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