0:06 This is Brent of the Brookbush Institute at the independent training spot in New 0:09 York City. Today we're going over cervical lateral flexion. So this is our 0:13 first goniometric assessment video for the neck, potentially our last, definitely 0:18 one of a very few that I use. The reason being is this is one of the very few 0:23 goniometric assessments for the neck that actually has good inter and intra tester 0:27 reliability. Some of the other ones like rotation, flexion and extension, not so 0:34 great when we're trying to measure against our own numbers from a previous 0:39 assessment. Really not good when two different testers take the same 0:44 measurement. So cervical lateral flexion, firm and feel, that has to do with some 0:48 of the ligaments in the spine itself coming to a hard stop, and 35 to 45 0:54 degrees is optimal range of motion. Now I'm going to have my friend Melissa come 0:59 out, she's going to help me demonstrate. 1:04 So what we're measuring is lateral flexion right, what we have to make sure 1:10 is happening so that we are just measuring our cervical dysfunction is 1:17 that somebody has good posture, I generally have my patients sitting 1:20 that's just so I'm consistent ,and then go ahead and turn sideways for me. What 1:26 people love to do if you're not paying attention, and when I show you that how 1:29 to do this and you're standing behind somebody, you'll see how easy it is for 1:32 them to get away with it, but generally what people do is as they go into 1:36 lateral flexion, they steal range of motion by going into that forward head 1:41 translation. So you need to be doubly careful and when you're taking them into 1:47 cervical lateral flexion that they're in good alignment, and 1:52 that's the only thing that I'm measuring. Now I'm going to go ahead and have 1:56 Melissa turn around and face me. You'll notice I have an orange dot over here 2:03 over spinous prominence, or the spinous process of C7, that's the landmark we're 2:07 using as our pivot point. The other thing you're going to find is your external 2:13 occipital protuberance which is that bony notch in the back your head here, 2:18 and the reason why melissa has a bun, which she wanted me to tell you that she 2:23 normally wouldn't wear hair like this, I forced her to do it. Alright so external 2:28 occipital protuberance, spinous prominence. I'm going to go ahead and pull 2:32 into lateral flexion, and then what you do is your stability arm can either go 2:39 straight down the spine, or straight up, and my movement arm is going to follow 2:46 that external occipital protuberance. So I'm going to go ahead and come to the 2:51 other side, show you guys how I would actually measure. For this one I do like 2:57 to get them into position first, and then hold my goniometer up. So she's 3:02 going to go into lateral flexion. I'm going to make sure that she doesn't jut her 3:06 head out forward, make sure you warn somebody before you put your hands on 3:10 their face. When she's there go ahead and set up my goniometer, 3:21 and melissa has 32 degrees of lateral flexion to the right, that's just shy of 3:30 optimal. We do have a little problem here, where in this particular test the taller 3:36 somebody is, the further this fulcrum gets from the point that we're watching, 3:40 the more it's going to underestimate the value of this measurement. So keep that 3:47 in mind, if somebody comes in between 30 and 35 but happens to be five foot ten, 3:52 you might go ahead and leave lateral flexion alone. So I'm going to show you 3:57 guys this one more time, we'll go to the other side, go ahead and side bend for me. 4:04 Looks good right there, I'll go ahead and do it the other way this time, we'll go 4:08 ahead and go movement arm or I'm sorry stability arm straight down, fulcrum 4:14 right over spinous prominence, and then I'm going to line up with their external 4:18 occipital protuberance, and again I got 32 degrees. Thank you Melissa. 4:28 So she happens to have even range of motion on each side, and 32 is pretty 4:34 close to 35, if she were my patient I would probably just leave this alone 4:39 especially since Melissa is a little taller and we have that that little 4:43 discrepancy in this test. But let's say she came in and she had 15 degrees and 4:48 was complaining about neck pain, what would I do with this, well as I mentioned 4:53 before cervical lateral flexion is one of these measurements, it's kind of nice 4:59 that this is the the one measurement that actually works out, because it's 5:02 usually the first thing somebody loses and the last thing they get back if they 5:06 have neck dysfunction. So this becomes a really good measure to track the 5:11 progress of our cervical dysfunction over time. Another great thing about this 5:16 test is if you think about it, it actually implies every muscle in the 5:22 cervical spine, or just about every muscle in the cervical spine. Anything 5:26 that lies lateral to midline could potentially contribute to a restriction 5:31 in lateral flexion, which might be part of the reason why this is the last range 5:35 of motion people are likely to get back. You see a huge list of muscles here guys 5:39 scalenes, levator scapulae, upper trap, SCM, splenii, semispinalis, suboccipital, 5:45 transversal spinalis, you know those four right there are grouped portions of 5:49 the erector spinae, and even your platysma can all affect this range of motion. It's 5:55 going to take a little bit of time for you guys to understand which muscles are 6:01 most likely to restrict range of motion, which had the biggest contribution to 6:07 restriction. But it's also important to really know your functional anatomy, 6:11 because what if it what if I release the scalenes, levator scapulae, upper trap, SCM, 6:16 the big guys I get all of them out of the way, and I only get five degrees 6:21 improvement which only takes them to 20 degrees of lateral flexion, and now I 6:25 don't know what to do, well I need to know what some of these other structures 6:30 are so that I can address them as well. For all we know it's the little 6:34 transversal spinalis muscles between a couple segments in the cervical spine 6:39 that are actually restricting lateral flexion. 6:44 Facet joints, alright so let's go muscle, joint. We have those facet joints in the 6:49 cervical spine. I can tell you I know a lot of personal trainers watch my videos 6:55 the neck is not an easy thing for a personal trainer to to try to correct, 7:01 because often we have joint dysfunction. Generally speaking to get somebody's 7:07 neck back to optimal takes a fair amount of manual work, and knowing how to 7:14 mobilize those facet joints in various directions is going to be important if 7:19 you start having a lot of cervical dysfunction patients. You had inner 7:23 transverse ligaments and the capsular ligaments, of course that's all going to 7:27 be related to dysfunction of those facet joints. Fascia, there is a lot of fascial 7:36 layers in the cervical spine, but even just the cervical fascia the superficial 7:41 layers, and the cervical thoracic fascia which we might be able to get at with 7:45 once again those pin and stretch, or instrument assisted soft tissue 7:49 mobilizations. I know a lot of you guys have seen like the Graston technique on 7:53 the neck, which tends to be very visually stunning because it'll leave a fair 8:00 amount of petechiae the first time you do it, but it definitely can affect that 8:04 range of motion. It's definitely something to kind of work through and 8:07 I've definitely had good success myself with adding some of those fascial 8:11 techniques to my cervical treatment plan. And of course nerves, as soon as we get 8:18 to the neck guys we're not even talking about the long nerves and the arm 8:21 anymore. We could have new nerve root involvement, if somebody goes into 8:25 lateral flexion they can pinch down on a nerve root and if that nerve root 8:29 happens to be inflamed, that is not going to feel good. And of course the brachial 8:34 plexus of them, for example this is a little simplistic but if i were to 8:38 laterally flex this way, pinch on this side might be nerve root, but this side 8:42 I'm getting a pretty good stretch on my brachial plexus. Alright guys once again 8:48 huge graph, necks are very challenging to work with, but I enjoy them very much 8:54 because they are a puzzle. There is a huge amount of things that we could do, 8:58 and I'm sure any of you guys out there working on a lot of neck patients know 9:03 if you can relieve somebody of neck pain they think you are a saint, which is 9:08 quite rewarding. I hope to hear about great outcomes, I hope you guys enjoy 9:13 learning this particular technique and start learning from what it implies, 9:19 look forward to hearing about great outcomes. Talk to you soon. 9:29
