Cervico-Thoracic Management Exercise and Manual Therapy. Deep Neck Flexor Training. Deep Neck Flexor Training. FPTA Spring 2011 Eric Chaconas 1

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1 Cervico-Thoracic Management Exercise and Manual Therapy Eric Chaconas PT, DPT, CSCS, FAAOMPT Deep Neck Flexor Training Evidence of dysfunction in the longus coli and longus capitus. Chronic Neck Pain Idiopathic Neck Pain Whiplash Associated Disorder 2 Deep Neck Flexor Training 3 FPTA Spring 2011 Eric Chaconas 1

2 Deep Neck Flexor Training 4 Deep Neck Flexor Training 5 Peri-Scapular Training 6 FPTA Spring 2011 Eric Chaconas 2

3 Low Level Middle Trapezius Prone Row Scaption below 80 ER Lower Trapezius Prone ER Latissimus Dorsi Standing extension Peri-Scapular Training 8 Peri-Scapular Training 9 FPTA Spring 2011 Eric Chaconas 3

4 Middle Trapezius - Rhomboids 10 Lower Trapezius 11 Peri-Scapular Training 12 FPTA Spring 2011 Eric Chaconas 4

5 Middle Trapezius - Rhomboids 13 Low Level Serratus Anterior Wall push up plus Supine punch Scaption below 80 with ER Rhomboids Prone Row Standing Row 45 and Wall Protraction 15 FPTA Spring 2011 Eric Chaconas 5

6 Serratus Punch With Perturbation 16 Moderate Level Serratus Anterior Knees push up plus Push up plus Scaption above 120 ER D1 Flexion Rhomboids ER in neutral Prone horizontal abduction IR 17 Knees Protraction 18 FPTA Spring 2011 Eric Chaconas 6

7 Floor Protraction 19 D1 Flexion 20 Closed Chain Serratus 21 FPTA Spring 2011 Eric Chaconas 7

8 Closed Chain With Perturbation 22 Middle Trapezius - Rhomboids 23 Moderate Level Middle Trapezius Prone extension Prone horizontal abduction 135 with ER Lower Trapezius Prone Horizontal abduction 135 Prone 90 Latissimus Dorsi Standing extension FPTA Spring 2011 Eric Chaconas 8

9 Middle Trapezius - Rhomboids 25 Middle-Trapezius 26 Lower Trapezius 27 FPTA Spring 2011 Eric Chaconas 9

10 Lower Trapezius 28 EMG Muscle Activity References Bagg SD, Forrest WJ. Electromyographic study of the scapular rotators during arm abduction in the scapular plane. Am J Phys Med 1986; 65(3): Decker MJ, Hintermeister RA, Faber KJ, et al. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med 1999;27(6): Ebaugh DD, McClure PW, Karduna AR. Scapulothoracic and glenohumeral kinematics following an external rotation fatigue protocol. J Orthop Sports Phys Ther. 2006; 36(8): Elkstrom RA, Donatelli RA, Soderberg GL. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. J. Orthop Sports Phys Ther 2003; 33(5): Freeman S, Karpowicz A, Gray J et al. Quantifying muscle patterns and spine load during various forms of the push-up. Med Sci Sports Exerc 2006; 38(3): Hardwick DH, Beebe JA, McDonnell MK. Et al. A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. J Orthop Sports Phys Ther 2006; 36(12): Ludewig PM, Hoff MS, Osowski EE, et al. Relative balance of serratus anterior and upper trapezius muscle activity during push up exercises. Am J Sports Med 2004; 32(2): Reinold MM, Wilk KE, Fleisig GS, et al. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther (7): Schachter AK, McHugh MP, Tyler TF, et al. Electromyographic activity of selected scapular stabilizers during glenohumeral internal and external rotation contractions. J Shoulder Elbow Surg. 2010;19(6): Deep Neck Flexor Training Armstrong BS, McNair PJ, Williams M. Head and neck position sense in whiplash patients and healthy individuals and the effect of the craniocervical flexion action. Clin Biomech. 2005; 20(7): Cagnie B, D Hoodge R, Achten E, et al. A magnetic resonance imaging investigation into the function of the deep cervical flexors during the performance of craniocervical flexion. J Manipulative Physiol Ther. 2010; 33(4): Falla D, O Leary S, Farina D, Jull G. Association between intensity of pain and impairment in onset and activation of the deep cervical flexors in patients with persistent neck pain. Clin J Pain Dec(20) Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009; 14(6): O'Leary S, Falla D, Hodges PW, Jull G, Vicenzino B. Specific therapeutic exercise of the neck induces immediate local hypoalgesia. J Pain. 2007; 8(11): FPTA Spring 2011 Eric Chaconas 10

11 Management of the Cervicothoracic Spine: An Evidence Informed Approach FPTA Spring Conference Viti J, Chaconas E, Rot J, Stanborough R. Mid-Cervical Upslide Patient Position: Supine lying with a neutral position of the cervical spine. Therapist Position: Standing at the head of the table gently supporting the occiput with the left hand, right hand in position to contact the cervical articular pillar. Technique: The therapist will utilize the right first phalanx to contact the cervical articular pillar on the right side of the spine. The therapists right hand will support the cervical spine while a force is provided in the facet plane. As the upward force is provided by the therapist it is important to hook the articular pillar resulting in an upslide motion of the facet. Reference: Paris SV. S1 Introduction to Spinal Evaluation and Manipulation. 4 th ed. University of St. Augustine for Health Sciences; 1997:87

12 Management of the Cervicothoracic Spine: An Evidence Informed Approach FPTA Spring Conference Viti J, Chaconas E, Rot J, Stanborough R. Upper Thoracic Rotation Patient Position: Seated and supported with pillows under the arms. Therapist Position: Standing behind the patient, right thumb contacts lateral to the inferior spinous process, left thumb lateral to the superior spinous process. Technique: As the patient moves into left rotation, the therapist provides a medial force with the left thumb and an opposing force through the right thumb. Reference: Paris SV. S1 Introduction to Spinal Evaluation and Manipulation. 4 th ed. University of St. Augustine for Health Sciences; 1997:87

13 Management of the Cervicothoracic Spine: An Evidence Informed Approach FPTA Spring Conference Viti J, Chaconas E, Rot J, Stanborough R. Supine Mid-Thoracic Manipulation (Same Side Arm) Patient Position: Long sitting with arms across chest, grasping opposite shoulders. Therapist Position: Standing at the side of the patient, left hand makes contact to the transverse processes with the fist in a position of opposition. The thenar eminence will contact the right transverse process and the flexed 4 th and 5 th fingers will contact the left transverse process. Technique: The therapist supports the patients head and neck with the right hand. The patient will be lowered to the mat slowly while contact is maintained with the center of the therapists chest over the center of the patients body. As the neck is maintained in a flexed position the therapist imparts a high velocity low amplitude therapeutic movement through his own torso into the patient in a posterior direction. Reference: Paris S, Irwin M, Yack L. S2 Advanced Evaluation and Manipulation of Pelvis, Lumbar and Thoracic Spine. University of St. Augustine for Health Sciences; 2004: