When Mobility Doesn't Stick: The Cervical Spine

Original Post by Dr. Weingroff, DPT, here

It is a great post on why your patient may be losing mobility quickly after gaining it. With his permission, I though I'd apply his very well written and succinct principles to other joints: Today's joint is the cervical spine.

There can be a couple things going wrong if you are working on mobility, achieving it, and then losing it quickly.

1) You are not achieving it

Remember the goal of any stretch, whether it is STM, TASTM, JM, or patient generated forces is to get out of the elastic range of the stress/strain curve, and into the plastic range. The more restricted the tissue, the more stress you have to impart to get a strain that actually deforms the tissues into a new range that doesn't just go back to the original resting length.

2) You are not using it

If you are achieving a new range, then the patient is not! Make sure they are performing there HEP to the specific mode of your prescription. I'm a fan of 10 times/hour for stretching and/or derangement reduction. The stretching will prevent the viscoelastic nature of tissues to go back to their restricted length as much as possible and if deranged, will reduce and hopefully maintain the reduction.

3) You are not integrating it

Once the derangement is reduced and/or the new movement is achieved, restoration of function into ADLs must be integrated. For those with jobs that require a lot of flexion, make sure to educate them the 10 reps/hour is for normal ADLs, not flexing 500 times/hour. It's a simple equation, they must correct for the repeated loading with correction in the directional preference to offset the load. For some, 10 times/hour is suffice, for others like dentists/assistants/hygienists and hairstylists, they may have to do 2-3 reps every 5-10 minutes. The scapula should also repeatedly be set in a neutral position along with the cervical spine.

4) The rest of the body isn't keeping up

Other than MDT exercise prescription, you must integrate any new movement with other movements along the chain. Make sure you are not only doing OMPT on the painful area, but look at the junctional areas, OA, AA, CT, scapulothoracic, glenohumeral, and thoracic. Integrate movements and exercises for these areas if the cervical retractions just aren't cutting it.

Cervical HEP