Neck and thoracic extensor strengthening | The MSK Physio
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- čas přidán 25. 06. 2024
- Neck and thoracic extensor strengthening | The MSK Physio
Neck endurance article - themusculoskeletalclinic.co.n...
Neck pain and disability is the third cause of disability worldwide across all age groups (1).
Like most chronic pain, it is multifaceted (2). Unless there is an obvious cause, such as an acute injury like a strain from movements, collisions in sports or car crashes, your neck pain and disability may be related to many things. Research indicates these could be factors such as endurance, flexibility, depression, anxiety, pain catastrophizing and social determinants, to name a few (2-4). While structural issues can also contribute, they do not always correlate to results found on X-rays, MRIs and CT scans (1).
As always, a good assessment is important! It is relevant to have a health professional help you understand what may be going on, especially if that cause of pain does not relate to a specific injury or cause. As discussed in our lower back workshop. We can filter what may contribute to our pain using the below framework.
Below is an exercise which aims to strengthen the cervical and thoracic extensor muscles. Home exercise programs that include strengthening exercises have been shown to be effective in reducing pain and disability in specific and non-specific neck pain populations (3).
Personally, I find this movement extremely useful as a teaching tool. You get instant feedback from the ground, along with straightforward progression or regression options. I find patients learn faster with this movement over resistance exercises with bands or a cable machine. Not to say those exercises aren’t helpful. I just find this particular exercise as a better entry point for learning.
References:
1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006 Jun;15(6):834-48.
2. Walton DM, Balsor B, Etruw E. Exploring the Causes of Neck Pain and Disability as Perceived by Those Who Experience the Condition: A Mixed-Methods Study. ISRN Rehabilitation. 2012 Nov 14;2012:1-7.
3. Zronek M, Sanker H, Newcomb J, Donaldson M. The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature. J Man Manip Ther. 2016 May;24(2):62-73.
4. Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. Do psychological states associate with pain and disability in chronic neck pain patients? Journal of Back and Musculoskeletal Rehabilitation. 2015 Jan 1;28(4):797-802.
Chapters:
0:00 - Intro
0:58 - Anatomy discussion
1:38 - Who might suit this exercise?
3:43 - How to do the exercise
4:15 - How to progress the exercise
4:59 - How to regress the exercise
6:03 - How much should you do?
7:39 - Outro
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#themskphysio #neckexercises #thoracicmobility
that works for a while (on a flat surface) then not anymore, then only sometimes. I watched this video more than 10 time but I'm missing an important piece of information probably on how to position the head (maybe because there are several ways to do it with the chintuck). On a flat surface, should we start with chintuck (double chin) then push the head? Should the low back, and or the shoulders contract too or remains lose?
The end goal for technique would be able to lift your chest, shoulder and, lower back off the surface. Chin tucked will make this harder, chin untucked will be easier - in most cases. Neither is better or worse as such. Focus on what is hard for you. The shoulders eventually will be loose - as your erectors become stronger.
great video
Theres a few back muscles that i cant seem to find much about strengthening exercises online. I wonder if you could cover them one day?
they are
1. semispinalis thoracis, cervicis and capitis and spinalis
2. upper and middle multifidus (lumbar is covered extensively but not much on upper activation)
3. longissimus
Also, do you do any exercises for hiatal hernia?
Thanks mate! Sure thing. I'll add it to the list 😊.
Much of these exercises will include those muscles just by nature of putting load through the area.
Re hernia. It can be tricky if the integrity of the passive tissue has been compromised. Check out the stomach vacuum exercise on the channel. That would be a place to start 👍. Changing some lifting strategies may help too. Hard to reduce though👌. If it is symptomatic best to get some medical input to make an informed decision on management.
Vacuum exercise - czcams.com/video/tR4FGK-Yzq0/video.html
@@theMSKphysio thank you, i will give all of them a try
Can you suggest exercises for those with Cranio-Cervical Instability? Where ligaments are too laxed and they need to strengthen the occipital muscles.
Sure thing. It is tricky to isolate during testing. This makes identifying an impairment to inform your exercise prescription tricky. Essentially the clinical accuracy of the tests hasn't been thoroughly established yet. So what can we do? We need to challenge the head on the neck, as these are the attachment points. The goal would be to limit neck movement and emphasise head movement. You could go the other way but it gets pretty awkward to keep your head still and move your body :). I have a few videos trying to emphasise head movement on the neck. They are roughly ordered in difficulty levels. More relative to coordination.
1. czcams.com/video/HSr4wcXoAhs/video.html
2. czcams.com/video/b4gg9velMhk/video.html
3. czcams.com/video/q5C9rhIMOJQ/video.html
4. czcams.com/video/15Lm-R9FT0A/video.html
Consider flexion exercises as well. It is useful to exercise both sides of a joint. A quick search on the channel will bring these up :).
What about the lower back: should we keep it straight, or should be bend it ?
No issue with bending the back 😊. The harder your press, the more you recruit.
I'm confused about the chin down thing which can be done in many ways: you advise to look down, between the legs but does it mean we should tilt the head forward (that's the way to look more down)?
Apologies about the clarity. Yes, precisely. Head tilt forward.
@@theMSKphysio Thanks for your responses! (Comments under your videos are really helpful).
Could this exercice (4:28) be done on the belly using weight like in your other video (by raising the head up a bit) czcams.com/video/2iGz2_N9FtY/video.html Are they similar (do they strengthen the same muscles)?
Extremely similar. The difference is when you are on your back you can more easily use/feel your pelvis in creating the force. In the linked video, it is more purely head. Value in both. The linked video at least has some research around it with standardised scores to consider! I use this exercise more for those needing to improve upper body flexibility.
This is impossible because I’m stuck in a breathing with my neck pattern. Whenever I go against a wall I’m too lordotic. Bending the knees is the only way to get my back flat. After bending if I attempt to get my head against the wall my jaw hurts or I can’t breathe. Difficult stuff.
I hear ya! Breathing patterns are tricky to unravel. More passive support and a change of position might be your answer. Have you tried a prone position? This exercise can help one start to quieten down the other muscles/regions trying to help out - czcams.com/video/53IqrQj4jbs/video.html
There is also a link to a couple articles I put together in the description, which you may find useful to help problem solve the scenario.
Interesting exercise - I notice you mentioned inhalation/exhalation. I was stuck in a deep forward head/kyphosis posture for 20 years (I'm 38) so the back of my head wouldn't touch the wall in standing. I used this move (czcams.com/video/cN6wLjzkdAo/video.html) and it got me out of forward head posture and I gained 2 inches in height! The model that therapist uses is from the postural restoration institute which takes the diaphragm/lungs/ribcage/pelvis into account for movement.
Nice catch on the breathing cue. Yes, it's a similar concept. What you see consistently in practice is individuals unable to dissociate nearby regions of the body. At the same time, these areas must also be able to associate! How this relates, or could relate to pain or injury risk is a different conversation. Much research would argue there is a low relationship.
Structural/postural changes can happen though! Particularly if you're environment changes to accommodate what you're trying to solidify.
Interesting that the above exercise worked for you, particularly because its a flexion based position for breathing in! I am familiar with Bill Hartman and PRI. Really useful stuff for the right issue.
Thanks for the comment :)
I'm interested by the more advance video (you ask if people are interested too in 4:53 (is this one: czcams.com/video/2iGz2_N9FtY/video.html ?)
It would be working into this sort of range. It's a natural progression of the exercise in this video. The strength required for it isn't necessarily what most people require though. pccblog.dragondoor.com/wp-content/uploads/2015/08/DanEarthquakeWrestlersBridgeLead.jpg
@@theMSKphysio it looks great, but isn't risky for the vertebra (or the disks in between)?
@ytrew only if you don't take the time to build up to the ability. It's definitely a more advanced skill.