Here are 5 tips on getting to end range for a cervical derangement with a loss of cervical SB.
I discovered some of these things recently on vacation at Disneyworld!
1) Make sure the patient has good alignment prior to starting the exercise
- many patients correctly demonstrate the exercise without worsening in the clinic, but say it made them worse between visits
- increase the lumbar lordosis, elevate the sternum, scapula set, then perform the exercise, does it still hurt? They may need some manual work to improve the movement quality
- a caveat, if the cervical SB has PDM, and it increases and remains worse, you may try slight flexion to get to a further end range
2) Educate them on the difference between increase and no worse
- patients hear you, but often do not really listen or understand
- many patients are noncompliant in fear of pain with movement
- make sure they know to push through it a few times, really get to end range, and then see what happens
- much like any manual technique, if an exercise is uncomfortable, it should not remain worse as a result
- plus, they should increase the frequency of the exercise as long as it does not remain worse if they have a loss of motion
3) Slack the contralateral upper trap
- patients following directions and getting to end range often feel "sore" in the contralateral upper trap
- have them use an arm rest, lean into it to passively elevate the contralateral scapula, slacking the upper trap, this often increased end range into the DP
4) If end range is excessively painful try isometrics
- is this just PNF, it sure is!
- on vacation, I woke up with a severe loss of motion with cervical SB to the right and extension deviated to the left
- I immediately started hammering away at retractions and SB toward the painful side
- the motion increased, but the end range pain did not
- I found by performing isometric hold relaxes at the end enabled slightly increased ROM, and significantly decreased pain
- this is also very easy to instruct to your patients who are having difficulty performing end range
5) To decrease pain during whether moving toward the DP or back to neutral, try resistance during the motion
- this is basically agonist reversals, but I also noticed giving light resistance to my head significantly reduced the pain during the range in both directions (SB right and return to neutral)
PNF + MDT = less pain, increased compliance, better derangement reduction!
Have a great weekend everyone!
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