Everyone talks about strengthening of "CORE MUSCLES" to prevent back pain but, we rarely hear or talk about the core muscles of neck.
Research shows that 70% people experience neck pain at some point in their life.The cause of injury may range from accident to use of wrong pillow causing strain in their neck. Any injury has shown to inhibit recruitment and strength of muscles in neck. And these muscles are your DEEP NECK FLEXORS or Core muscles.
Similar to lumbar spine, cervical spine uses these deep muscles to ensure the intersegmental spinal control.
DEEP FLEXOR MUSCLES
Small stabilizing muscles are located in anterior and antero-lateral part of cervical spine. They are located deep to sternocleidomastoid.
LONGUS COLLI
ORIGIN and INSERTION
Superior oblique arises from anterior tubercle of transverse process of third fourth and fifth cervical vertebra and inserted into narrow arch of the tubercle of atlas.
Inferior fibres originate from first 2 or 3 bodies of thoracic vertebrae and is inserted intoanterior tubercle of the transverse process of 5th and 6th cervical vertebra.
It is the most common muscle injured during whiplash injuries.
Longus colli with other muscles forms a sleeve to stabilize the neck in antigravity positions.
LONGUS CAPITIS
ORIGIN and INSERTION
It arises from four tendinous slips from the transverse processes of third, fourth, fifth and sixth cervical vertebra and is inserted into inferior surface of basilar part of occipital bone.
Both the muscles together perform following role:
A low load program for craniocervical flexion exercise focusing especially on motor control of deep neck flexors have shown to reduce neck pain and headaches.
EXERCISES TO ACTIVATE CORE MUSCLES
1) CHIN TUCK IN EXERCISE:
Lie on the floor with neck supported.Tuck your chin in or push your head on the floor without bending your neck. Repeat the exercise for 12 counts for 2 sets. Gradually try to hold each count for 5sec.
2)HEAD LIFT EXERCISE
Lie on the floor. Tuck your chin in and lift the head just 3-4 inches above the floor and return.
3)NECK FLEXION
Ask the patient to lie on the floor with knees bent and feet on floor. Put finger at base of the skull and lift about 1/8th inch off the floor. Make sure the neck is not liftitng off the floor. Remember core exercises are slow movements. Feel down for a bony bump (7th cervical vertebra). Now ask patient to lift the neck till this bump and the skull but not the rest of the neck. Now gradually ask to release it.
4)BIOFEEDBACK
You can also keep a pressure sensor or pressure cuff beneath patients neck and ask him to slowly nod as if saying yes.Ask him to hold the position 2mmHg above the baseline and gradually increase the baseline to 4,6,8 10 mm Hg and 10 Sec hold. Highest level acheived in 10 repetitions 10 seconds hold.
PERFORMANCE INDEX MEASURE
Number of times patient can hold pressure level, multiply it by pressure increment. For example: if patient can achieve 4mmHg and could do 6 repetitions of 10 sec hold without breaking the form then the performance is 24. The highest is 100 that is 10 mmHg and 10repetitions.
5) CRANIOCERVICAL FLEXION WITH CERVICAL FLEXION
It works on deep as well as superficial muscles.
Tuck in the chin and lift the head off so that chin touches the chest.
PROGRESSION
a) Using resistance with help of theraband or manually applied resistance.
Patient is supine. The resistance is applied manually and the patient is asked to do 12 repetitions of craniocervical and cervical flexion.
Perform 3 sets of 12 repetitions for 2 weeks then by 4th week perform 15 repetitions.
b) In quadruped position
Ask patient to assume quadruped (on all four) position and perform chin tuck in or nods without bending the neck.
EXERCISE IN FUNCTIONAL POSITION
a) Sit with feet flat n buttock supported.Gently roll the pelvis forward on ischial tuberosity.
Instruct the patient to move thorax slightly up and forward for slight lift.Gently and minimally lift the occiput to position the head in neutral position away from cervical extension.
b) Also, Patient must be taught to maintain optimal neck position while performing upper extremity task.
Shoulder blade stabilization is integral part of stabilization of neck and hence shoulder blade exercises should also be performed.
Also a heat pad can help to relax the muscles and the perform the exercises, make sure that mild stretches are done after the exercises are over.
While performing all exercises breathing is very very important. Make sure during the course of exercise you donot hold your breath and perform the exercise.
Thus, training these muscles along with the treatment commonly practiced by the physiotherapists will serve to prevent the later complications or recurrence of any chronic dysfunction.
DISCLAIMER: The above given program is a general guideline to introduce the importance of the concept of core muscles of neck. Do thoroughly assess your patient before attempting any of the exercises.
Research shows that 70% people experience neck pain at some point in their life.The cause of injury may range from accident to use of wrong pillow causing strain in their neck. Any injury has shown to inhibit recruitment and strength of muscles in neck. And these muscles are your DEEP NECK FLEXORS or Core muscles.
Similar to lumbar spine, cervical spine uses these deep muscles to ensure the intersegmental spinal control.
DEEP FLEXOR MUSCLES
LONGUS COLLI
ORIGIN and INSERTION
Superior oblique arises from anterior tubercle of transverse process of third fourth and fifth cervical vertebra and inserted into narrow arch of the tubercle of atlas.
Inferior fibres originate from first 2 or 3 bodies of thoracic vertebrae and is inserted intoanterior tubercle of the transverse process of 5th and 6th cervical vertebra.
It is the most common muscle injured during whiplash injuries.
Longus colli with other muscles forms a sleeve to stabilize the neck in antigravity positions.
LONGUS CAPITIS
ORIGIN and INSERTION
It arises from four tendinous slips from the transverse processes of third, fourth, fifth and sixth cervical vertebra and is inserted into inferior surface of basilar part of occipital bone.
Both the muscles together perform following role:
- Responsible for initiating or starting neck flexion movement.
- reduce shearing force across cervical facet joint and disc.
- maintain neck posture.
A low load program for craniocervical flexion exercise focusing especially on motor control of deep neck flexors have shown to reduce neck pain and headaches.
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| chin tuck in |
EXERCISES TO ACTIVATE CORE MUSCLES
1) CHIN TUCK IN EXERCISE:
Lie on the floor with neck supported.Tuck your chin in or push your head on the floor without bending your neck. Repeat the exercise for 12 counts for 2 sets. Gradually try to hold each count for 5sec.
2)HEAD LIFT EXERCISELie on the floor. Tuck your chin in and lift the head just 3-4 inches above the floor and return.
3)NECK FLEXION
Ask the patient to lie on the floor with knees bent and feet on floor. Put finger at base of the skull and lift about 1/8th inch off the floor. Make sure the neck is not liftitng off the floor. Remember core exercises are slow movements. Feel down for a bony bump (7th cervical vertebra). Now ask patient to lift the neck till this bump and the skull but not the rest of the neck. Now gradually ask to release it.
You can also keep a pressure sensor or pressure cuff beneath patients neck and ask him to slowly nod as if saying yes.Ask him to hold the position 2mmHg above the baseline and gradually increase the baseline to 4,6,8 10 mm Hg and 10 Sec hold. Highest level acheived in 10 repetitions 10 seconds hold.
PERFORMANCE INDEX MEASURE
Number of times patient can hold pressure level, multiply it by pressure increment. For example: if patient can achieve 4mmHg and could do 6 repetitions of 10 sec hold without breaking the form then the performance is 24. The highest is 100 that is 10 mmHg and 10repetitions.
5) CRANIOCERVICAL FLEXION WITH CERVICAL FLEXION
It works on deep as well as superficial muscles.
Tuck in the chin and lift the head off so that chin touches the chest.PROGRESSION
a) Using resistance with help of theraband or manually applied resistance.
Patient is supine. The resistance is applied manually and the patient is asked to do 12 repetitions of craniocervical and cervical flexion.
Perform 3 sets of 12 repetitions for 2 weeks then by 4th week perform 15 repetitions.
b) In quadruped position
Ask patient to assume quadruped (on all four) position and perform chin tuck in or nods without bending the neck.
EXERCISE IN FUNCTIONAL POSITION
a) Sit with feet flat n buttock supported.Gently roll the pelvis forward on ischial tuberosity.
Instruct the patient to move thorax slightly up and forward for slight lift.Gently and minimally lift the occiput to position the head in neutral position away from cervical extension.
b) Also, Patient must be taught to maintain optimal neck position while performing upper extremity task.
Shoulder blade stabilization is integral part of stabilization of neck and hence shoulder blade exercises should also be performed.
Also a heat pad can help to relax the muscles and the perform the exercises, make sure that mild stretches are done after the exercises are over.
While performing all exercises breathing is very very important. Make sure during the course of exercise you donot hold your breath and perform the exercise.
Thus, training these muscles along with the treatment commonly practiced by the physiotherapists will serve to prevent the later complications or recurrence of any chronic dysfunction.
DISCLAIMER: The above given program is a general guideline to introduce the importance of the concept of core muscles of neck. Do thoroughly assess your patient before attempting any of the exercises.
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