Levator Scapulae Self Stretch

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Levator Scapulae Self Stretch

To stretch the right levator scapulae:

The patient is instructed to sit with the head positioned in flexion, left side bending and left rotation, as though looking down towards the left hip.
Their left hand is placed on top and around their head for support. Instruct the patient not to pull on their head with the left hand.
The right hand is placed behind the right hip and grasps the chair/bench.
Ask the patient to slowly lean forward and to the left to feel a stretch along the right side of their neck.
To facilitate a balance between the levator scapulae and ipsilateral lower trapezius, instruct the patient to pull their right shoulder down and back using the lower trapezius muscle. If done properly they should feel an additional stretch in the levator scapulae muscle.
They hold for 20 seconds and repeat 2-3 times on each side.

Eccentric to Concentric Strengthening in Supine

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Eccentric to Concentric Strengthening in Supine

The patient is lying on their back with their hands clasped behind the head.
Instruct the patient to only use their arms to lift their head up so that the chin is drawn toward the chest and a stretch is felt through the back of the neck.
Once the head is brought up fully the patient is told to hold this position for 5-10 seconds, then slowly lower the head back to the table segmentally from below up, using the deep neck flexors eccentrically to lower the head back down to the table and assisting the movement with their hands as needed.
The hands only support the head as needed and an emphasis is placed upon keeping the chin down as the head is returned back to the table.
They repeat 3-5 times.
Eventually as the deep neck flexors become stronger, the hands should no longer be needed to assist in slowly returning the head back to the table.
The goal with this exercise is for the patient to be able to segmentally flex the neck and return back down to the table segmentally without using the hands to assist with the chin staying down throughout the entire movement.

Dysfunctional Cervical Flexion Test

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Dysfunctional Cervical Flexion Test

Anatomy and Biomechanical Considerations:

The cervical flexion test assesses the ability of the patient to segmentally flex the cervical spine using the longus colli, longus capitis and rectus capitis anterior assisted by the SCMs, anterior scalenes and infra and suprahyoid muscles. When the primary deep neck flexors are inhibited/weak the SCMs and anterior scalenes substitute for this weakness and become the primary neck flexors resulting in the chin tipping up and the upper CS extending rather than flexing during the performance of this test (Janda, 1994).

Abnormal afferent information that can contribute to this muscle imbalance can occur when ERS dysfunctions of the cervical and especially upper thoracic spine are present. These ERS dysfunctions can result in inhibition of the longus colli and longus capitis due to restricted active and passive ROM for neck flexion. In addition, hypertonicity of the scalenes occurs in apical chest wall breathers as the scalenes, which are normally only accessory muscles recruited with deep inhalation, become recruited with every breath. Palpation of the scalenes in these patients will confirm the recruitment of these muscles even during relaxed breathing. This typically is felt to occur more on the R side than the L. Asking these patients to take a deep breath while the therapist palpates the lower lateral rib cage for normal bucket handle motion will reveal restricted excursion on the R side in these patients.

Self Mobilization for Adverse Neural Tension in the Cervical Spine

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Self Mobilization for Adverse Neural Tension in the Cervical Spine

To treat the right side of the neck:

The patient is lying on their back and places their left hand under the neck with their fingers wrapping around to the right side of the neck. The therapist instructs the patient as to the specific location for the patient to place their finger contact.
Tell the patient to gently pull their neck to the left using their left hand and hold this position.
The patient’s R arm is down at their side with the palm facing the ceiling.
Have the patient slowly abduct their arm as far as they can without allowing the cervical spine to translate back to the R.
The patient returns the R arm back down to the side and is instructed to take up any slack that they feel for additional R to L translation and repeat again.
The patient repeats the movement 8-10 times holding their neck still and translated to the L as they try to abduct their R arm higher with each successive repetition.

Mobilization of Adverse Neural Tension on the R side of the Cervical Spine

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Mobilization of Adverse Neural Tension on the R side of the Cervical Spine

The therapist introduces translation from right to left with his/her contact on the dysfunctional articular pillar.
The patient is instructed to slowly abduct their R arm along the table as far as they can while the therapist maintains the right to left translated position of the cervical spine and prevents the dysfunctional segment from translating back to the right.
This is repeated several times. Each time the patient lowers their arm to their side the therapist takes up any additional slack for right to left translation.
Goals for treatment: translation from right to left at the previously noted dysfunctional segment is now free and the patient should be able to fully and comfortably abduct the right shoulder overhead without the therapist feeling the cervical spine translate to the right at any segmental level.

Muscle Energy Technique for the Levator Scapulae

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Muscle Energy Technique for the Levator Scapulae

To stretch the right levator scapulae:

The patient is left side lying with the head positioned in flexion, left side bending and left rotation.
The operator’s right hand is placed on the lateral aspect of the neck from C1 through C4 to stabilize the cervical spine. The operator’s left hand is placed over the patient’s right shoulder in front of the clavicle so that the shoulder can be brought into posterior tilt with depression of the medial border of the scapula. The patient’s right hand should be placed upon and remain on top of the right hip.
The patient is instructed to raise the right shoulder towards their ear which is resisted by the therapist for five to seven seconds.
Upon relaxation further posterior tilt and depression of the scapula are introduced by the therapist.
This procedure is repeated 3-4 times.

Wall Press Self-Mobilizing Exercise

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Wall Press Self-Mobilizing Exercise

To Self-Mobilize ERS Dysfunctions in the Upper TS:

The patient is standing approximately three feet from a wall and places their hands on the wall at shoulder height.
Instruct the patient to drop their head down and push their arms against the wall fully extending their elbows and rounding their upper back. They should feel a stretch in their upper back.
Make sure that the apex of spinal flexion occurs in the upper and not the middle or lower back when they extend their arms.
Instruct the patient to rotate their head to the R to stretch L sided ERS dysfunctions or rotate their head to the L to stretch R sided ERS dysfunctions as they extend their arms fully.
Ask the patient to hold for 5-10 seconds.
Then have the patient stand up straight and lean into the wall maintaining a neutral low back. Ask the patient to try to touch the wall with their forehead.
The shoulder blades should draw close together as they drop into the wall.
Instruct the patient to hold this position for 5-10 seconds and repeat the entire exercise 3-5 times.

Muscle Energy Technique for ERS Dysfunctions of the Upper Thoracic Spine

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Muscle Energy Technique for ERS Dysfunctions of the Upper Thoracic Spine

For an ERS R from C7 to T5:

Patient places their R arm on your R leg with their whole arm resting and supported on your R thigh.
Place your R hand gently on top of their head and your L thumb on the L side of the interspinous space of the dysfunctional segment to monitor the motion barriers.
The patient is initially sitting in a slumped position, but with their head up. Ask the patient to sit up tall from below up by pushing their belly forward until you feel motion at your palpating L thumb.
Then with your R hand move the patient’s head from an extended position into flexion introducing flexion from above down to your palpating L thumb so that you create an apex for flexion at the dysfunctional segment.
L side bending is then introduced by translating your R leg to the R to create an apex for L side bending at your palpating L thumb.
The therapist then adds L rotation thru the head from above down to the dysfunctional segment making sure to go to just the feather edge and not beyond the motion barrier.
The patient is instructed to gently side bend their head to the R or pull their R arm down on your leg for 5-7 seconds.
When the patient relaxes you introduce additional L side bending to the new motion barrier by translating your R leg further to the R.
You repeat 3 to 4 times then reassess.

Upper Trapezius and SCM Stretch

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Upper Trapezius and SCM Stretch

These muscles extend the upper cervical spine, side bend toward the ipsilateral side and rotate the head to the opposite side
When tight these muscles may serve as long restrictors for mobility at C0-C1

To stretch the right upper trapezius and sternocleidomastoid:

Instruct the patient to position their head in flexion, side bending to the left and rotation to the right.
Their left hand is placed on top and around their head for support. Instruct the patient not to pull on the head with the left hand.
The right hand grasps the chair or bench behind the right hip.
The stretch is introduced by asking the patient to slowly lean forward and away and not by pulling on the head. They should feel a stretch over the top of the right shoulder and behind the ear.
Then instruct the patient to tuck the chin down (nod the chin) to add to the stretch which should be felt at the attachment behind the right ear.
Ask the patient to pull their right shoulder blade down and back to further increase the stretch.
They hold for 20 seconds and repeat 2-3 times. Have the patient alternate sides and stretch to symmetry as much as possible.

Cervical Flexion Mobility