Clinical Pearl: Why Cervical Retractions May Be Giving Red Lights | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Clinical Pearl: Why Cervical Retractions May Be Giving Red Lights

Yes Carl, I will recycle this picture forever

Is you cervical or TMD patient benefiting from your OA distractions and/or subcranial shear distractions, but the same technique performed via HEP flares them up?

Here are a few tips to try before you abandon this great reset.

1) Make sure they're sitting or standing upright
  • even a slightly depressed sternum makes this exercise difficult to do
  • also make sure their scapula are set, but only using just enough effort, not maximal
image from

2) Thoracic mobility is also important for this movement

  • a good end range cervical retraction needs the upper thoracic and some mid thoracic ability to handle loading
  • try some light IASTM to the upper and mid thoracic paraspinals, then have the patient try the movement again

3) The patient is not relaxed during the movement
  • I use the cue, "push farther" not "push harder" for self generated overpressure
  • with or without overpressure, often, the patient struggles to get to end range and irradiation of the cervical flexors along with the upper traps occur
  • make sure these muscles are relaxed during the movement
  • the overpressure should be given at their active end range, not throughout the range, as this often facilitates the cervical flexors
If I could think of two more quick tips, I would have posted this on Friday! Remember to exhaust other options prior to abandoning what may be the patient's directional preference.

Keeping it Eclectic...

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