Neck for Trunk

When the neck is strong and pain-free you can use it as a handle to exercise the trunk muscles. Both static and dynamic techniques work well. If there is a chance that motion will cause pain, pre-position the neck in the desired end range and use static contractions.

The head and neck are the handle, the action happens in the trunk.

When using neck flexion patterns, the main component of resistance is traction. With extension patterns, gentle compression through the crown of the head will facilitate trunk elongation with the extension.

9.4.1 Neck for Trunk Flexion and Extension

With the patient supine, use the neck to facilitate rolling forward (O Fig. 9.8 a, b). If the patient has good potential trunk strength use the neck to facilitate a supine-to-sitting motion. With the patient side lying or prone use neck extension to facilitate rolling back (O Fig. 9.8 c). Resist static neck flexion and extension patterns with the patient's head in the midline to facilitate static contractions of the trunk muscles in sitting. To challenge the patient's sitting balance use reversal techniques, either static or with small reversing motions.

When you exercise the patient in standing give gentle resistance to the neck patterns. Combine this with resistance at the shoulder or pelvis.

Points to Remember

— The head and neck are the handle to facilitate trunk activity

— You can use one hand to resist the scapula or pelvis a

□ Fig. 9.8. Neck for trunk flexion and extension. a, b Neck flexion for rolling forward; c neck extension for rolling backward

□ Fig. 9.8. Neck for trunk flexion and extension. a, b Neck flexion for rolling forward; c neck extension for rolling backward b c

9.4.2 Neck for Trunk Lateral Flexion

This activity can be used in all positions. The shortening on the working side results in concurrent lengthening on the other side. The trunk lateral flexion is facilitated by the chin tuck (upper cervical flexion), rotation, and lateral flexion. The head is positioned actively by the patient. After the head is in position all further motion occurs in the trunk. This exercise can be done with a flexion or an extension bias.

Points to Remember

— The head and neck are the handle to facilitate the trunk activity

— The head and neck position are pain-free

The basic combination of neck motions for trunk lateral flexion are:

— Full cervical rotation

— Ipsilateral lateral flexion

— Upper cervical (short neck) flexion

— Lower cervical (long neck) extension

Neck for Right Lateral Trunk Flexion with Flexion Bias (O Fig. 9.9 a-c)

Begin with the patient's chin tucked and the head turned so that the chin aims towards the front of the right shoulder.

Body Position and Mechanics

Stand at the patient's left side, opposite to the direction of rotation.

Grip

Place your right hand on the right side of the patient's head (by the right ear). Put left hand under the patient's chin.

Alternative Body Position and Grip

Stand so the patient turns towards you. Put your left hand by the patient's right ear. Place the fingers of your right hand under the patient's chin.

O Fig. 9.9. Neck for trunk right lateral flexion. a-c In supine with flexion bias

O Fig. 9.9. Neck for trunk right lateral flexion. a-c In supine with flexion bias a b c

Command (Preparation)

"Turn your head to the right and put your chin here (touching the front of the right shoulder)."

Command

"Keep your chin on your shoulder, don't let me move your head." "Now pull your chin farther to your shoulder" "Now do it again."

Resistance

Your distal hand (chin) resists upper (short) neck flexion, rotation and lateral flexion. Your proximal hand resists lower (long) neck extension, rotation and lateral flexion.

Motion

The upper trunk side-bends to the right, the right shoulder moves towards the right ilium. The motion includes flexion and right rotation.

Neck for Right Lateral Trunk Flexion with Extension Bias (O Fig. 9.9 d, f)

Begin with the patient's chin tucked and the head turned so the chin aims toward the back of the right shoulder.

Body Position and Mechanics

Stand at the patient's left side opposite to the direction of rotation.

Grip

The grip is the same as before.

Alternative Body Position and Grip

These are the same as before.

Command (Preparation)

"Turn your head to the right and try to put your chin behind your right shoulder."

Command

"Keep your chin on your shoulder and your ear back; don't let me move your head." "Now pull your chin farther behind your shoulder." "Now do it again."

Resistance

Your distal hand (chin) resists the upper (short) neck flexion, rotation and lateral flexion. Your proximal hand resists lower (long) neck extension, rotation, and lateral flexion.

O Fig. 9.9. Neck for trunk right lateral flexion. d-f in prone with extension bias

O Fig. 9.9. Neck for trunk right lateral flexion. d-f in prone with extension bias d e f

□ Fig. 9.10a,b. Patient with incomplete tetraplegia after a traumatic fracture C2 and C6. a Flexion, lateral flexion and rotation to the right. b Timing for emphasis with neck rotation to the left for good trunk extension to the left

When your patient is prone, the rotational resistance is away from you (toward the front of the patient). Therefore, your left hand grips the head, your right hand grips the chin.

Motion

The upper trunk side-bends to the right with extension, the right shoulder moves toward the back of the right ilium. The motion includes trunk extension and right rotation (□ Fig. 9.9 d-f).

Reference

Kendall FP, McCreary EK (1993) Muscles, testing and function.

Williams and Wilkins, Baltimore Lee DN, Lishman R (1975) Visual proprioceptive control of stance. J Human Mov Studies 1: 87-95 Shumway-Cook A, Horak FB (1990) Rehabilitation strategies for patients with vestibular deficits. Neurol Clin 8:441-457

Was this article helpful?

0 0
Fire Up Your Core

Fire Up Your Core

If you weaken the center of any freestanding structure it becomes unstable. Eventually, everyday wear-and-tear takes its toll, causing the structure to buckle under pressure. This is exactly what happens when the core muscles are weak – it compromises your body’s ability to support the frame properly. In recent years, there has been a lot of buzz about the importance of a strong core – and there is a valid reason for this. The core is where all of the powerful movements in the body originate – so it can essentially be thought of as your “center of power.”

Get My Free Ebook


Post a comment