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This is Brent of the Brookbush
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Institute, in this video I'm going to bring
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you the deep cervical flexor endurance
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test. Now I use this test in my
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assessments to replace those manual
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muscle tests we would do for under
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active structures, and those with
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cervical dysfunction. I think you'll find
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the traditional manual muscle tests
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focus on muscles that we presume, or
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theorized to become overactive or
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synergistically dominant in those with
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movement impairment and cervical
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dysfunction. So I have my friend Melissa
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come out, she's going to help me
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demonstrate this test, which is quite a
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challenging test. It is a test we have a
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lot of research on, it's fairly well
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standardized. Notice that Melissa starts
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in a hook lying prone position, so her
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legs aren't straight, and her hands are
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on her stomach which is going to help
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standardize the position of her
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shoulders and scapula. From here what I
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want to do is I want to tuck Melissa's
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chin, and then I'm going to raise her
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head off the table two and a half
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centimeters, and the way I'm going to
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standardize that is it's going to be the
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width of my index and third finger,
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second and third finger, just behind the
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most posterior portion of her occiput,
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and so she can just go ahead and relax
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there for a second. Now what I'm going to
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do from here is cue her to tuck her
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chin as far as she can, and lift her head
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up just far enough so she can feel, but
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not squish my fingers. And once she's
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there, go ahead relax for a second, once
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she's there I'm going to time her and look
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for one of the few dysfunctions to
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happen. Once those dysfunctions happen of
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course the time is over. Those very few
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dysfunctions are does she lose her chin
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tuck, and the way I can tell by that is
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does she lose these lines right here,
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this is the double chin test. I think
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you'll find that your clients hate this
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test because it makes them do a double
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chin, that's what she has, these lines
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here. If she loses those I know she lost
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a chin tuck. If when she raises her head
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she then loses that head elevation, right
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loses that flexion of the cervical
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spine and
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crushes my fingers, test over. If she
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does the opposite, so I have her in this
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chin tucked position and she starts
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going into that forward head, good sign
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that she's very synergistically dominant
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in these muscles here, then I then the
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test is over. So we got those three signs
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right off the bat, and a fourth sign
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being she just doesn't want to continue
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with the test. Maybe she feels fatigued
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and and she she just doesn't like how it
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makes her neck feel, that's also the end
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of the test. So there's four standardized
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signs: we got the loss of these lines in
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the chin tuck, increase of pressure on my
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fingers, decrease in pressure on my
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fingers, or her not wanting to go further
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with the test, that would be the end of
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the time. The other thing we can do that
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is not standardized, is get a little
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additional information for my manual
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therapists out there is have her chin
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tuck, have a raise her head into flexion
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here, just just barely off my finger so
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she can just feel it, and I can use my
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other hand to palpate some of these
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muscles. We do have good research that
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shows the sternocleidomastoid is often
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very overactive in those with cervical
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dysfunction. We could try to palpate the
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scalenes, here are her anterior and
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middle scalenes very overactive. What
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about our levator scapulae, this might
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just give us a little additional
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information on some stuff we can do
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during our mobility portion, or release
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portion of our intervention to help with
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cervical function, before we start doing
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these deep cervical flexor activation
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exercises. Now you got those signs, how
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long should she be able to hold this
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perfectly? Minimum of 30 seconds. If we're
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just going to build some general
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guidelines less than 30 seconds, I'm
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definitely going to call weak regardless
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of what the population is. Less than 30
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seconds the individual needs to work on
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their deep cervical flexor endurance. 30
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to 60 seconds, probably sufficient for a
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normal not active fairly sedentary
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population.
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So maybe that's our first goal is just
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to get to 30 to 60 seconds. 60 seconds
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plus very good for a sedentary
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population, but probably insufficient for
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an active population who may need to go
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90 seconds, maybe even two minutes. You
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think of the amount of force that's put
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on somebody's cervical spine during
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sporting activity in the fact that a
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play generally lasts longer than 60 to
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90 seconds, we're going to need to take
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them a little longer. So take you guys
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through this test, you're going to go
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flexion and then up on the fingers, have
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Melissa raise her head keeping that chin
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tuck, I'm monitoring chin tuck, finger
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pressure. Melissa's already lost pressure,
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that would be the end of the test at
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roughly 10 seconds, as I monitor the
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clock behind me. There you guys go,
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another test you can add to your arsenal.
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You're going to probably want to start
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with a postural or movement assessment,
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then move on to these more specific
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assessments to see if isolated
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activation techniques are necessary. I
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hope you guys enjoy using this test and
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it refined your intervention, so that you
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guys can decrease dysfunction and
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improve performance. Thank you.