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Re: Deep Neck Flexor Endurance
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Re: Deep Neck Flexor Endurance - April 1, 2005 4:01:00 PM
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Synergy
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From: Texas
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Jason/Barrett,
Thanks for your replies! Barrett, I have head of ideamotor activity, but apparently I am not very well versed in the subject. I suppose I need to delve into ideamotor activity quite a bit so that I can understand it better.
Jason, thanks for providing the rationale and potentially the answer to my problem. I wished I would have seen your reply earlier because I could have used it on one of my patients.
_____________________________
Chris Adams, PT, MPT
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Re: Deep Neck Flexor Endurance - April 5, 2005 5:58:00 AM
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JLS_PT_OCS
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Chris-
Good luck. Keep in mind that's just one technique.
Barrett-
OK, fair enough. If you've been specific about it over in the Bullypit, it wouldn't serve either of us well for me to ask you to repeat it.
I'll check out the threads you suggest, thanks.
Jason.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Deep Neck Flexor Endurance - April 8, 2005 6:04:00 PM
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jbeneciuk
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From: Jacksonville, FL
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Barrett:
I appreciate your approach and I respect your knowledge, however when you mention that "I don't take the patient there, I follow them"...I tend to disagree with you a bit. Without posting the current literature regarding patients with neck pain and the performance of the superficial vs. deep neck flexors, the method I re-educate patients in cases like the above mentioned is similar to what Jason described. The rationale is that if the deep neck flexors are not performing optimally, this impairment is one that "could be" and it would seem plausible that it is contributing to the patients aggravating sx...now lets say we are talking of chronic neck pain patients and not an acute situation, because then my theory would differ. If we can address these muscular impairments in the abscence of any muscle guarding or myofascial restrictions...won't this assist in the patient being able to function (if our goal of improved muscular performnane of the deep neck flexors is improved)?
I question that if we let the patient lead the way, "I follow them"...then aren't they in jeopardy of making an already altered state of motor control even worse ?
I'm interested to see how you feel about my reply Barrett, because I also take what you say into consideration and it often assists me in dealing with certain patients.
**In closing: I think the whole idea of training the deep neck flexors has gained popularity after the research regarding the deep abdominals and their influence on the lumbar spine...it really is a similar situation (generally speaking)...I feel more research needs to be done regarding the progression of a deep neck flexor program compared to an aproach that does not alter the patients current pattern of neck function...and although all research has flaws...positive outcomes regarding this approach will tend to strengthen why it is used for pts with neck pain.
Thanks for listening to my ramblings !!
**great topic Jason
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Re: Deep Neck Flexor Endurance - April 8, 2005 6:24:00 PM
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Barrett
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From: Cuyahoga Falls, Ohio
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Whomever,
Do you disagree with what I say I do, or do you disagree with why I do it? I presume you don't actually know what I do, and I don't agree that the "muscular impairments" or the "myofascial restrictions" (these have never been demonstrated to exist to my knowledge) are the reason the patient hurts to begin with.
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Deep Neck Flexor Endurance - April 8, 2005 6:33:00 PM
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jbeneciuk
Posts: 112
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From: Jacksonville, FL
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Barrett:
I was not implying that muscular impairments or myofascial restrictions were the cause of any reason the patient "hurts"...what I was referring to was that training of the deep neck flexors would not be performed in the prescence of abnormal muscle guarding, and if you believe that a patient cannot present with asymmetrical muscle tone in the superficial neck musculature, then that is a whole different discussion
**I never claimed to actually know what you do Barrett...I was just wondering why you disagree with the approach of re-training the deep neck flexors...I didn't mean to strike a bad discussion
jbeneciuk
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Re: Deep Neck Flexor Endurance - June 13, 2005 10:29:00 AM
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JLS_PT_OCS
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From: USA
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I have completed my newer DNF progression and some Cervical Stabilization exercise progressions. If you'd like them, please send me a PM and I will email you the files.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Deep Neck Flexor Endurance - June 14, 2005 5:26:00 AM
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Yogi
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From: San Antonio, Tx., USA
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January, thanks for the axial extension/shoulder elevation technique, I believe it will be quite useful in training axial extension, which I used to do in standing against a wall. I also used to use a polaroid photo of uncorrected FHP and corrected FHP they took home for family to see to help provide feedback for the pt.'s development of a new habit. Positioning for low intensity long duration levator scap stretches was a concurrent home program also.
But actually, you mentioned a technique for lumbar stabilization that you use, can you describe it? My lumbar stabil. pt. has a neurogenic bladder, so the technique of using the "holding urine" to elicit pelvic floor and multifidi contractions doesn't work for him. He also cannot find lumbar neutral in any position but supine. Ideas, anyone (simple ones for dummies)?
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Re: Deep Neck Flexor Endurance - June 14, 2005 6:04:00 AM
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JLS_PT_OCS
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Yogi-
For people who can't find neutral spine or who have difficulty with the local/australian approach to stability, I often try some more general stability and strength exercises with good results. Less specific, but then again, I think the jury is still out on which subgroup of patient will respond best to the local (vs global) stability approach.
J
I'll try to send out the DNF/Cx stability program sheets in a few days, giving it some time for people to ask...
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Deep Neck Flexor Endurance - June 14, 2005 10:23:00 AM
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Randy Dixon
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Yogi,
I'm not sure exactly what you are asking but you can have them activating the TrA simply by forcing air through pursed lips, the pelvic floor muscles come along for the ride.
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Re: Deep Neck Flexor Endurance - June 14, 2005 12:12:00 PM
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Yogi
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From: San Antonio, Tx., USA
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Thanks, Jason. Randy, we'll try that. I was searching the internet on lumbar stabilization to try to find out how to activate the multifidis and that Kegel-type bladder thing was what I found. Anyone else?
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Re: Deep Neck Flexor Endurance - June 14, 2005 1:49:00 PM
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FLAOrthoPT
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i try a prone technique where they activiate the spinal rottors as stabilizers to do a contralateral leg extension off the table but in minimal like 5-10 deree range just enough to activiate the spinal rotators, I usually palpate or wth the spine to see if it can stabilize without dropping anterior towards the side lifting..i add light resistace if they are not getting it...not sure if it is sound, but seems to work for me..
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Re: Deep Neck Flexor Endurance - June 14, 2005 1:53:00 PM
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nari
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From: Australia
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I have been following this thread with interest; and appreciating all the different outlooks on the DNF /TrA thing.
Usually, when a patient runs into trouble with DNF work, it is because they are trying too hard and have not gained the concept of isolating the shunting movement - ie the head shunts a fraction back on the spine. This is not an anatomical thing (that I know of) but purely a sensation. Most make the mistake of flexing or extending the head-on-neck.
If I am really keen on training the DNFs (and mostly I don't, it has become a bit passe here)I ask the patient to look in the mirror and I might take a few strands of hair (with permission)and tension the hair upwards just behind the vertex.
They get the idea quickly, and the superficial SCMs etc let go.
I don't think of strengthening muscles anymore, but activating them in a functional manner, and leaving the patient with that concept.
Randy, you are right - activating TA can be done precisely as you said. That concept has been around since the 1970s with a PT called Beryl Kennedy - 'abdominal bracing' - and Hodges et al validated it. I used to teach my antenatal women;
purse out and purse up (use your imagination) and they connected quite well with both ends....
Nari
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Re: Deep Neck Flexor Endurance - June 15, 2005 4:08:00 AM
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JLS_PT_OCS
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Nari- love the hair trick. It's too bad I work in a military setting, I would have to use tweezers to do that! :)
Nari makes a good point reference "strengthening".
Hopefully we all know that just as we cannot separate manual care into "joint effects", "nervous effects" and "muscle effects", we cannot separate exercise out either.
I think, after some reflection, that even though we call so many exercises "strengthening", that's really not what it's about.
I would argue that most of what we teach is neuromuscular reeducation and modulation of pain input, and the "strength exercises" are merely a vehicle to help acheive that.
Whether there are better vehicles for that, and I believe some here have argued that there are, is another discussion (but equally interesting).
So I think we can't isolate the effects of exercise into muscle strengthening, pain modulation, motion improvement, etc. It's all of the above.
And even though I call these "deep neck flexor endurance/strength exercises", they are designed to accomplish much more than that.
I think I left behind the sports strengthening /athletic trainer type approach long ago. It is terribly myopic and fosters a technician type approach to dysfunction, in my opinion.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Deep Neck Flexor Endurance - June 15, 2005 10:56:00 AM
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srcase
Posts: 551
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From: Michigan
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Yogi,
Multifidus stabilizes segmentally, especially during arm and leg movements; so you can have the patient stabilize against many different movements that induce rotary forces in the trunk, such as walking forward with a sport cord around contralateral shoulder, or walking backward with sport cord around ipsilateral shoulder; quadruped over a Swiss ball with alternating arm or leg lifts or opposite arm and leg lifts (prone or quadruped); PNF diagonals sidelying, seated on Swiss ball, or standing with resistance (pulley or medball). Basically, the sky is the limit, just be sure to cue the patient to activate the transversus during all the exercises.
Sarah
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Re: Deep Neck Flexor Endurance - June 15, 2005 11:01:00 AM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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Jason,
I receieved your DNF program. Thanks! We are not allowed to hand out unsanctioned home exercise programs, but maybe I can stick our logo at the top and use your likeness for educational purposes only! You're not kidding about the hair ;)
Seriously, I teach those exercises often, and have never had a really good picture for patients. The only one I would modify is the prone off the table, I have patients do this with the head on the table (forehead on towel roll) to prevent excessive shearing forces in the spine, and I usually combine it with scapular "setting" which is basically a Pilates exercise. I can email you a picture of yours truly doing that one if you are interested.
Sarah
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Re: Deep Neck Flexor Endurance - June 18, 2005 6:16:00 PM
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nari
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From: Australia
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Jason
I agree with everything you said in your post; and it has all been said before in perhaps different ways, and with different interpretations.
Strengthening is a misnomer - but try to explain that to an orthpaedic surgeon..... ;)
It is the essence of why sit to stand to sit is so effective for older patients for LE activation.
It has everything in the CNS going with it.
Nari
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Re: Deep Neck Flexor Endurance - June 19, 2005 6:18:00 AM
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avalon
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Yogi,
[QUOTE]so the technique of using the "holding urine" to elicit pelvic floor and multifidi contractions doesn't work for him.[/QUOTE]I'm january but lost my email account password and thus the january's one with.
1/ Holding urine is a technique to avoid absolutely because it reinforces bladder problems. We haven't any voluntary control on bladder just on the “tap”. If a bladder is weak then it will contract with increased pressure and will be weaker.
2/ I'm not sure that technique cited for lumbar area is efficient for bladder problem. I didn't tried it.
position; Patient is lying back on a table, knees bent comfortably.
Begin with abdominal breathing.
Then, knee bent and grasped with my arms close to my chest, I say to patient to push me, as they wanted to put their feet down to the table. They must sense all the slow movement in each direction. 4/5 times.
I'm focusing attention of patients to the fact that they are the directors of the movement and they control it totally. If they move slowly, they'll be warned if something may fail!
More they do it with strength, more easily the pain disappears!
In my view, the movement erases the anticipation component of pain?
The abdominal muscles are not activated in this trial and have not to to contracted.
_____________________________
http://www.somasimple.com
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Re: Deep Neck Flexor Endurance - June 21, 2005 1:37:00 PM
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Jon Newman
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I've been reading Michael Shacklock's book, Clinical Neurodynamics. One of those Alf Breig photos lingered in my consciousness for a while and I think it's because of this thread. On page 37, for those of you with access to the book, there is a picture (fig 2.8) demonstrating the effects of gravity on the spinal cord. For those without the book, the picture illustrates the resting position of the spinal cord in supine and how it is brought back toward the center of the canal with cervial flexion. It made me wonder if there might be room here to explain a portion of those who get better with DNF exercises. Any thoughts?
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Deep Neck Flexor Endurance - June 21, 2005 7:28:00 PM
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avalon
Posts: 181
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Hi Jon,
I'm reading actually the book and I found in the text that the picture you cited is from lumbar area. It shows how moving neck in flexion may have long distance effects. There is also another comment about moving lower limb, may move cervical region (that's normal).
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http://www.somasimple.com
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Re: Deep Neck Flexor Endurance - June 21, 2005 9:00:00 PM
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nari
Posts: 1568
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From: Australia
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jon
I don't get the connection....the DNF activation is done with the neck in neutral; not flexion, so could you explain a bit further re the connection?
nari
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