cervical dynamic stabilization/motor control

global vs local active stabilizing system for c-spine

- global: superficial flexors and extensors (multi-segmental)

- local: deep flexors and extensors (segmental control)

what are the superficial neck flexors

- SCM

- scalenes

*joint excursion & force

what are the deep neck flexors

- longus capitis (flexes head on neck)

- longus colli

*stability & support cervical lordosis

what are the superficial neck extensors

- splenius capitus

- semispinalis capitus

*joint excursion & force

what are the deep neck extensors

- multifidi, rotatores

- semispinalis cervicis

*proprioceptive feedback mechanism

what happens when deep cervical flexors lose endurance and strength?

superficial substitute

overuse of ____ and weakness of _____ in presence of neck pain

- levator scap

- upper trap

cervicogenic headaches show a positive response to training of what group of muscles?

DNF

atrophy of what muscle group is found in patients with neck pain related to whiplash?

DNE

craniocervical flexion test

- deep cervical flexor strength/control

- place BP cuff behind neck, abuts occiput

- inflate to 20 mmHg

- tell pt to tuck chin in and nod

- pt increases by 2 mmHg each time they nod (hold 10 seconds)

- relax back to 20mmHg in between

- normal: change in 10mmHg w/ 10 second hold

common substitutions for craniocervical flexion test

- superficial cervical flexor use

- neck retraction

- performed quickly and w/o control

- too forceful

- teeth clenched

- holding breath

- too much movement

findings for craniocervical flexion test for those with chronic neck pain

only able to produce 2-4 mmHg

deep neck flexor endurance test

- pt performs maximal chin tuck and lifts ~1in off table

- pt holds position

- PT focuses on neck folds; when folds begin to separate >1 sec, test ends

cervical extensors endurance test

- prone, head and neck just past edge of table w/ CT junction stabilized

- sustain chin tuck for 20 secs

- loss of chin tuck = superficial extensor dominance (weak deep)

- neck moves into flexion/can't hold head up = weak deep and superficial

before work on endurance of cervical muscles you must

work on motor control (selective recruitment of DNF)

motor control phase of craniocervical flexion exercise

- 20-30 mmHg, increments of 2

- 5 sec x 5 with 15-30 sec rest

- stop at form fatigue

endurance phase of craniocervical flexion exercise

- start where pt can hold w/o compensation for 10 secs

- 10 sec x 10 with 5 sec rest

- stop at form fatigue

(progress to holding with UE/scapular muscle exercises)

what is the last phase of craniocervical flexion exercise?

functional

for cervical stabilization, what are different ways to work on chin tuck/DNF?

- sitting

- supine

- prone

- UE motions/resistance

- functional movements

- unstable surfaces

examples of chin tuck in standing with UE exercise

- pulldowns

- rows

- wall push ups

- Bilateral shoulder ER

- shoulder flexion (uni vs bi)

examples of cervical stabilization program for DNE w/ UE exercise

- prone with head over table, keep neck extended

- perform Is, Ys, and Ts