that requires a lot of thought from the client and once this is achieved, one can look at postural corrective work. For example: A kyphotic lordotic posture

15 15 P a g e NB: The majority of clients have very little isolated mobility in the spine, however due to the fact that they have never experienced true mobility, they are not aware of the restriction that it creates in their spine and the release of tension that can occur when the spine is able to mobilize in all positions. It is up to the instructor to assess the various areas of the spine to get a good idea of what is required and how well the client understands the concept of spinal isolation. Below are a few tests that one can do. Please note that if you are already familiar with the tests below, then you need to ensure that you are able to see the compensations and correct these or note what is causing the compensation. Testing: Spinal mobility and isolation in cervical, thoracic and lumbar spine Cervical spine: The cervical spine tends to be very controlled in its movement with very little free movement occurring in the neck. Movement should be free and easy. The lack of this is due to neck & shoulder tension. This is really a mind body connection fault that needs to be addressed. Free movement will also relieve tension in the neck which is vital for healthy living. Care should be taken that the client has no neck conditions that would be affected by these movements. Exercise Description Common compensations Neck rotations and lateral bending Neck rolls free movement NB: The movement should not look robotic or cause unnecessary twinges or aches.

16 16 P a g e CIMR = This concept can create substantial body resistance in an exercise whereby muscles create resistance within the body for primary movers. Thoracic spine: It is very important to focus on the closing of the ribs when assessing and teaching thoracic extension. Flaring ribs will encourage lumbar extension. Rib closure also creates conscious initiated muscular resistance (CIMR). There should also be a feeling of contracting at the area near the mid and lower Trapezius. Bear in mind that the Erector Spinae are responsible for the thoracic extension. There should be a feeling of extending up and over a pole and pulling down with the back extensors just between and below the shoulder blades. Exercise Description Common compensations Basic thoracic extension sitting Basic back extension prone Lumbar spine: The mobility of the lumbar spine is client specific. Pelvic tilt will also play a role in the constant position of the lumbar spine. Therefore it will also affect the true mobility of the lumbar spine. Emphasis needs to be placed on the rectus abdominus to produce the movement of lumbar flexion or the lumbar back extensors to produce spinal extension. As this movement is produced, there should still be a feeling of extension through the top of the head to avoid sinking or collapsing in the spine. Exercise Description Common compensation Sitting lumbar mobility (flexion) Pelvic curl (flexion) Can you think of a low load exercise that would encourage lumbar flexion? (Supine on a 65cm ball / Anterior theraband sitting on a 65cm ball) Why is it important that we emphasize the exercise to be low load? If we add high resistance from the beginning, the muscles might spasm as they are not used to high load work.

17 17 P a g e Spinal rotation: Spinal rotation is imperative if the client has no injuries. There are numerous areas that can restrict spinal rotation e.g. stiffness in the obliques, restriction in the pectorals (if you want them to rotate with abducted arms) and general stiffness in the spine. Alignment plays a vital role here as it is very easy to cheat rotation through extending the spine or flexing in the hip and lumbar spine. Also note that rotation occurs mainly from the lower thoracic spine. Exercise Description Common compensations Side lying rotation Cross legged rotation Entire spine: This is so important to test as it will give you a good idea of whether the client is capable of segmental extension and flexion as well as the tension that they carry in their spine on a daily basis. What information can we get from a pelvic curl when it comes to spinal mobility? 1. Lumbar flexion 2. Lower thoracic extension 3. Spinal isolation Cueing: Cues that are beneficial to use when teaching spinal isolation are: Extend up and over when doing thoracic extension Draw the back extensors towards the hips as you do thoracic extension Open the chest as you extend the thoracic spine & push your chest through your shoulders Draw the rectus abdominus through to flex the lumbar spine Feel the activation underneath the shoulder blades in thoracic extension Release into the rotation of the spine Heavy movement of the neck with the neck rolls but without force Be hands on with your clients; apply pressure when needed as they are able to recruit better when they know where it should be working.

18 18 P a g e Common cheats during training of the back extensors Use of the arms inhibits the back extensors from working efficiently The clients either lift their arms giving the illusion of height in the back or they press their arms into the floor. This can be seen by activation in the anterior deltoid as they lift up. Overuse of the neck extensors gives the illusion of height in extension The clients lift their head off the floor with very little change in the back thus giving them an illusion of lifting high in their backs. Use predominantly the lumbar spine during back work inhibiting the thoracic spine This is normally evident when a client lifts quite high off of the surface. They tend to press off of their abdomen with little change in the thoracic spine and a deep arch in the lumbar spine or they press their legs into the floor causing the lumbar spine to arch as they go into a posterior tilt in the pelvis. Changing the pelvic position to encourage back extension It is common for the client to unknowingly go into an anterior pelvic tilt which will encourage lumbar back extension. Thoracic spine How do we get our clients to isolate into their thoracic spine The true feeling of thoracic extension is so seldom felt by clients. It is almost better to ask the client to go into a slight posterior tilt whilst trying to perform thoracic back extension. In this way the lumbar spine will be inhibited from extending. It is a common occurrence that the thoracic spine is inhibited in extension and the lumbar spine gives the illusion of back extension along the length of the spine. The importance of thoracic extension is directly related to posture improvement as our everyday lives tend to exaggerate thoracic flexion. The initial feeling of TRUE thoracic extension is that of restriction or a slight spasm. There should be a feeling of maintaining the position of the lumbar spine and only moving the thoracic spine. Exercises to aid this: Exercise Description Common compensations Thoracic extension on the foam roller

19 19 P a g e Exercise Description Common compensations Thoracic extension with the discs HOME WORK: Can you design two new exercises for thoracic back extension See our examples below! Exercise Description Common compensation Thoracic extension with the 65cm ball seated Thoracic extension seated with a 20cm ball Exercises to encourage segmental extension: Exercise Description Common compensations Sitting extension chair / wall Roll down sitting upright

20 20 P a g e The importance of spinal isolation Why is spinal isolation important? It creates body awareness It relieves tension It enables the spine to be more functional without compensating It also allows all areas of the spine to strengthen effectively which will then encourage good posture and breathing It is injury preventative as other areas of the spine do not need to over work due to another areas weakness Lumbar mobilization and strength The lumbar spine is directly affected by the position of the pelvis due to its connection at the sacroiliac joint. Therefore it can create various muscular imbalances around and spine. These imbalances will then radiate to the knees, ankles and shoulders over time. Mobilization of the lumbar spine is very important as it directly affects isolation of the lumbar back extensors as well as the Rectus Abdominus. What is the importance of the co-ordination of these two muscle groups in relation to each other Co-ordination of these two areas is vital in order to achieve involuntary hip disassociation. Isolation of the lumbar spine allows us to correct certain postures without any negative repercussion occurring along the rest of the spine. Example of a posture requiring this: Posture Thoracic spine Changed position & muscles involved? Lumbar spine Changed position & muscles involved? Kyphotic / Lordotic Flexion Neutral to extension Thoracic spinal extensors, flexibility of upper rectus abdominus Extension Neutral Lower abdominals & hip extensors

21 21 P a g e CIMR = This concept can create substantial body resistance in an exercise whereby muscles create resistance within the body for primary movers. We have to imagine the body as a pulley system, where antagonists create resistance for the agonists. This term is known as Conscious Initiated Muscular Resistance (CIMR). As an isotonic movement is being executed, the body automatically creates this resistance by the antagonist maintaining a certain amount of tone to avoid another joint from being affected in the movement. However, the intensity of this can be consciously initiated in order to increase the intensity in the mover. To correct many postures we need to change the common movement of the lumbar spine and the common movement of the thoracic spine. These movements could be in opposite directions to one another. As we know, isolation is a mind body connection. Therefore this needs to be established before the true feeling of isolation can be felt. Exercises that incorporate all the corrective elements of the following tilts: (Remember the importance of flexibility for range of motion) Focal point Exercise Compensations Posterior tilt (supine on the 65cm ball) / Prone over the ball / seated hip flexion with a hinge) Anterior tilt (Prone on the 65cm ball / supine pelvic ball press) Lateral tilt (left hip higher) (Standing hip hike) You can design exercises that will suit your client. If you are unsure, please us so that we can assist you!

22 22 P a g e The deep neck flexors Longus Colli Longus capitis What are the deep neck flexors When we speak of the deep neck flexors, we refer to the Longus Capitis and Longus Colli. These muscles, together with muscles that are situated posteriorly on the neck, form a sleeve of support for the cervical spine. These can be described as the core muscles for the cervical spine. Hence, if an injury takes place in the cervical region or if you have a bad posture, these muscles become inhibited. The functions of these muscles are flexion, lateral flexion (not the Longus Capitis) and rotation of the cervical spine. Normal range of motion of the cervical spine is: Flexion 50 Lifting Extension 60 Lateral flexion 45 Rotation Therefore it is important to remember that when exercising the neck, care should be taken as to how much pressure is applied to the neck as well as the range of movement that you expect from your client. Exercises to re-educate deep neck flexion Exercise Compensation Tips Supine with triangular cushion Theraband neck retraction Remember that when it comes to the spine, rather safe than sorry should be the order of the day. If you are not sure, do not attempt to correct. Rather consult other practitioners for advice or guidance and do additional research. You will only gain from the efforts.

23 23 P a g e Thank you for choosing Of-courseonline We hope that you have had as much fun as we have. We value your input and are here to service your inquisitive needs. Remember, Post education through motivation and inspiration is a way to build on a powerful career and opportunity to make a positive change in many peoples lives. We hope to hear from you soon! Bibliography 1. Reference 1: Kendall, F. P., McCreary, E. K., Provance, P. G., Mcintyre Rodgers, M, Romani, W. A. (2005). Muscles testing and functions with posture and pain. Lippincott Williams & Wilkins. 2. Reference 3: Website: ; Last visited, March 2012, Wikimedia foundation incorporated. Pg. 3, 6,7,8,18 3. Website: Last modified, 3 March 2011 at 07:28, Wikimedia foundation incorporated. 4. Website: Last modified, 14th March 2011, Wikimedia foundation incorporated 5. Website: contraction ; Last modified, 14th March 2011, Wikimedia foundation incorporated. 6. Website: ; Updated Thompson, T. (2007) Pilates Unlimited Post educational course Agur, A. M. R (1999) Grants Atlas of Anatomy. Lippincott Williams & Wilkins. Pg 92 93, , , , , , , , Comerford, M. J, Mottram, S L, (2007) Post educational course Performance stability. Pg 15, Comerford, M. J, Mottram, S L, (2007) Post educational course Performance stability. Pg 6, Agur, A. M. R (1999) Grants Atlas of Anatomy. Lippincott Williams & Wilkins. Pg 92 93, , , , , , , , Website: ; Last modified, 3 March 2011 at 07:28, Wikimedia foundation incorporated. 12. Website: ; Last modified, 14th March 2011, Wikimedia foundation incorporated. 13. Website: Updated Website: Website: Website: Website: Website: