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NASM CES Chapter 16: Corrective Strategies for the Cervical Spine 1

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    Chapter Goals:

    • Know the basic functional anatomy of the cervical spine.
    • Find the mechanisms for common injuries to the cervical spine.
    • Describe the influences of alterations of the cervical spine movements and the kinetic chain. 
    • Find the right strategies for systematic assessment of the cervical spine.
    • Be able to choose the right strategies for corrective exercise in the cervical spine. 

    Introduction

    According to a survey, neck pain is the third most common form of pain for the American population and also one of four main disability causes for the entire world. about 2/3 of the population will experience some form of this pain throughout their life.

    It has the ability to be mild or even severe and interfere with our normal life like sitting, turning, and sleeping.

    It can be acute pain or chronic.

    It is also known that women are 3 times more likely to experience this problem than men.

    When someone is under stress, the pain in their neck chances will increase by 150%. 

    Review of the Cervical Spine Functional Anatomy

    The cervical spine has a lot of influence on the rest of the kinetic chain. We have numerous bones, joints, and muscles that are involved in the cervical spine. This section is for those. 

    Bones and Joints

    The cervical spine starts at the base of the skull and it has seven different vertebrae in it.

    These are C1 to C7. the C1 is known as the atlas. Anterior to the cervical spine is our hyoid bone, and it does not articulate with any other bones and instead is suspended with muscles.

    Muscles 

    The cervical spine is a somewhat small region of the spine, but there are still many muscles responsible for proper functioning.

    The deep neck flexors, lower traps, and the serratus anterior make up the upper oblique subsystem along with the pecs, upper traps, and the levator scapulae. 

    The key muscles that we have to know that are associated with the cervical spine will be the levator scapulae, rhomboids, trapezius, sternocleidomastoid, pec minor, scalenes, cervical extensors, and the deep cervical flexors. 

    One of the more common problems with the muscles comes from upper crossed syndrome being present in the body. 

    Altered Cervical Spine Posture and Movement

    People will take on many different head and neck positions while doing activities.

    Forward head posture is going to be one of the most common posture impairments that we see.

    It is very common for workers that work at a desk, people that use smartphones, and kids that play video games for long time periods. 

    Static Malalignments

    Forward head posture will be when the head and neck both protrude forward and force the lower cervical spine to flex and the upper cervical spine to extend so that the head can be kept upright in the right form somewhat.

    This condition will cause a lot of stress to the cervical vertebrae, lengthen the anterior muscles of the neck, and shorten the posterior muscles of the neck.

    These compensations will have a good amount of influence elsewhere in the body, especially the shoulders right below. 

    Causes of Forward Head Posture

    Kids and adolescents that have poor posture for long times from playing video games for extended time periods will bring these poor alignments with them into adulthood.

    Spinal remodeling can be an effect of this long time poor posture.

    It increases the risks we have for degenerative conditions occurring. 

    When people use computers, primarily for desk job, we see this chance of forward head posture increase.

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    This is also seen to cause more headaches and neck pain.

    Smartphones are another factor that plays a role in the occurrence of forward head posture.

    We see people looking down to their phones for long time periods and this accentuates the poor posture of the head. 

    Abnormal Movement Patterns

    When we see the forward head posture in the static assessment, it is reasonable to consider that there will be imbalances of the myofascial system.

    Muscles will be found to be overactive and underactive and we can usually guess these.

    The advanced stages of forward head posture will have compression of the upper cervical spine, and this will end up having serious effects to the ability to rotate C1 around C2. 

    Dynamic Malalignment 

    With our movements, the neck, head, shoulder girdle, and the thoracic spine all work as an independent part of the body. when forward head posture is present, excessive strain may be put on regions below the head.

    Range of motion decreases will be a result of forward head posture in the cervical and the upper thoracic spine.

    These issues will be more common in the adolescents and adults that are participating in using computers for long time periods and online gaming or smartphones. 

    Cervical Spine Dysfunction and the Regional Interdependence Model

    Dysfunction of the spine, like all checkpoints we look into, will have some effects resonate in the other parts of the body. there will be issues above and below the cervical spine. 

    Hyoid Bone Positioning

    This is a floating bone, meaning that it has no attachment to another bone, but instead it is suspended by muscles.

    It is a link between the cervical spine and the head and has a big role in chewing, swallowing, speaking, and proper breathing.

    Forward head posture increases the tension in the muscles relating to the hyoid bone and may lead to jaw pain and poor swallowing of food. 

    Influence Above the Cervical Spine

    The load bearing on the muscles and joints in the upper cervical spine is affected by forward head posture.

    If it is sustained constantly, it may lead to overactivity and shortening of the extensors ad suboccipital muscles.

    Pain thresholds and predisposition for myofascial trigger points are linked with forward head posture. 

    TMJ is a hinge joint of the jaw and it can be negatively influenced by these problems of forward head posture also. 

    Influence Below the Cervical Spine

    Many people that have forward head posture will also have rounding of their shoulders, showing a clear link between the dysfunction of the cervical spine affecting the proximal and inferior thoracic spine and shoulder region. 

    The scapulohumeral rhythm is affected and this can lead to scapular dyskinesis.

    This is when the scapula is unable to move in a normal way during humeral elevation and associates with shoulder pain and impingement. 

    Forward head posture is also likely to affect our respiratory system.

    Normal breathing is initiated by contracting the primary muscles of respiration of the diaphragm and the external intercostals. 

    Assessment Results for the Cervical Spine

    Like the other regions of the body, the cervical spine can and will be assessed using the static posture assessments, dynamic and transitional assessments of movement, and the range of motion or mobility assessments.

    Look at the table in this part of section two of the chapter to see the various results we may receive from going through these different assessments. 

    Static Posture

    The postural dysfunctions that are highlighted for this region are the upper crossed and the layered cross syndrome, and these will all include a forward head posture and rounded shoulders.

    Both of these are what you look for primarily in the static posture observations. 

    Transitional Movement Assessment

    Like how we see some people’s feet turn out in an overhead squat, there will be some muscle imbalances of the neck that only show up when we put the body under non-static testing.

    The overhead squat and the pushing and pulling loaded assessments are going to be the most useful ones for us here. 

    Overhead Squat Assessment

    In the overhead squat, the cervical spine may extend too much into the forward head posture.

    This is usually due to overactive extensors that cause the deep neck flexors to get underactive and lengthen. 

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    Loaded Movement Assessment

    Overactivity in the sternocleidomastoid, upper traps, and/or the scalenes may cause forward head posture, but those muscles can also impact the dynamic posture in the shoulder.

    So, there will be two regions directly affected by poor function of these muscles. 

    Dynamic Movement Assessments

    These are similar to the biomechanics in a loaded pushing movement, so the Davies test will be the primary one used for highlighting dysfunctions of the cervical spine. 

    Mobility Assessments

    When clients show static or dynamic posture problems in their neck and shoulder checkpoints, the professional should be doing mobility assessments in the cervical spine. 

    Corrective Strategies for the Cervical Spine

    Forward Head Posture Program:

    Inhibiting with the use of SMR on the muscles of the sternocleidomastoid, levator scapulae, upper trapezius, and the cervical extensors will be used in this phase. We will also pay attention to and use the acute training variables that were established for this phase of corrective exercise in the associated chapter. 

    Lengthening the sternocleidomastoid, levator scapulae, and the upper traps and the scalenes with the use of static stretching is the second part of the process. We will also pay attention to and use the acute training variables that were established for this phase of corrective exercise in the associated chapter. 

    Activation with the use of isolated strengthening will be used third, and this has us isolated strengthening the muscles of the deep cervical flexors, rhomboids, and the mid and low traps. We will also pay attention to and use the acute training variables that were established for this phase of corrective exercise in the associated chapter. 

    Integration is the final stage. Here we are using the integrated dynamic movement with the deep cervical flexors, rhomboids, and the mid and lower traps. We will also pay attention to and use the acute training variables that were established for this phase of corrective exercise in the associated chapter. 

    Make sure to go through the step and the pictures that are associated with the program. 

    Common Issues Associated with the Cervical Spine

    Local injuries to the cervical spine:

    • Pain and stiffness in the area
    • Text neck
    • Elevation of the hyoid bone
    • Dysfunction of the traps
    • Dysfunction of the levator scapulae
    • Dysfunction in the cervical joint
    • Cervical strains of the muscles
    • Dysfunction of the deep flexors
    • Lesions of the cervical discs

    Injuries that are above the cervical spine:

    • Cervicogenic headaches
    • Dizziness and lightheadedness
    • Symptoms relating to TMJ

    Injuries below the cervical spine:

    • Pain and weakness of the upper extremity
    • Impingement of the AC
    • Dysfunction of breathing, the scapula and thoracic spine
    • Thoracic outlet syndrome
    • Anterior pelvic tilt and lower back pain
    • Dysfunction of the sacroiliac joint

    Muscle Strain

    The cervical spine is exposed often and especially so when doing sports and athletics.

    There is a risk for collision during contact sports.

    The most common injury of the neck is going to be a muscle strain, and this happens when a tendon or a muscle is overstretched or overworked, and this results in disruption or tearing of the muscle tissues.

    We also know this as a pulled muscle. The result is pain, swelling, spasms, and weakness. 

    Stenosis of the Cervical Spine

    Spinal stenosis is seen in older people more often. Some middle aged people will be predisposed to it, and they will have it occur sooner than old age.

    There is a reduction in disc height and thickening and reduced flexibility of the ligaments of the spine. 

    Degenerative Disc Disease

    The intervertebral discs will make up one fourth of the height in a healthy spine.

    During the natural process of aging, the height in the spinal discs will e less able to hold fluids, and this will show up in the form of lost height and reductions in shock absorption.

    In advanced ages, we see the discs dry out and become thinner. 

    NASM CES Chapter 16: Corrective Strategies for the Cervical Spine 2
    NASM CES Chapter 16: Corrective Strategies for the Cervical Spine 3
    NASM CES Chapter 16: Corrective Strategies for the Cervical Spine 4

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