00:00 - 00:03This is Brent coming at you with another progressions video for the deep
00:03 - 00:07cervical flexors. Now we've been through isolated activation exercise, we've been
00:07 - 00:11through two progressions videos for stabilization exercise, now if we've
00:11 - 00:16managed to activate the deep cervical flexors and then increase endurance and
00:16 - 00:20stabilization so that an individual is able to maintain, good, cervical posture,
00:20 - 00:25it's time for us to start working on that range of motion that was lost. Now I
00:25 - 00:28have to thank Doctor of Physical Therapy Michelle Petrowski, over at Dynamic
00:28 - 00:33Sports Physical Therapy for giving me the idea for these progressions, they all
00:33 - 00:37start the same way. They're all going to start with one of our upper body
00:37 - 00:42activation exercises to stabilize the scapula and help to inhibit those
00:42 - 00:48overactive synergists in the cervical spine, followed by retraction to activate
00:48 - 00:52the deep cervical flexors, and then we're going to work in to whatever range of
00:52 - 00:56motion that we've lost. I have my friend Leanne to come help me out. She's going
00:56 - 01:00to demonstrate these exercises. The first thing we're going to do is a very common
01:00 - 01:03exercise you have seen, which is that bilateral, external rotator
01:03 - 01:07activation up against this wall. I think you will see the advantage of
01:07 - 01:12having this wall here really quickly. This is definitely an exercise that I choose to
01:12 - 01:19use initially, when I'm just starting to work on range of motion. So, Leanne is
01:19 - 01:23going to get into her external rotator activation position, she's going to go
01:23 - 01:28ahead and rotate out, that's the "chest out thumbs out" position, scapula are
01:28 - 01:32stabilized, she's going to retract against the wall, that's going to
01:32 - 01:38activate those deep cervical flexors, and then from here, I can go in any range of
01:38 - 01:42motion that I've lost. Let's say Leanne's lost some flexion, so I can have her try
01:42 - 01:50to touch her sternum and then come back up. If she's lost lateral flexion, having
01:50 - 01:53the wall here is really nice for this one, I can have her go into a
01:53 - 01:58little bit of retraction, and then maintain that retraction as she goes
01:58 - 02:03into lateral flexion, and back. Good. I could do rotation. This is
02:03 - 02:07actually one of my favorite exercises regardless of if somebody is starting, or
02:07 - 02:14has progressed quite a bit, having this wall here to queue somebody into rotation, is
02:14 - 02:19extremely helpful! Now, with whatever range of motion you have lost,
02:19 - 02:23it would seem just from from my experience, you want to get somebody to
02:23 - 02:29activate first, retract, they're going to go into whatever range of motion they
02:29 - 02:34lost, they're going to try to maintain that for two to four seconds, come back
02:34 - 02:39to neutral, and start over. This is what I found to work best from a practical
02:39 - 02:43perspective, and then we can go back to those 12 to 20 repetitions that we
02:43 - 02:47normally do for activation exercise. Now, other than this exercise we could do
02:47 - 02:54cobras. Cobras are great because they they resist depression.
02:54 - 02:59The resistance is pulling upward, so as she pulls down and back we get a lot of
02:59 - 03:04depression in the scapula, we get a lot of inhibition of our lateral flexors of
03:04 - 03:09the cervical spine, which is why I love to use this one to work on lateral
03:09 - 03:16flexion. So, if I have her retract and then move this way, I'm sure Leanne can feel
03:16 - 03:21it. This is a great exercise for working on that active flexibility
03:21 - 03:25of these structures in here, and then she can go back up. If she had only lost
03:25 - 03:28range of motion on that side, I would only go to that side. If she's lost range
03:28 - 03:31of motion in both directions I could have her then go to lateral flexion to
03:31 - 03:36the other side, work on getting all the active flexibility in these structures,
03:36 - 03:41and then back, and then of course she can start over.
03:41 - 03:46Down, she's nice and stabilized here, she's retracted, and then once again go
03:46 - 03:54back into lateral flexion. The next exercise that I really enjoy using for
03:54 - 03:59this deep cervical flexor activation and range of motion, is, I don't know if you
03:59 - 04:03saw that serratus anterior progressions video we did, where we did
04:03 - 04:11this modification of this Sarmon serratus anterior activation, but
04:11 - 04:19if we start with that, here's what happens. As Leanne moves her arms up, and
04:19 - 04:27focuses on scapular depression, she forces her scapula into upward rotation.
04:27 - 04:33That upward rotation already starts to lengthen the levator scapulae, and
04:33 - 04:41lengthening that levator scapulae I can start working on that flexion and
04:41 - 04:45rotation combination that so often becomes a problem for people with
04:45 - 04:53cervical dysfunction. Then she can go into the other direction, and then
04:53 - 04:58relax for a second. Alright, good. Draw-in. Let's do one more rep.
04:58 - 05:05So she can draw-in, squeeze up, make sure she's focusing on scapular
05:05 - 05:14depression, so we forced upward rotation, and she can go here. Now I know I've
05:14 - 05:17thrown out a lot of words, a lot of queues, a lot of information in this video, but I
05:17 - 05:22want to show you guys how easy it is to incorporate all of these exercises in
05:22 - 05:27to an activation sequence, or an upper body warm up for somebody with
05:27 - 05:32cervical spine and upper body dysfunction. So, if Leanne starts off with
05:32 - 05:37her isolated cervical flexor activation, and it works to do this much
05:37 - 05:41better in front of a mirror, but we'll make do with what we've got right now, so
05:41 - 05:46she can start off with her 15 repetitions just doing her deep cervical
05:46 - 05:49flexor activation, so this is getting her prepared to work on those
05:49 - 05:56range of motion exercises. Relax, and back. Now we're going to say that
05:56 - 06:01most of Leanne's problems were on her right side. So I'm going to go ahead, and
06:01 - 06:05after she's done 12 to 20 repetitions of this, have her flip around use
06:05 - 06:07the same wall,
06:10 - 06:16and we're going to have her do her bilateral external rotator
06:16 - 06:22activation, keep her scapula depressed, and now I can have her work on right
06:22 - 06:31lateral flexion, or right rotation. Good. I'll have her do 12 to 20 reps of that, then I
06:31 - 06:38can have her jump over to her cobras.
06:39 - 06:43Same thing here. If I did right rotation here, maybe I want to do right lateral
06:43 - 06:48flexion here, or work on some range of motion she's lost, have her do her 12 to
06:48 - 06:5520 repetitions. Good. Then I can go ahead and have her do her Sarmon exercise.
06:58 - 07:03And now, maybe I worked on rotation here, lateral flexion here, I can work on that
07:03 - 07:09rotation lateral flexion and flexion on this one, going to the levator scapulae
07:09 - 07:15active stretch, and cervical spine range of motion, making sure the whole time I'm
07:15 - 07:19queueing retraction. Now, I realized if I did 12 to 20 reps of that, and I had
07:19 - 07:23it set up in a nice tight area like this, it might take five minutes to get
07:23 - 07:27through this, and I've also activated her external rotators her serratus anterior,
07:27 - 07:33and her lower traps. All of this has been done so that she can go into whatever
07:33 - 07:38upper body exercise, or whatever functional task for her upper body you
07:38 - 07:42want her to be able to do with better form, and of course better motor unit
07:42 - 07:46recruitment. I hope you have enjoyed these exercises, I hope you enjoy
07:46 - 07:51these progressions, I hope you get great outcomes!