I have a 40-year-old client who has ruptured her third, fourth and fifth cervical disks. She also has two degenerating thoracic disks. I am trying to find exercises that would be the most beneficial to her without putting stress on her back and neck. Any suggestions?
Without a comprehensive assessment, we could not give you exact exercises, but we can explore possibilities. The exercises presented are not intended to replace medical advice! Consult with your client’s health care provider, keeping in mind that many treatments dispersed by physicians, chiropractors and physical therapists are prescribed for symptoms and are not directed toward preventing future problems. It is important to communicate with the medical world; however, your role should concentrate on the prevention of your client’s dysfunction.
The term dysfunction could be used whenever changes in the disk alter its biomechanical properties and prevent normal function. The goal of the exercise program should focus on reducing pain, restoring “normal” function or as much movement as possible under the given circumstances. If your client is experiencing painful positions, move around the pain or up to the pain, then release the pressure and return to the starting position.
To prevent further dysfunction, it is important to correct all postural impairments. If there is dysfunction in the cervical spine, more than likely there is dysfunction throughout the entire kinetic chain.
WHERE TO START
Breathing re-education! Excessive use of the secondary respiratory muscles is a common finding in cervical dysfunction, which can add a compression load to the cervical spine. Diaphragmatic breathing encourages an optimal breathing pattern and unloads the cervical spine. Suggestions: In-between sets, as active rest, teach proper breathing techniques.
- Lie down in a comfortable position with legs straight. If lying down is impractical or not comfortable, sit in a chair.
- Close eyes and place one hand on breastbone and the other over belly button.
- Without trying to change the normal breathing cycle, become aware of the parts of the body that are moving as your client inhales and exhales. This will assess her subconscious actions and what you need to help her with. The hand on the breastbone monitors chest breathing, and the other hand monitors belly breathing (diaphragmatic).
- If the abdomen moves up with inhalation, followed by a lateral excursion of the ribs, your client is breathing diaphragmatically. This is the breathing you’re looking for! Practice this technique in a relaxed state.
- If the chest is first to rise with inhalation, this is considered to be chest breathing. This breathing pattern needs to be corrected. Follow the tips below.
- If your client is having difficulty breathing diaphragmatically, have her press her hand down on the abdomen as she exhales and allow the abdomen to push the hand back up as she inhales deeply. The pressure from the hand increases the awareness of the action of the abdomen during breathing.
- Another position that may increase the awareness of proper breathing is lying on the stomach. The head can rest on the hands. Instruct her to take deep abdominal breaths so that the belly pushes against the floor as she inhales.
- Place tongue on palate
- Do not clench teeth
- Breathe through the nose
The most common muscles to become weak with neck dysfunction are the deep, single segment cervical flexors. An isolated exercise for this region is the head-nod exercise. It is important to remember that function is integrated, multi-dimensional movement and involves the control of systems, which allow load to be transferred and movement to be smooth and effortless. In other words, when you isolate, you must integrate!
- Lying supine, place a rolled up towel under the cervical spine. The towel supports (as opposed to distorts) the normal cervical curve.
- Place tongue on palate while breathing diaphragmatically and draw the chin toward the sternum as far as can be controlled without lifting off the rolled towel.
- Hold for five seconds, rest for five seconds and repeat for one minute (this is just a guideline, change as necessary).
- Note: The head should not lift off the towel! This is a sign of excessive anterior translation and recruitment of other cervical flexors substituting for the deep cervical flexors.
- The range of motion will depend on individual anatomical factors as well as strength. Base range of motion on control.
Whole Body Exercises with Cervical Strength Emphasis
The head-nod technique can and should be integrated into whole body exercises. Examples include:
- Supine Swiss Ball Chest Press - Place the back of the head and shoulders on the ball and repeat the head-nod directions while performing the chest press.
- Seated or Standing Uni-Lateral Row - Maintain perfect cervical alignment throughout the exercise. Make sure your client is aware of her posture during movement. NEVER allow the head to jut forward!
- Push-Up - Maintain cervical alignment. This prone position is more challenging due to gravity being 90 degrees to the cervical spine. Monitor for fatigue!
*Examples of the above can be found by going to the PTN Exercise & Flexibility Library.
Postural correction and maintenance should form the foundation of the exercise program. Teach your client how to lift, sit, stand, walk, sleep, push, pull, reach, turn, bend and drive. This functional approach will positively affect her for the rest of her life. Good postural habits are essential to prevent further degeneration.