Vidcast Wednesdays! Q&A on Cervical Retraction and "Shear" | Modern Manual Therapy Blog

Vidcast Wednesdays! Q&A on Cervical Retraction and "Shear"

OMG! The Discs... the discs! I can hear the annulus tearing!

A reader works with a FAAOMPT who is strongly opposed to doing cervical retraction as an exercise because of shear forces.
Good afternoon Dr. Religioso,I hope this email finds you doing well. Some background on myself: I am a 3-year post grad-school therapist working in an outpatient facility. I joined a company that is gracious enough to provide assistance for AAOMPT courses, of which I am several months into.

My boss himself is a fellow, and he could not be more adamant about avoiding cervical retraction; citing the shearing forces cervical retraction places on the discs in the cervical spine. Now I am not as well versed in the literature to either agree or disagree with his stance, but I am aware of your "end range is where the magic happens" stance regarding the cervical spine and retraction. I was hoping you could help share some light as to possibly where the shearing belief comes from and/or counter points to why retraction works soo well.

And that's what I never understood...if poor posture over time sets the head forward creating the classic upper cervical type extension....then why even bother attempting to "correct" the posture by pulling the head back over the shoulders if it is damaging to the discs. deep neck flexor recruitment/endurance is great...but how are they supposed to work in a physiologically appropriate length and postural position if the head never gets there? blood pressure cuff blood pressure cuff blood pressure cuff....but I have a hard time believing going from 30-40 on the dial is going to be enough to counter decades worth of posture.

thank you for your time and insight

Thank you for your time
Curtis Brock Howard, DPT, AT, CSCS

Another thing to add. "Years" of bad posture is like "years" of chronic pain. Most people have the available motion loss, they are just not accessing it. A smaller percentage of individuals fit into slow responder categories that will not be able to move into a cervical retraction position due to true motion loss. Manual therapy enhances their ability to move easier, thus getting to end range and resetting the area, reducing HA, neck, and UE pain. It's important to remember that optimal posture in sitting and standing emphasizes frequent movement out of those static positions. The only position we should be in static for hours is lying and that of course has micro movements to prevent body skin breakdown.


  1. That may be one of the silliest things I've heard a therapist say.....and I've heard a lot. No offense to Curtis but does your boss also tell patients to avoid flexing the knees in WB for fear of causing early onset arthritis? We've got to remember that movement is the medicine! If something hurts, it's simply the nervous system warning the patient that it needs to be moved! Unfortunately, too often patients come in with fear avoidance beliefs and catastrophization because someone in the medical community (your boss) has royally scared them by something they saw on some dumb imaging machine or just their beliefs....whether it be OA, bone spurs, disc herniation, alignment issues etc. A normal person shears different parts of their body routinely with normal ADLs but it's not a problem. Remember that movement is the medicine!

    Keep up the good work Dr. E!

  2. Dr. E. how often do you feel you need to unload a patient in order to achieve a reduction?

  3. Bill, that's a great question, for cervical patients, less than 10%, for lumbar maybe a bit higher, more like less than 20-30%. The unloaded movements are easier to perform hourly, thus tend to reduce/reset better.

  4. Awesome. Thank you, sir.