Friday, March 27, 2015

How About A Few Self Care Tips For The Upper Neck?

Upper cervical care, Self Care, Upper Neck Problems

Editor's Note: This article is part of a larger article from Dynamic Chiropractic, a Chiropractic publication, so it is written as if the chiropractor was reading it.   You can find the full article here.)

Self-Mobilization Exercises For The Upper Neck

Our patients often have recurrent patterns of fixation. When I can, I like to show them how to self-mobilize these areas. Here are two exercises to address these patterns.

1. Upper Cervical Side-Bending. This is an exercise I developed for one of my patients who kept experiencing upper-cervical jamming and headaches. This is useful for a patient who lacks side-bending at the occiput or has a recurrent atlas fixation. Look at the patient. Is their head "on straight"? If not, here is a way to teach them to straighten it out.

This exercise is a bit tricky and requires decent motor control, so you will need to teach the patient how to do it a few times. We are not trying to get them to stretch or side bend their whole neck. We don't want the motion to occur in the middle or lower cervical spine. We are trying to induce side-bending motion into the upper cervical spine. The visualization is to see their face spinning or rotating around their nose. Think of a clock face with the nose in the middle.

Step one is to straighten the head in the sagittal plane by activating the deep neck flexors. You probably already know this as a stand-alone exercise. This begins to correct the chin poke and lack of posterior glide. Next, the patient should hold this chin tuck position and put their hands on their head and face. One hand is on the temporal region; the other on the opposite side, over the jaw. They are going to resist gently and move their head against the resistance of their hands. Ask the patient to move about 1-2 inches. This is not an isometric exercise; it is about inducing motion.

The usual error is to just push against the top hand, which puts the fulcrum lower in the neck. The patient needs to equally push against the opposite hand, the one on the jaw. Some patients need to start to push with the jaw first to get the right motion started. Caution may be needed if they have a TMJ issue. As always, remind them to gently resist; this is motor control, not a strength contest.

2. Sternocleidomastoid stretch.  What muscle is pulling on the occiput? The primary short and tight muscle is usually the SCM. This is another exercise that may be challenging for your less-coordinated patients. It can be done either supine or sitting. Let's outline it step by step. (By the way, this same routine can be done by the doctor to the patient as a pin and stretch.)
Start by instructing the patient to use their opposite hand to grasp the bulk of the SCM muscle. Aim at the tightest part of the SCM; it could be up high or down near the clavicle. Grasp it between the thumb and fingers. If this proves too challenging, you can have the patient place their opposite hand on the top of the medial clavicle and pull downward, stabilizing the origin of the muscle.

Patient tucks the chin, lifts the sternum and elevates the crown toward the ceiling. This is the basic motion that activates the deep neck flexors and puts the head in the proper start position.

Patient rotates the head about 20 degrees toward the side you want to stretch. This is counterintuitive; the SCM has an obliquely upward path, which lengthens the muscle.
Patient tips (side bends) the head away, maintaining the chin tuck position; then pulls downward on the tight part of the SCM with the hand grasping it. (They can also lubricate with lotion and glide with compression down the muscle belly.)
Here are the common errors: They lose the chin tuck. They tend to want to rotate to the same side as they are side-bending, instead of rotating to the opposite side. Some patients have a hard time grasping the muscle; the glide way may work better for them.

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

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