0:04 This is Brent of the Brookbush 0:06 Institute, in this video I'm going to bring 0:07 you the deep cervical flexor endurance 0:09 test. Now I use this test in my 0:11 assessments to replace those manual 0:14 muscle tests we would do for under 0:16 active structures, and those with 0:17 cervical dysfunction. I think you'll find 0:19 the traditional manual muscle tests 0:21 focus on muscles that we presume, or 0:24 theorized to become overactive or 0:27 synergistically dominant in those with 0:29 movement impairment and cervical 0:31 dysfunction. So I have my friend Melissa 0:33 come out, she's going to help me 0:34 demonstrate this test, which is quite a 0:38 challenging test. It is a test we have a 0:40 lot of research on, it's fairly well 0:42 standardized. Notice that Melissa starts 0:45 in a hook lying prone position, so her 0:48 legs aren't straight, and her hands are 0:49 on her stomach which is going to help 0:51 standardize the position of her 0:53 shoulders and scapula. From here what I 0:56 want to do is I want to tuck Melissa's 0:59 chin, and then I'm going to raise her 1:02 head off the table two and a half 1:04 centimeters, and the way I'm going to 1:06 standardize that is it's going to be the 1:08 width of my index and third finger, 1:10 second and third finger, just behind the 1:13 most posterior portion of her occiput, 1:16 and so she can just go ahead and relax 1:18 there for a second. Now what I'm going to 1:21 do from here is cue her to tuck her 1:22 chin as far as she can, and lift her head 1:25 up just far enough so she can feel, but 1:29 not squish my fingers. And once she's 1:34 there, go ahead relax for a second, once 1:37 she's there I'm going to time her and look 1:40 for one of the few dysfunctions to 1:42 happen. Once those dysfunctions happen of 1:45 course the time is over. Those very few 1:47 dysfunctions are does she lose her chin 1:50 tuck, and the way I can tell by that is 1:52 does she lose these lines right here, 1:54 this is the double chin test. I think 1:57 you'll find that your clients hate this 1:59 test because it makes them do a double 2:01 chin, that's what she has, these lines 2:03 here. If she loses those I know she lost 2:05 a chin tuck. If when she raises her head 2:08 she then loses that head elevation, right 2:13 loses that flexion of the cervical 2:15 spine and 2:17 crushes my fingers, test over. If she 2:21 does the opposite, so I have her in this 2:24 chin tucked position and she starts 2:26 going into that forward head, good sign 2:29 that she's very synergistically dominant 2:31 in these muscles here, then I then the 2:35 test is over. So we got those three signs 2:38 right off the bat, and a fourth sign 2:40 being she just doesn't want to continue 2:42 with the test. Maybe she feels fatigued 2:44 and and she she just doesn't like how it 2:48 makes her neck feel, that's also the end 2:50 of the test. So there's four standardized 2:53 signs: we got the loss of these lines in 2:55 the chin tuck, increase of pressure on my 2:58 fingers, decrease in pressure on my 3:01 fingers, or her not wanting to go further 3:04 with the test, that would be the end of 3:07 the time. The other thing we can do that 3:09 is not standardized, is get a little 3:14 additional information for my manual 3:17 therapists out there is have her chin 3:19 tuck, have a raise her head into flexion 3:22 here, just just barely off my finger so 3:24 she can just feel it, and I can use my 3:26 other hand to palpate some of these 3:28 muscles. We do have good research that 3:30 shows the sternocleidomastoid is often 3:33 very overactive in those with cervical 3:34 dysfunction. We could try to palpate the 3:36 scalenes, here are her anterior and 3:39 middle scalenes very overactive. What 3:41 about our levator scapulae, this might 3:43 just give us a little additional 3:44 information on some stuff we can do 3:46 during our mobility portion, or release 3:50 portion of our intervention to help with 3:54 cervical function, before we start doing 3:56 these deep cervical flexor activation 3:58 exercises. Now you got those signs, how 4:03 long should she be able to hold this 4:04 perfectly? Minimum of 30 seconds. If we're 4:08 just going to build some general 4:10 guidelines less than 30 seconds, I'm 4:11 definitely going to call weak regardless 4:14 of what the population is. Less than 30 4:16 seconds the individual needs to work on 4:18 their deep cervical flexor endurance. 30 4:21 to 60 seconds, probably sufficient for a 4:25 normal not active fairly sedentary 4:28 population. 4:30 So maybe that's our first goal is just 4:32 to get to 30 to 60 seconds. 60 seconds 4:36 plus very good for a sedentary 4:40 population, but probably insufficient for 4:44 an active population who may need to go 4:46 90 seconds, maybe even two minutes. You 4:49 think of the amount of force that's put 4:52 on somebody's cervical spine during 4:54 sporting activity in the fact that a 4:56 play generally lasts longer than 60 to 4:58 90 seconds, we're going to need to take 5:00 them a little longer. So take you guys 5:03 through this test, you're going to go 5:05 flexion and then up on the fingers, have 5:10 Melissa raise her head keeping that chin 5:13 tuck, I'm monitoring chin tuck, finger 5:15 pressure. Melissa's already lost pressure, 5:19 that would be the end of the test at 5:21 roughly 10 seconds, as I monitor the 5:25 clock behind me. There you guys go, 5:27 another test you can add to your arsenal. 5:30 You're going to probably want to start 5:32 with a postural or movement assessment, 5:34 then move on to these more specific 5:36 assessments to see if isolated 5:38 activation techniques are necessary. I 5:41 hope you guys enjoy using this test and 5:44 it refined your intervention, so that you 5:46 guys can decrease dysfunction and 5:48 improve performance. Thank you. 5:57
