Active Care Final

Normal cervical flexion ROM

60°

Normal cervical extension ROM

80°

Normal cervical rotation ROM

80°

Normal cervical lateral flexion ROM

45°

How much cervical rotation occurs at C1-C2?

40° (50% of total cervical rotation)

How much cervical rotation occurs from C3-C7?

40° (50% of total cervical rotation)

Most cervical rotation occurs where?

Upper cervical spine (C1-C2)

Most cervical lateral flexion occurs where?

Lower cervical spine (~35° of 45°)

Upper cervical coupled motion

Lateral flexion and rotation occur to the SAME side

Lower cervical coupled motion

Lateral flexion and rotation occur to OPPOSITE sides

Protrusion mechanics

Upper cervical extension + lower cervical flexion

Retraction mechanics

Upper cervical flexion + lower cervical extension

What happens to cervical facets during flexion?

Open (move up and forward)

What happens to cervical facets during extension?

Close (move down and back)

What happens to the disc during flexion?

Anterior compression and posterior displacement

What happens to the disc during extension?

Posterior compression and anterior displacement

What happens to the foramina during flexion?

More space

What happens to the foramina during extension?

Less space

What happens to neural tension during flexion?

Increases

What happens to neural tension during extension?

Decreases

Effect of cervical rotation on foraminal size

Ipsilateral decreases, contralateral increases

Effect of cervical lateral flexion on nerve roots/dura

Contralateral tensioning, ipsilateral slackening

Are cervical flexors or extensors stronger?

Extensors

Why are cervical extensors stronger?

Gravity assists flexors

Relative strength of cervical flexors

Flexors are ~60% as strong as extensors

Longus colli function

Dynamic anterior longitudinal ligament, stabilization, prevents hyperextension, counters lordosis

Three stability subsystems

Control (nervous system), Active (muscles), Passive (spinal column)

Primary goal of cervical examination

Rule out red flags and develop a working diagnosis

Most common postural dysfunctions in neck pain

Anterior head carriage, head extension, rounded shoulders/hyperkyphosis, elevated shoulders, scapular winging

Natural history of neck pain

Variable course, recurrent episodes common, complete resolution uncommon

Common risk factors for neck pain

Female sex, middle age, smoking, stress, sleep disorders, sedentary lifestyle

Poor prognostic factors for neck pain

Previous history, older age, sleep disturbance, high-strain job, passive coping

Neck pain with unilateral arm symptoms suggests

Cervical radiculopathy

Neck pain with bilateral arm symptoms and balance issues suggests

Cervical myelopathy

Most common diagnosis causing neck pain

Non-specific/mechanical neck pain

George Costanza method in rehab

Do the opposite of the dysfunction found

Most common cervical trigger point muscles

Upper trapezius and SCM

Where are trigger points actually located?

The brain

Posture exercise prescription

3-5 second holds, 5-10 reps, every 15-20 minutes

Most common cervical directional preference

Extension/lower cervical retraction

Purpose of cervical nodding

Improve upper cervical motion and strengthen deep neck flexors

Repeated retraction/extension loading effect

Can peripheralize symptoms

Purpose of CARs

Improve mobility using active end-range control

Purpose of SNAGs

Improve upper cervical rotation

Purpose of neck planks

Strengthen deep neck flexors

Purpose of positional isometrics

Strengthen deep neck flexors

Purpose of resistance band neck exercises

Strengthen deep neck flexors and reduce neck pain

Wall angels are most useful during which rehab phase?

Functional management (Phase 2/3)

YTWL scapular retractions purpose

Functional scapular strengthening

Wall slides strengthen what?

Deep neck flexors and scapular retractors/depressors

Purpose of prone stability ball pull-aparts

Strengthen deep neck flexors and scapular retractors/depressors

Purpose of sphinx with band

Strengthen deep neck flexors and scapular retractors/depressors

Purpose of prone swimmers

Cervical stability and strengthening

Purpose of DNS positions

Cervical stability and strengthening

Most common thoracic dysfunction

Mobility deficit (especially extension)

Movement hierarchy

Mobility → Motor Control → Functional Patterning

Brugger posture break key components

Sit tall, feet turned out, chin retracted, arms externally rotated, deep breath

Frequency of Brugger posture break

8-10 reps, twice daily

Goals of postural exercise

Restore tonic/phasic balance, reposition spine/ribs/pelvis, improve breathing

Primary inhalation muscle

Diaphragm

Primary exhalation mechanism

Elastic recoil

Benefits of nasal breathing

Parasympathetic activation, improved posture, air filtration, oxygenation, cognition

Effect of inhalation on heart rate

Increases HR

Effect of exhalation on heart rate

Decreases HR

Normal diaphragmatic breathing

Diaphragm descends, abdomen expands cylindrically, bucket-handle expansion

Apical breathing pattern

Excessive chest/sternal elevation

Paradoxical breathing pattern

Abdomen draws inward during inhalation

Signs of faulty breathing

Shallow breathing, rapid breathing, jaw tension, frequent yawning

Breathing retraining focuses on what?

Intra-abdominal pressure and spinal stability

Thoracic mobility exercises

Cat-cow, spinal segmentation, prayer stretch, roll-outs, T-spine extensions, foam roller extensions

Percentage of low back pain that is non-specific

90%

Back pain fact: Is persistent pain usually dangerous?

No

Back pain fact: Does aging cause back pain?

No

Back pain fact: Does imaging usually reveal the cause?

No

Back pain fact: Does pain during movement always indicate harm?

No

Back pain fact: Is back pain caused by bad posture?

No

Back pain fact: Is back pain caused by a weak core?

No

Hyperlordosis muscle imbalance

Overactive erector spinae and hip flexors, inhibited abdominals

Anterior pelvic tilt imbalance

Overactive hip flexors, inhibited glutes and abdominals

Posterior pelvic tilt imbalance

Overactive glutes and hamstrings, inhibited hip flexors and low back

Foot flare imbalance

Overactive external rotators, inhibited internal rotators

Knee valgus imbalance

Overactive adductors, inhibited abductors

Lumbar position during sitting

Flexion

Temporary tissue deformation from sustained posture begins after

~20 minutes

Is sitting commonly aggravating for low back pain?

Yes, often due to sustained flexion

What happens to lumbar extensors during full flexion?

They become silent; passive tissues take over

Is spinal flexion avoidable?

No

Most daily activities require what spinal position?

Flexion

Does flexion commonly aggravate low back pain?

Yes

People without low back pain spend more time in what position?

Extension

People with low back pain spend how much time in extension?

Very little or none

Is flexion during lifting a proven risk factor for low back pain?

No

When are spinal injuries most likely?

Early morning and after prolonged sitting

Primary goal of lumbar rehab

Integrate lumbar spine function with surrounding regions

Best early-stage lumbar stabilization strategy

Segmental stabilization

Primary dysfunctions of the lumbopelvic-hip region

Core instability, breathing dysfunction, hip mobility dysfunction, thoracic dysfunction, poor posterior pelvic tilt control

McGill Big 4 + Dead Bug

Front plank, side plank, curl-up, bird dog, dead bug

Front plank trains

Anterior chain stability

Side plank trains

Lateral chain stability

Curl-up trains

Anterior chain stability