CERVICAL CENTRALIZATION

Size: px

Start display at page:

Download "CERVICAL CENTRALIZATION"

Laurel Harrison
6 years ago
Views:

CERVICAL CENTRALIZATION Flex with Rotation Sit up straight. Drop the chin down towards the chest. Glide the neck back. Rotate the head to the.

Place your finger against your chin. Retract the neck straight back, moving your chin away from the stationary finger. Perform this exercise as needed to decrease pain.

Keeping your chin down, move the neck forward, toward the stationary finger. Perform this exercise as needed to decrease pain.

1 CERVICAL CENTRALIZATION Flex with Rotation Sit up straight. Drop the chin down towards the chest. Glide the neck back. Rotate the head to the. Perform this exercise as needed to decrease pain. Hold seconds Repeat times Cervical Retraction Sit up straight to bring the head in line with the shoulders. Place your finger against your chin. Retract the neck straight back, moving your chin away from the stationary finger. Perform this exercise as needed to decrease pain. Hold seconds Repeat times Cervical Protraction Sit up straight to bring the head in line with the shoulders. Place your finger out in front of your chin. Keeping your chin down, move the neck forward, toward the stationary finger. Perform this exercise as needed to decrease pain. Hold seconds Repeat times Towel Traction Fold a towel to a width of ~ 3. Place the center of the towel at the base of the head. Grasp the edges of the towel and extend your arms overhead, creating a gentle pull on the neck. If you are unable to sufficiently relax your neck and shoulders, have someone pull for you. Hold seconds/minutes.

CERVICAL EXTENSOR TRAINING HEAD PRESS Lie down or sit up as directed by your therapist. Place your hands behind your head. Be careful not to press your head forward with your hands.

2 CERVICAL EXTENSOR TRAINING HEAD PRESS Lie down or sit up as directed by your therapist. Place your hands behind your head. Be careful not to press your head forward with your hands. Gently push your head back into your hands. Turn head from side to side as directed by your therapist. Try to localize the effort to the center of the neck as much as possible. Repeat time(s). Total time mins. HEAD LIFT Maintain the chin in proximity with the Adam s apple. Keeping the face horizontal, bring the head straight back, moving at the base of the neck. Keep the shoulders relaxed. Try to localize the effort to the center of the neck as much as possible. Total time mins. HEAD TURN Maintain the chin in proximity with the Adam s apple. Keeping the face horizontal, bring the head straight back, moving at the base of the neck. Turn head to the side, maintaining chin tuck, as if pivoting the head on skewer. Try to localize the effort to the center of the neck as much as possible. Total time mins.

3 CERVICAL FLEXOR TRAINING Chin Tuck: 1. Lie down on your back, knees bent. Focus on relaxing your head, neck, and shoulders. Slowly and carefully elongate the neck by sliding the back of the head away from the shoulders. You might also think of this movement as looking down at your knees, tucking your chin, or making yourself taller. Do not lift your head or press it down into the supporting surface as you perform this motion unless instructed to do so by your therapist. 2. It is very important that you avoid tightening the muscles on the sides and back of the neck as you perform this motion. The target muscles for this exercise are located in the front of the neck, behind the throat. That is the only place you should feel muscle exertion. Keep in mind that the level of activation for these muscles during this movement is 10-25% of a maximum contraction, so this exercise should not feel like a lot of effort. If directed, add resistance to this motion by applying pressure from your thumb as shown in the picture. 3. Hold this gentle contraction for seconds. Repeat times, or for a total of minutes. Head Lift: 1. Assume the chin tuck position as described above. Ensure that you are keeping the shoulders and sides/back of the neck relaxed before proceeding. Very slowly, while maintaining the chin tuck, begin to curl your head up from the supporting surface. Think of gliding your neck vertebrae backwards as you lift. Once you have cleared your head from the surface, stop and hold. 2. It is very important that you avoid tightening the muscles on the back of the neck and in the shoulders as you perform this motion. You will feel some tension in the front and sides of the neck with this exercise, as this exercise requires more effort than the chin tuck. If you feel tension developing in any other areas, lower your head down and rest. 3. Hold position for seconds. Repeat times, or for a total of minutes. Arm Lift: Perform chin tuck/head lift as previously described. Once in position, slowly raise one or both arms from the supporting surface as shown. Maintain tension in the front and sides of the neck. If you feel tension developing in the top of the shoulders or back of the neck, lower your head and arms and rest. Add lbs per arm. Hold seconds. Repeat times, or for a total of minutes.

CERVICAL-LUMBAR EXTENSOR TRAINING FOR THORACIC EXTENSION DYSFUNCTION HEAD PRESS Lie down or sit up as directed by your therapist. Place your hands behind your head.

4 CERVICAL-LUMBAR EXTENSOR TRAINING FOR THORACIC EXTENSION DYSFUNCTION HEAD PRESS Lie down or sit up as directed by your therapist. Place your hands behind your head. Be careful not to press your head forward with your hands. Gently push your head back into your hands. Keep your sternum tucked in as your perform this motion. Repeat time(s). Total time mins. HEAD LIFT Maintain the chin in proximity with the Adam s apple. Keeping the face horizontal, bring the head straight back, moving at the base of the neck. Keep the shoulders relaxed. Keep the sternum tucked in (mid back pushed to the ceiling) as you perform this motion. Total time mins. TRUNK RAISE Allow head and upper back to extend over the edge of a firm supporting surface. Tuck your sternum into your chest, rounding out your middle back. Maintain your position using your low back muscles. Total time mins.

5 CERVICAL-LUMBAR FLEXOR TRAINING FOR THORACIC FLEXION DYSFUNCTION HEAD LIFT Tuck the chin down toward the neck about 50% of the available range. Then, perform a curling motion of the head, leading with the forehead. Lift the head no more than one inch from the supporting surface. Do not allow mid back to press down (round) into table while performing this motion. Repeat time(s). Total time mins. HEAD LIFT WITH ARM LIFT Perform head lift as directed in first exercise. Hold this position. Lift arms off supporting surface. Do not allow mid back to press down (round) into table while performing this motion. Total time mins. DOUBLE LEG RAISE Pre-tighten lower abdominal muscles. Use lower abdominal muscles to support both legs a few inches away from the table. Do not allow mid back to press down (round) into table while performing this motion. Total time mins.

CT SPINE MOBILIZATION TENNIS BALLS Place 2 tennis balls next to each other at the base of the neck/upper thoracic spine.

To increase ball pressure, place your hands behind the head. Relax. Sustain minute(s).

Turn your trunk and shoulders to the side. Turn you head to the opposite side.

. PEC STRETCH Place a foam roller or a firmly rolled large sheet down the middle of the spine.

6 CT SPINE MOBILIZATION TENNIS BALLS Place 2 tennis balls next to each other at the base of the neck/upper thoracic spine. Allow the head and back to relax, letting the pressure of the balls push into the spine. To increase ball pressure, place your hands behind the head. Relax. Sustain minute(s). TENNIS BALLS WITH HEAD TURN Place 2 tennis balls next to each other at the base of the neck/upper thoracic spine. Turn your trunk and shoulders to the side. Turn you head to the opposite side. Pressure should increase on the ball that your head is turning away from.. PEC STRETCH Place a foam roller or a firmly rolled large sheet down the middle of the spine. Maintain head, shoulders, mid and low back in contact with supporting surface. Tilt shoulder blades back and down, until a stretching sensation is felt in the upper part of chest. Hold second(s). TENNIS BALL WITH HEAD EXTENDED Position yourself at the edge of a firm supporting surface. Place 2 tennis balls next to each other at the base of the neck/upper thoracic spine. Extend your head back, using your arms for head support as needed. Try to keep your chin tucked while extending.

UPPER CERVICAL MOBILIZATION TOWEL TURN Place the center of a towel at the base of the head/upper cervical spine. Fix one end of the towel.

Once you have reached the end of your range of motion, use the free end of the towel to pull your neck into more rotation.

Hold seconds Repeat times TOWEL PULL Wrap a towel around the top of the neck. Pull the towel forward while tucking the chin.

7 UPPER CERVICAL MOBILIZATION TOWEL TURN Place the center of a towel at the base of the head/upper cervical spine. Fix one end of the towel. Turn your head in the direction of the fixed end of the towel. Once you have reached the end of your range of motion, use the free end of the towel to pull your neck into more rotation. You should feel a light stretch at the top of the neck. Perform this exercise sitting up or lying down, as directed by your PT. Hold seconds Repeat times TOWEL PULL Wrap a towel around the top of the neck. Pull the towel forward while tucking the chin. You should feel a light stretch at the base of the skull. Hold seconds Repeat times HEAD TILT Sit up straight, chin slightly tucked. Wrap your hands around your neck to keep the neck immobilized. Lift your ear up toward the ceiling, as directed by your therapist. You should feel a light stretch, near the base of the skull, on the side that is lifting. Hold seconds Repeat times

LOWER CERVICAL MOBILIZATION SCALENE STRETCH Sit up tall and use your hand, or a long sheet, to anchor the collar bone and rib on the side to

The stretch should be felt on the front/side muscles of the neck (see X). Sustain minute(s).

Apply gentle overpressure as tolerated with the opposite hand. The stretch should be felt on the back/side muscles (see X) Repeat time(s).

Press in the direction of the arrow. Allow the head to tilt toward the hand applying pressure as you press in.

8 LOWER CERVICAL MOBILIZATION SCALENE STRETCH Sit up tall and use your hand, or a long sheet, to anchor the collar bone and rib on the side to be stretched. Tip head away and back, as if you re lifting your head off your body. The stretch should be felt on the front/side muscles of the neck (see X). Sustain minute(s). LEVATOR STRETCH Place your arm behind your neck on the side to be stretched. Look down and away from your arm. Apply gentle overpressure as tolerated with the opposite hand. The stretch should be felt on the back/side muscles (see X) Repeat time(s). HEAD TILT Use the outer aspect of your pinkie finger to press into the back/side of the neck at the level of soreness. Press in the direction of the arrow. Allow the head to tilt toward the hand applying pressure as you press in. Hold seconds Repeat times UPPER TRAP STRETCH Sit up straight (slight chin tuck) with the hand of the involved side anchored under hip. Let head side-bend away. Add slight over-pressure with the opposite hand. The stretch should be felt on the outside muscles of the side you are bending away from. Hold seconds Repeat times

Lift from the tips of the shoulders, not the base of the neck. Progression: Hold arms off the wall. Press lb weights into air as you shrug. Repeat time(s), for a total of mins.

12 UPPER TRAPEZIUS TRAINING Wall Slide Stand about one foot away from a wall or door. Place forearms on the wall in a vertical orientation. Slide forearms up the wall until movement in the shoulder ceases. Do not lean into the wall or allow the forearms to leave the wall. At the top of the motion, shrug the shoulder blades up. Lift from the tips of the shoulders, not the base of the neck. Progression: Hold arms off the wall. Press lb weights into air as you shrug. Repeat time(s), for a total of mins. High Row Maintain an upright spinal posture as you bring your arms above shoulder height. Use bands or weights for resistance. Shrug your shoulders up at the end of the motion. Lift from the tips of the shoulders, not the base of the neck. Repeat time(s), for a total of mins.

MID AND LOW TRAP TRAINING RETRACTION Hang the arm over the edge of a supporting surface.

You should feel tension between your shoulder blades with this exercise. Avoid tension into the neck or top of the shoulder. Hold seconds.

Once in position, slowly raise your arm out to the side. You should feel tension primarily in the area of the white arrow.

RETRACTION WITH OVERHEAD RAISE Assume the arm and shoulder blade position described in the retraction exercise at the top of the page.

13 MID AND LOW TRAP TRAINING RETRACTION Hang the arm over the edge of a supporting surface. Keeping the arm relaxed, pull your shoulder blade across (toward the spine), or down (toward the hips), as directed by your therapist. You should feel tension between your shoulder blades with this exercise. Avoid tension into the neck or top of the shoulder. Hold seconds. Repeat times, for a total of mins. RETRACTION WITH LATERAL RAISE Assume the arm and shoulder blade position described in the retraction exercise at the top of the page. Once in position, slowly raise your arm out to the side. You should feel tension primarily in the area of the white arrow. Avoid tension in the neck or top of the shoulder. Repeat time(s), for a total of mins. RETRACTION WITH OVERHEAD RAISE Assume the arm and shoulder blade position described in the retraction exercise at the top of the page. Once in position, slowly raise your arm overhead. You should feel tension primarily in the area of the white arrow. Avoid tension in the neck or top of the shoulder. Repeat time(s), for a total of mins. SNOW ANGEL Stand with your back to a door, shoulders and elbows flexed to 90degrees. Using your shoulder blades, create an arching motion of the arms, moving them up the door until motion ceases. You should feel tension primarily in the mid back. Repeat time(s), for a total of mins.

SERRATUS TRAINING Punches Lie on back with arm extended out in front of you, palm up. Imagine that you are holding something heavy that you need to place on a shelf in front of you.

Keep the top of the shoulder, neck, and chest as relaxed as possible. Use your opposite hand to resist motion at the shoulder blade to improve performance.

14 SERRATUS TRAINING Punches Lie on back with arm extended out in front of you, palm up. Imagine that you are holding something heavy that you need to place on a shelf in front of you. Slowly extend your arm away from your body. Try to make this motion come from the bottom edge of the shoulder blade, below the armpit. Keep the top of the shoulder, neck, and chest as relaxed as possible. Use your opposite hand to resist motion at the shoulder blade to improve performance. Progression: Elevate arms above shoulder height while reaching out (see arrow in picture) Hold seconds. Repeat times. Total of mins. Push-Up Plus Prop up on your elbows and knees. Using the muscles below your armpits, lift your chest away from the floor. Think about tucking your sternum into your chest, and rounding out your upper back. Keep neck and top of shoulders relaxed. Hold seconds. Repeat times. Total of mins. Overhead Raise Hold one arm at shoulder height in front of body, elbow flexed to 90. Using the muscles below the armpit, reach the arm diagonally, across the face, until the crease of the elbow is around eye level. Do not allow the head or back to move. Hold seconds. Repeat times. Total of mins.

THORACIC MOBILIZATION SIDE STRETCH Reach one arm up toward the ceiling.

Encourage the movement to come from the middle back.

LAT STRETCH Maintain head, shoulders, mid and low back in contact with supporting surface.

Maintain full elbow to hand contact as arms flex back overhead.

SPINE ROLLER Lie down cross-wise over a ~3 firmly rolled sheet or foam roll.

15 THORACIC MOBILIZATION SIDE STRETCH Reach one arm up toward the ceiling. If directed by your therapist, use opposite hand to anchor ribs down on the side of stretch. Encourage the movement to come from the middle back. Breathe in as you reach up to encourage additional rib movement. LAT STRETCH Maintain head, shoulders, mid and low back in contact with supporting surface. Bring hands and elbows together at the midline of body. Maintain full elbow to hand contact as arms flex back overhead. Do not allow low back to break contact with supporting surface. Hold second(s). SPINE ROLLER Lie down cross-wise over a ~3 firmly rolled sheet or foam roll. Localize the roll to your middle back as directed by your therapist. Extend your arms toward the ceiling. Rock your trunk back and forth on the roll, or extend your arms overhead, as directed. Repeat seconds/minutes. RIB ROLLER Lean onto a 6 foam roller or firmly rolled sheet/ball. Try to sidebend your body over the roller. For additional stretch, raise your top arm overhead. Roll forward/backward on the roll as directed by your therapist. Repeat seconds/minutes.

THORACIC CENTRALIZATION QUADRUPED FLEXION From a hands and knees position, rock your hips back onto your heels.

Tuck your sternum into your chest, rounding out your middle back.

Use your arms to push up, allowing your elbows to fully extend at the end of the motion.

16 THORACIC CENTRALIZATION QUADRUPED FLEXION From a hands and knees position, rock your hips back onto your heels. Arch your middle back up at the end of the motion. PRONE ON ELBOWS FLEXION Prop up on your elbows and knees. Tuck your sternum into your chest, rounding out your middle back.. PRONE PRESS UPS Lie down flat on your stomach with your hands resting on either side of your head. Use your arms to push up, allowing your elbows to fully extend at the end of the motion. Allow your middle back to sag in at the top of the motion. Keep the back and hips relaxed at all times Hold second(s). SEATED EXTENSION Sit in a chair with a backrest that comes to your mid back. Elevate the knees above the hips. Assume hands behind head position and lean back to stretch middle back.

THORACIC EXTENSOR TRAINING CHEST RAISE Lie down on your back with your knees bent. Arch your middle back (between your shoulder blades) away from the supporting surface.

SCAPULA LIFT Support the head and chin with rolled towels to ensure that the neck stays relaxed throughout this exercise. Pull the collar bones back away from the table.

Progress to lifting the hands off the table 1 inch. Tension should primarily be felt between the shoulder blades. Repeat time(s). Total of mins.

17 THORACIC EXTENSOR TRAINING CHEST RAISE Lie down on your back with your knees bent. Arch your middle back (between your shoulder blades) away from the supporting surface. Your sternum should raise up to the ceiling. You should feel tension in the muscles along your spine, between your shoulder blades. Do not let your low back tense or arch off the table. Total of mins. SCAPULA LIFT Support the head and chin with rolled towels to ensure that the neck stays relaxed throughout this exercise. Pull the collar bones back away from the table. Think of flattening your middle back as you perform this motion. Initially, keep your hands in contact with the table, and your arms away from the sides of your trunk, while performing this motion. Progress to lifting the hands off the table 1 inch. Tension should primarily be felt between the shoulder blades. Repeat time(s). Total of mins. TRUNK LIFT Lie down on your stomach, hands behind your head. Slowly lift the chest off the supporting surface with emphasis placed on the muscles of the upper back, between the shoulder blades and closest to the spine. Avoid over-activation of the neck or lower back. Hands can be placed at the sides instead of behind the head if the exercise is too difficult. Total of mins.

TOWEL CURL UP Place a towel under your upper back and head. Reach your hands back to the towel and hold the top edges. Tuck your sternum into your chest, rounding out your middle back.

18 THORACIC FLEXOR TRAINING QUADRUPED FLEXION Prop up on your elbows and knees. Tuck your sternum into your chest, rounding out your middle back. Use your upper abdominals and the muscles below your armpits to complete this motion. Hold your head straight as you perform this motion. Total mins. TOWEL CURL UP Place a towel under your upper back and head. Reach your hands back to the towel and hold the top edges. Tuck your sternum into your chest, rounding out your middle back. Use your abdominal muscles to lift your chest off the bed. Keep head and hands back, in contact with the towel.. Total mins. CURL UP Tuck your sternum into your chest, rounding out your middle back. Use your upper abdominal muscles to lift your chest off the bed. Total mins.

University of Texas Southwestern Medical Center Physical Therapy 6011 Harry Hines Blvd.

Tongue Cluck make a clucking noise with your tongue.

Tongue tip on ridge behind top, front teeth. Lips closed gently. Teeth parted slightly.

Remember to: Place tongue tip on roof of mouth Monitor joint with one finger 3.

a variety of directions to promote normal positioning of the jaw.

Upper Cervical Distraction - relieve pressure at the base of your skull.

20 University of Texas Southwestern Medical Center Physical Therapy 6011 Harry Hines Blvd. Dallas, TX Rocabado 6X6 Exercises 1. Tongue Cluck make a clucking noise with your tongue. Use this to remind yourself of the proper rest posture. Tongue tip on ridge behind top, front teeth. Lips closed gently. Teeth parted slightly. Breast bone elevated (imagine a string tugging upward) Head over shoulders Shoulders relaxed Comments: 2. Turn the knob and open the door controlled rotation on opening and closing your jaw. Remember to: Place tongue tip on roof of mouth Monitor joint with one finger 3. Jaw Stabilization - place your jaw in its proper rest position and apply resistance in a variety of directions to promote normal positioning of the jaw. Press up Press down Press to left Press to right 4. Upper Cervical Distraction - relieve pressure at the base of your skull. Hug your neck with your hands Nod your head to feel a stretch at the base of your skull 5. Cervical Retraction - correct forward head posture and align head, neck and jaw. Sit up tall Draw head back, chin level 6. Shoulder Blade Squeeze - pull your shoulder blade back toward your spine and shrug down. Poor position Good position

21 University of Texas Southwestern Medical Center Physical Therapy 6011 Harry Hines Blvd. Dallas, TX Jaw Mobility Exercises Turn the knob and open the door controlled rotation on opening and closing your jaw. Comments: Phase I Phase II Phase III Phase IV Hold seconds. Repeat times. Controlled Motion with Tongue Blade Opening and closing Slide jaw left Slide jaw right Hold seconds. Repeat times. Passive Stretching Thumb pads behind canine teeth, middle fingers on central jaw. Relax facial muscles and allow your fingers to do the work. Hold maximum opening for seconds. Repeat times.

Snow Angels on Foam Roll

Snow Angels on Foam Roll Thoracic Mobilization on Foam Roll Lie on your back with a foam roller positioned horizontally across your mid back, and arms crossed in front of your body. Bend your knees so your feet are resting flat