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