Top 5 Fridays! 5 Considerations for Cervical Retractions | Modern Manual Therapy Blog

Top 5 Fridays! 5 Considerations for Cervical Retractions

Here are 5 Considerations for the Cervical Retraction Exercise!

neutral/start position
cervical retraction
 1) Start in neutral, end in neutral

  • some patients are "spring loaded" and after successfully performing a retraction, rapidly return to near full protraction
  • if the DP is retraction, this defeats the purpose of end range loading in that direction
  • have them start with their thumb on their sternum with their index keeping them in neutral
  • have them retract away from their index finger, but not bash through it
    • also make sure they're not just moving their index finger away - surprising how many do this!

2) End range, end range, end range!

  • Just like REIL, end range is where the magic happens!
  • with the above self generated overpressure performed hourly, I rarely have to use the progression to retraction with extension
  • make sure they remain tucked - double/triple chin time!
  • end range is sternum slightly raising
3) Just enough, but not too much!
  • many patients may find this exercise uncomfortable, but are trying so hard to do it correctly, they tense their masseter, scalenes, and upper traps
    • I learned the #3 consideration from a fellow mentee of mine, Dr. Kris Bosch, who successfully integrates pilates and OMPT
  • make sure the movement gets to end range, but not through force 
    • range = range
4) They should be performing retractions (WB/loaded) with good posture
  • it is easy enough on many patients to show cause/effects of posture by checking cervical rotation/extension in slouching, then rechecking in neutral
5) Do not forget about unloading, especially for headaches
  • if loading (but more function) retractions are not tolerated for HEP, the patient may perform in supine over a pillow or cervical roll
  • for headaches, they can hold this for 3-4 minutes to see if the referred Sx centralize
  • after a few days of performing unloaded, try to progress back to loaded, which are easier to perform repeatedly throughout the day


  1. Good info again Dr. E! I have been printing these out and passing along to my colleagues (only 1 of whom is MDT trained) so the extra tidbits are helpful. The form really does matter in these movements and you have to keep a close eye out on the patient as they usually look down and perform upper c spine flexion, rather than retraction. I say sometimes pull away as you just smelled something gross(this usually gets retraction and not flexion).


  2. Thanks HV! Actually, I use (but didn't make up) pretend like an ugly guy is going to kiss you. Works for both sexes!

  3. Good tip (pull away as you just smelled something gross) ! I have difficulty explaining this movement but this sounds like it should help my pts. Thanks @3e5cf82c20f808a8f1cbc29c169bca2e:disqus

  4. Haha yes it will. Gets a good laugh out of this ridiculous motion. Being rural, I say sort of like a chicken clucking.

  5. Great suggestions from the post and the comments! Thanks! Any extra tips for cueing the relaxation of the scalenes, masseter, and upper traps?

  6. I think spell check changed septum to sternum.