Mar 21, 2012

Common Cervical Treatments


Here are my cervical "go to" techniques for commonly restricted areas starting from superficial to deep.

IASTM to: (direction of repeated stroke and common restriction)

  • occiput
    • lateral to medial, 3-4 minutes, improves OA mobility
    • helps with cervicogenic HA
  • cervical spine
    • normally more restricted C2-4 in proximal to distal, 3-5 minutes
    • improves cervical/subcranial mobility, commonly restricted segments due to forward head
  • upper trap/levator scapula
    • restricted in prox to dist and dist to prox, as well as transverse (perpendicular to fibers) bending, 5 minutes
    • improves first rib mobility and shoulder elevation ipsilaterally as well
JM to subcranial and cervical spine
  • subcranial shear distraction, typically 3-4 sets of 6 reps
  • unilateral OA nod, 2-3 sets of 3 reps
  • cervical thrust if needed (I do translation > 90% of the time vs rotation) and have never done an AA rotatory thrust outside of a course
  • 1st rib inferior, anterior, posterior glides, 3-4 minutes




4 comments:

Anthony Distano said...

Good stuff Doc! For sub cranial shear I usually stabilize the atlas with one hand and use the opposite hand on the forehead (as opposed to shoulder on forehead) to create the retraction, almost like the uni OA nod you showed. I'm going to try with the shoulder to forehead....I assume you get greater overpressure with shoulder versus hand.

Dr. Erson Religioso III, DPT said...

Thanks Doc! This shear was modified by Dr. Rocabado of Chile. He noticed a subset of TMD/upper cervical pts were not responding to the normal OA nod (bilateral) you described. He x-rayed them. Saggital plane showed adhered atlas to occiput in neutral and flexion, with instability of C1-2 gapping in flexion. He then applied A LOT of shear force and found by stabilizing C2 (so much shear that the pt for a second has difficulty breathing - he did this on me and assured me it was normal). After several tx and deep cervical flexor strengthening, plus postural correction, he re-xrayed them and found increased space OA and AA not gapping excessively in flexion. Of course, the pts also had subjective improvement as well. That's why this is one of my "go to's"!

Chris Dukarski said...

Nice mobs. Very familiar as we spend a lot of time in the OMT program on the cervical spine. Just wondering if you are simply doing a "general" mob of the neck during your traps and levator stretches? The best way to stretch the lev scap is a combo of cervical flex, rot and SB away. For upper traps it would be flex, SB away and rot towards.

Dr. Erson Religioso III, DPT said...

Not a fan of stretching too much into flexion probably because of my MDT bias and flexion causing posterior derangements. I've had your question asked before, and you are correct strictly thinking of what each muscle is supposed to do by attachments. In terms of functional release, it's just a general movement of one attachment away from the other, increasing stretch tolerance very gently and under the patient's control.

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