The Cervical Powerhouse

Chapter 1

Introduction

Hi, I'm Carol Reeser and I'm Jeremy Labrador. And together we have a continuing education program for pilates professionals called movement science. Made simple and moving science made simple looks at PyLadies protocols and other movements through the lens of anatomy, biomechanics, motor learning theory and pain science. Now a normal motor movement science made simple course is two days long and we go kind of regionally through the body. So we have a course that's looking at the relationship between the pelvis and the hips and the low back for example.

Or we have a course that looks at leg alignment and how the hip and the foot affect the knee. Uh, but we love to come to plays anytime because it gives us a chance to do sort of a distilled excerpt where we get to give you guys part of one of our courses with a particular kind of a focus. So today we're here at plot is anytime to offer a section of a course that we teach that's on the cervical spine and the shoulder girdle. Today we are going to zero in on looking at plays protocols and other protocols for the cervical spine. And we're calling this class the cervical powerhouse. And with the idea being that, um, we want to focus on positive ways to strengthen and control the cervical spine.

And we also want to help Pleiades teachers just sort of gain a little more confidence, have a little less fear when their clients report in, Oh, I really feel that on my neck or I'm afraid of my neck hurts. And oftentimes we'll be like, oh, put your head down, here's a pillow. And rather we want to sort of boost our confidence and help people really, um, train the neck for strength and control. So one of the things we do and move insides made simple as well. We study a lot and we find inspiration, a lot of other experts and we'd like to pull quotes, um, that help inspire, um, the, the course that we're teaching.

So I'm going to read this quote. This is from a, um, kinesiology textbook by Levann Jian Norkin and it reads, the neck needs to be flexible enough to orient the eyes, ears and mouth in space regardless of what the body is doing. And it needs to be stable enough to support the weight of the head while providing this range. The neck moves 600 times every hour, whether we're awake or asleep. So just a little plug for, um, how much we need that cervical spine to keep moving and stay strong. Yeah.

And the research really supports the use of strengthening exercises to reduce pain in the neck. And the research also supports the notion that we can work with people's a head position. For example, our clients who have a really pronounced forward head posture through strengthening the cervical flexors. Uh, so we'll provide you all with a list of references at the end of this workshop so you can look at the research yourself and certainly the idea that strengthening helps with pain and posture a and function as what we see with our patients and clients. Absolutely. And you know, I come from the tradition of Kathy Grant. I was a student of Kathy grants and I came to her with a uh, fractured, you know, I was recovering from fractures in my thoracic spine and I had a lot of neck pain and she went right for it. I mean, we did a ton of neck strengthening exercises, a lot of which I'm going to share today. Um, it was a lot about building that power. And when Jeremy and I look back at some of the archival exercises taught by Mr Plots, we also see a lot of next strengthening, even apparatus and exercises that seem to be somehow lost in the system.

And so part of it is also to kind of like bring, bring that back and to try to give you a little bit more confidence about how to strengthen the neck and how not to be afraid when your client complaints of, of those sensations. Yeah. And it was always actually my appreciation of how great a Kathy's work was with respect to how it treats the neck and head and shoulders that really provided the inspiration for, for me to propose to Kara that we create the series of courses that became movement science made simple. I was in physical therapy school and getting to have a little better understanding of anatomy and biomechanics. And I was really struck by in particular how Kathy's work around the head and neck made a lot of sense.

One of the things that we like to also promote in this programming and we're going to start with is uh, a a stronger sense of, of anatomical truths. And um, so we're going to start looking at some, um, reviewing some anatomy with Jeremy, some basic anatomy with Jeremy. And um, I just want to give you the lens for this. So our view is that we're gonna do anatomy. We don't want you to like worry about the name of the muscle or how to spell it or the insertion point. But mostly we want you to visualize what is this structure, who supports this structure or how you know, and how would you use the structure given what the joints actually are allowed to do. So it's again a soft lens on the anatomy part, but just really trying to visualize what it's like to realize you and your clients all carry this architecture inside themselves. And that's always as we go through the workshop, we'll be talking about some general move principles and making some general recommendations. But as Kathy grant said, one size doesn't fit all right.

So you might find that you need to modify things for your particular clients. And certainly any recommendations that we make during the course of this workshop with regard to particular conditions, um, are no substitute for your own judgment, first of all. And also if you have clients who have a particular diagnosis that seems to be the cause of their neck pain, then it's always wise to be in contact with her physical therapist or their physician. So you're making sure that you're understanding any precautions or contraindications that that particular person might have. Great. So we're going to get started with some anatomy of the cervical spine. Now in considering the neck in this course,

Chapter 2

Bones of the Cervical Spine

we're not just going to be thinking about the cervical spine itself, right?

We want to think about sort of the upper thoracic spine all the way to the top of the head. And in the two day version of this course, we go through the bony anatomy of that whole area and the muscular anatomy pretty thoroughly. Uh, but because we're have a shorter amount of time here, we're going to keep our focus as least in the anatomy portion on the upper cervical spine. And the reason is that the upper cervical spine moves very differently than the rest of the cervical spine and the rest of the spine altogether. And as PyLadies teachers, we're very often coaching people to move their spine in a sequential fashion. And very often it's from the top of the spine, right? So we want to have a clear understanding of how the top of the spine works so that we're getting the results that we want when we're doing our Polonius protocols.

And it's also gonna clear up a lot of our questions about how people's sort of posture presents through this part of their spine, right? So, uh, an image that care very often uses a, that speaks to this is of the, the head as the first vertebra of the spine, right? So that every movement that we initiate from the top of the spine initiates with the skull. So the first thing we're going to look at is the relationship between the skull and the rest of the cervical spine. All right, so this is a cutout of your cranium, right? Just like on this guy. And if I flip it over, you can see the underside, right? There's the opening where the spinal cord goes in the frame and magnum.

And then there's these articular surfaces, surfaces, these occipital condyles, which is where the skull articulates with the first cervical vertebra and the surfer [inaudible] cervical vertebra is sometimes called the atlas, right? It's refers to the mythical guy that holds up the planet, right? So if you look at the atlas, it's basically a ring, right? And it also has articular surfaces where the skull articulate on the first cervical vertebra. It also has transverse processes that will uh, pell pate later on ourselves. And I want you to take a look at the ring structure of it cause that's going to be important when we look at the next vertebra down, right?

So if we take these articular surfaces on the underside of the cranium and these surfaces on the atlas and put them together, we get the skull sitting on the first cervical vertebra. And because of the shape of those surfaces, it mostly produces a nodding movement, right? A flection movement and an extension movement of the skull on the atlas. And that movement is referred to as Capitol flection or capital extension. Capital just means head by Cara has an acute, a mnemonic device, and that is that. It's like you're tipping your cap, right?

So that's how we remember Capitol flection and capital extension. And we'll be using those words a lot throughout the workshop. Now there's a cute little demonstration we'd like to do to help you visualize that capital flection the capital extension and is going to help me with it. So Kara's hands are going to represent the articular surfaces on the atlas on C1 right in this bowl is going to represent her cranium, right? So just like, uh, if the way care's actual head is, if, if this was her head facing towards me, her nose would be pointing towards me right now. And when she tips or cap right when she does that little bit of capital Flection, her skull is gonna roll on those articular surfaces of the atlas.

Now if it just rolled, it'll eventually roll right off those articular surfaces, right? So what has to happen for it to maintain contact is as it rolls forward, it has to do a simultaneous kind of gliding back on those surfaces, right? Likewise, as she looks up into a little bit of capital extension, the ball rolls back, but it has to glide forward, right? So there's a combined rolling forward and gliding back motion there. And this is a combined rolling back in gliding forward motion that allows those surfaces to stay in contact with each other. So now we'll look at the next joint down where the atlas or c one sits on the axis or a c two. So your second cervical vertebra is remarkable. Uh, mostly because of this really prominent sticky Audi, uh, thing, which is called the dens or the odontoid process, right?

And the dense fits into that ring of the atlas that we looked at, which allows a rotational movement to happen between the atlas and the axis, right? In real life, there's a ligament that goes across that and closes that circle. But I think you can see really clearly just from the structure of these bones, how our rotational movement is produced there, right? So if you're at home, take your, take your hands behind your ears into this little sort of divot behind your ear and your jaw. And if you push in a little bit, you should feel like a little hard bit, or maybe it's really tender back there. Uh, and those are actually the transverse processes of your axis that we have your atlas rather that we looked at before, right? So you could do that little nodding motion of capital flection and capital extension there. Now the access of the skull rotating, it's probably somewhere up around here, but we could use our ear holes as sort of an imaginary axis as we produce that motion. And then if you go to the back of your skull, right, you can feel the, the Nabi occiput of your skull and then work your way down the midline, your feeling for a spinus process.

And you could maybe feel the spinus process of c two, right? It's pretty prominent, whereas the axis doesn't have much of a spinus process to speak of. So go with your hands, feel your pure C2 spinus process if you can, right? And then you're going to take your fingers onto as many of your spinus processes as you can kind of get. So you want to feel the bones of your neck and then see if you can do that capitol flection and extension without really moving too much of your, your, your, your neck around, right? We're trying to isolate that capitol flection and extension.

See if you can sense that. And what you might feel is that there's actually a little more capital extension than there is capital flection. We have probably about twice as much extension as we have fluxion at the top of our spine. And the reason I'm pointing that out is I think that's a movement that really gets trained out of us as plus teachers, right? We're, we're so worried about sort of wrinkling the backs of our necks that we never utilize that capital extension. Right? Uh, and now there's one more sort of bony landmark that we're going to be using throughout the course. So if you take your fingers to your holes and kind of run them up to the top of your head, right?

So you're finding a point that's at the level of the ear holes and in the midline of your head we're gonna use that point as sort of the top of your head or the crown of your head. So you could rub it with your finger or kind of tap it so you have a good felt sense of where that is. Cause we'll be asking you to sort of direct that point in space. And what that is is actually sort of this place right above where your spine goes into your skull. So that would be the axis of rotation for that rotational movement of the atlas on top of the Axis.

And you've got about about half of your neck rotation comes just from that, that movement. So maybe do a little bit of that side to side movement and see if you can just feel how or imagine how the skull and the atlas move on top of the axis. All right, so that's the outline for the bony anatomy. And now we're going to look at some of the muscles that produce that Capitol flection, capital extension and that rotation at the top of the spine.

Chapter 3

Muscles of the Cervical Spine

So as Karen said a few minutes ago and move insights made simple, we really want to look at the anatomy so that we have an image in our own minds of how things work so that when we're looking at a body or talking to ourselves, when we're doing movement, we have sort of an accurate picture.

It's not our goal that you should learn the names of everything or the insertions of every, every muscle. So try to keep sort of a soft focus while we're going through this, uh, anatomy stuff and you can always go back over it again. Uh, and certainly there's plenty of resources available online if you want to do some more research. So here we have an image of the cervical spine, uh, and this is taken from Wikipedia. These, these computerized looking images are available for, uh, use for everybody through creative Commons license. So youtube can go online and make your own PowerPoint. The reason I like this image is because you can see as it passes around how the Dems have the access fits into the atlas, right?

Just like we were talking about. So again, we're not going to go comprehensively through all of the musculature of the neck, but we want to draw your attention to two kind of groups of neck muscles. The first group we're going to refer to as the deep neck flexors, so these are the muscles that are on the front of your cervical spine, sort of behind your throat, right onto the front of the spine. And these images are taken from Grey's anatomy, also in the public domain. You can also use these images yourself. All right, so rectus capitis interior is a muscle that produces capitol flection and muscles are named because of their shape, because of where they are because of what they do, right? So rectus is a muscle that's kind of rectangular shaped.

Capitas means it's doing that capital movement. It's moving your head. And Interior means it's on the front. So it's called Rectus capitis anterior. And you could see it highlighted here. And there's another one on the other side, but it's obscured by other muscles in this image. So you have to keep in mind that it's a paired muscle and attaches from in front of those occipital con dials down onto the atlas on to c one.

So you can see how as it contracts, it would produce that movement of capital flection. Right? Okay. Rectus capitis letter Vallis it's recklessly shaped. It's capital. It does this something with your head and it's lateral. It's more off to the side and this muscle goes from sort of farther out on the side.

We're on the other side of the occiput to the transverse process of the atlas and because of what's where it's positioned right. Again, it would be paired with one on the other side because of what's where it's positioned. You could imagine that it could produce a little bit of side bending at that first joint, the joint between your skull and the atlas. Now there's not a lot of that kind of movement available because of the shape of the condyles. Right. We said there's mostly this flection extension available, uh, at the AOL joint. The Atlanto occipital joint, but there is a tiny bit of side bending available and we're really gonna imagine that movement when we get into side bending later. Longest capitis, right as long.

And it's a capital muscle and it goes again from sort of just in front of those occipital condyles down onto the transverse processes of like c two c three c four or something like that. I'm, I'm, I might be a little inaccurate with my insertion sometimes. So you can send me a message and the messages and we can clear up any confusion if there is any. Okay. And again, this would be paired with another muscle on the other side, producing Capitol flection. All right, so now we're transitioning from the muscles that do capital flection and to the muscles that do cervical flection, right? So this muscle is called longest [inaudible] and it's has one name, but it's actually a bunch of little slips of muscle, right?

Maybe you can see going from that ac one down on to c three going from C, two down under c four going sun for three years and blah, blah, blah, et cetera. And then at the bottom going out from the transverse processes into the bodies of the Virta prey and it goes as far down as like t three right, so here's one example of a muscle that is from the thoracic spine into the cervical spine, which is why I said earlier we want to consider the neck is not just the cervical spine per se, but the thoracic spine as well. The upper thoracics so taken together. These muscles produce a cervical flection, but if they're in a situation where our head was still right, held still, like if we're lying down on a table or on a mat and we can track those muscles, what we're going to get is actually a flattening of the cervical spine and we'll look at that a little bit later when we do some exercises with Kara. Now, this is not one of your deep neck flexors, but I wanted to point it out because it's going to bear on some of the stuff we talk about later. A, your sternocleidomastoid, you're probably familiar with because it's a very prominent muscle on a lot of people, right? It's superior insertion is on the mastoid process, right?

This boney, uh, knob just behind your ear and of course is down and forward and has two heads, one on your clavicle and one on your sternum, right? Sternum clavicle is CLLATO mastoid muscle. Now the insertion up here is behind that imaginary axis of rotation, which was our ear hole, right? So it would produce actually capital extension if it was taken on its own. It also produces some rotation, but we're going to look later at how and some of our polities protocols.

It's actually assisting in capital and cervical flection. Now this next group of muscles is on the back of our skull, right below the occiput, the suboccipital muscles, and they are the muscles that produce that Kapital extension. And also some of the muscles that contribute to that rotation of the atlas on the axis, rectus capitis, posterior major, right? It's recklessly shaped. It's a capital muscle, it's posterior, and there's two of them. And this is the bigger one. It's major, right? And it goes, you could see the inferior insertion.

The lower insertion is on the spinus process of c two which we palpated before and of course is up and out onto the occiput. Right. And you could see how taken together that would produce capital extension, right? But it could produce a, maybe a little bit of rotation because of the angles. If we just took one muscle at a time, it would rotate the skull in one direction or the other breakfast. Capita's posterior minor, right? It's the baby sibling of the previous muscle. Right. And this goes from the access from just the back part. Wait, it doesn't have a spinus process per se, but it has a sort of a back part of the arch of the atlas up again onto the occiput. And you can see the line of it just goes kind of straight up and down.

So it seems like it would be well positioned to do that capital extension, but it's kind of a short muscle. And because of the, the line of pool, it's actually not in that great of a spot to do that. So this is a muscle that actually might have more of appropriate exceptive rule at this point in our evolution rates. So one of the ways our brain gets information about where our parts are in spaces by knowing how much tension is in our muscles and our tendons. So this might contribute to something like that rather than being, having a major role in movement. Wait, Oblique has capita superior.

These two muscles go from the transverse processes of the atlas up onto sort of a more lateral part of the cranium on the occiput and you can see how they would produce a one at a time aside bending movement, right and taken together, they were produced that capital extension and oblique is capitas inferior again goes from that spinus process of c one c two rather, which we palpated before. And you could see there basically a horizontal and they go out onto the transverse processes of the atlas. So then a really good position to turn that atlas on the Axis and produce that movement of rotation at the top of the spine. Great. And then you could see all of the suboccipital muscles taken together. Now if you take your hand again back into that divot, right, which is the space sort of between your s, your occiput, and that a c to spinus process that we felt earlier, right?

And you do a little bit of capital flection, you should feel those muscles kind of bulge out a little bit. And then if you bring it back into a more in your head back into a more neutral position, you should feel them relax and soften. And then you'll have that little divot there again, right? So that's a little self palpation that we'll be using later to feel whether our head is in kind of a neutral position, or we've already gone into some capitol flection. All right, so now we're gonna take this into some movement.

Chapter 4

Basic Movements of the Cervical Spine

So one way we can start to work on strengthening the neck muscles is through isometric contractions.

And before we talk about why and how we're going to do that, let's just review what isometric contractions are, right? So if I pick up this heavy block with my hand and I bend my elbow to do it, my bicep muscles are contracting and they're shortening as they contract, right? As I let it go back down, my biceps muscles are lengthening as they're contracting, right? So this is called a concentric. My muscles are shortening as they can tract, and this is called an East centric contraction.

My muscles are lengthening as they contract. Now, if I just hold the block, my muscles are still contracting, but they're not changing their length. And that's called an isometric contraction. And in that case, my joint isn't moving either, right? So we might use isometric contractions to start working on neck strengthening with somebody who, for example, doesn't want to, can't as afraid to move their neck in a certain direction, right? So if I have a, a client or a patient who has been told not to do neck extension in their exercise protocols, but I know they need to work on neck extensor strength, I could start with neck extension exercises, a neck, neck extensor isometrics, right? Isometric contractions also have sort of an analgesic or pain relieving a quality for reasons that we don't totally understand, but it's, it's something we certainly observe clinically and the research has shown.

So if somebody has a lot of neck pain, just doing these contractions of their neck muscles can help start to reduce that pain. Right? So I'm going to have Kara be my client here and I may have her lie down and Cara is going to go through in great detail a ways to sort of make sure that your person is coming from sort of a neutral, had a neck position before you start some of these exercises in a little bit. For now I'm just going to take a more general approach and just make sure that I want to have her head basically in line with your spine. And Cara's has good posture, right? So she looks really good here, but if she was somebody with a big forward head posture, right? I might have to give her a little something underneath her head to put her head in line with her spine, just for us to be able to start. She's not that person, so we're not going to do that today. Now in the muscle anatomy section, we were talking about the deep neck flexors and the relationship to the sternocleidomastoid, right?

And I said that if somebody was lying down and their head is fixed and they can track to their deep neck flexors, they would get a flattening of their neck towards the mat in this case, right? Uh, and, and that is actually a way that people train deep neck flexor strength. We think that it's not very functional and that's certainly not going to translate well into your Pele's movements. So we're going to take an approach where we want people to actually do a head lift to begin to work on their deep neck flexors. Now the deep neck flexors are not strong enough to lift the head by themselves.

So we need the sternocleidomastoid. But if we were just going to use the sternocleidomastoid to try to lift our head and nothing else, we said it's behind that axis of rotation, right? And we would get capital extension. So we need both the deep neck flexors and the sternocleidomastoid to start to lift the head, right? So the deep neck flexors are actually, and this capital flexors are going to inhibit that tendency to go into capital extension as Kara lifter hedge is the tiniest little bit off the table, right? And then she can put her head back down. We're going to do that a lot, right? But I would expect to see that sternocleidomastoid, cause I know that her deep neck flexors can't do that by themselves. And in fact, when this is studied, I read a study recently where they had a very specific number.

They said the sternocleidomastoid is doing 83% of that work and the deep neck flexors are doing 17% of that work. They somehow arrived at those numbers. So I certainly would expect to see her Sternocleido mastoid working. And I can't see with my eyes whether her deep neck flexors are working or not. I have to infer that they're working by the fact that she's not going into that capitol extension when she lifts her head. I hope that's clear. So this is the first exercise that I would give somebody as an isometric, right?

I want them to have their head in that sort of neutral position and then just lift off the tiniest little bit. Just enough for me to stick a piece of paper under her head. She's going to hold for a count of let's say five and then she's going to lower it back down. Yup. And again, she's going to lift up, she's going to hold 1001 1002 1003 1004 1005 and she's going to lower back down. And I would expect somebody in good health with like decent neck strength to actually be able to hold up their head in that position for about a minute. Right? So if somebody comes in and five seconds is really taxing, I'm going to have them work in five second increments with at least a five second rest in between until they could build up to say 30 seconds in five second increments over one kind of bout of exercise.

And then I would increase to ten second increments and 15 and so on until they were doing maybe 30 seconds at a time. Right now the my second step and you could, there are probably written out protocols for doing these eyes and metrics. There's probably studies where they do different versions of this. I'm just giving you my sort of go to starting place that I use with a lot of folks, so I would do this one first, right? Working on those deep neck flexors. And then I'm going to walk work alternately on the neck extensors and the deep neck flexors, so you won't be able to see Cara do this probably, but I'm going to have her press the back of her head down into the table again for a count of 1001 1002 1003 1004 1005 I want her to rest completely for a count of two 1001 1002 and then I'm going to have her do that same head lift for a count of 1001 1002 1003 1004 1005 and then she's going to rest back down.

And then I'll have her do that again. She's going to press the back of her head down into the table and it doesn't have to be 100% effort, right? I would start with maybe 25% and it should be a pain free effort for that person, right? So for somebody with a lot of neck pain, it might be even less than 25% but she's in a pressed down 1001 1002 1003 1004 1005 she's going to rest completely for 1001 1002 and she's gonna lift 1001 1002 1003 1004 1005 and rest all the way back down. So the reason I like to go alternately between working on the neck extensors and working on the deep neck flexors is there's a couple of reasons. One is in theory, if we can track the neck extensors first and then use the deep neck flexors, we could get the extensors to relax a little bit through the mechanism known as reciprocal inhibition.

The other reason is that for as a neuro motor skill, it's nice to be able to go back and forth between, uh, opposite groups of muscles sort of quickly and also to contract muscles and then relax them completely sort of quickly, right? So that's why I'm really stressing the importance of her taking that count of two in between. Let's do that one more time. So everyone at home can write it down on their little piece of paper or they could practice it. You might try this while we're doing it. So she's gonna press the back of her head down for 1001 1002 1003 1004 1005 she's going to relax completely and she's going to lift her head for 1001 1002 1003 1004 1005 and she's going to give it a rest. Now you could do the same thing with yourself on the front, but it's, it's, it's sort of awkward because of the shape of people's bodies.

So I almost never do isometrics lying on the front, but I very often do them lying on the side. So I'm going to have Cara turn to face you. And again, we can't just ever had like resting on the ground because it's not in sort of a neutral position, right? So, depending on somebody's size, you might have to build up this, that or the other. For Kara, I'm going to use just a yoga block with a towel on it. You need something that's kind of firm cause it still needs to give resistance. Right, and that's true. And then when you're lying on your back as well, right. If somebody needed a pillow, I wouldn't give them a squishy pillow.

I'd give them something from, and this is exactly the same procedure and I would do it in the same way. I'm going to start just with the head lift. She's going to lift just enough for me to slide a piece of paper underneath her head. She's going to count for a hold for a count of five and she's going to lower back down. And we didn't look at the muscles really that produce this movement. But you can imagine the muscles on your side of your neck, your scaliness, right.

All of the muscles that connect from your head and your cervical spine down into your shoulders or so sort of involved in this, this motion. So again, she's going to do the head lift, 1001 1002 1003 1004 1005 and she's going to lower her back down and we would progress in the same way, right? Incrementally kind of building up to 30 seconds or even a minute. And then I would also do that alternating business we did lying on her back. So she's going to press her head down into the block, kind of pressing the part of her head just above her ear, down into the block for five, four, three, two, one. She's going to rest completely for one, two and she's going to lift for five, four, three, two, one. Good. So again, these isometrics are great for working with somebody who is afraid to move, has been told not to move, has a concrete reason for not being able to move. Um, and also for beginning to build up some strength for our sort of high level movements that we need to do in our pilates exercises. Now there's uh, one little set of things I want to show that's not isometric but we're going to put it in here because it fits sort of with what we're doing and it's also a something that I'm going to use in the mat class that comes along with this a workshop. So I'm going to take Kara's block away, but she's going to try to figure out how to hold her head in that same position that she was using when it was on the block.

And here's the place where I could use that crown of the head curator. Her head was very far forward and she was confused about where her head could be. I could have her bring your head back by sort of touching her on that crown of the head spot. Now Karen is going to do a little bit of side bending from here, from the top of her sponsor's thinking about her head moving. She can go up towards the ceiling and then she's going to come back trying to find that sort of straight line and then she's going to go down towards the floor and then back up towards that straight line and again she's going to go up towards the ceiling and then she's going to go into that straight line and then show what happens if you don't actively do that, that at least imaginary capital side bending movement.

If you just let your heads sort of fall towards the floor. I do see how different that looks, how uncontrolled it is, how undifferentiated it is through the rest of her spine. Everything kind of was at once. Right? And it kind of produces like a shearing effect on her next we're practicing that controlled side bending movement against gravity here it's actually quite difficult. You should try it. And now she could also do a little rotation towards the ceiling around that imaginary crown of head point we've painted earlier and towards the floor.

Great. So I teach it as a very often, and actually I have a patients and you can rest and pull audience clients with like quite a bit of kind of nagging neck discomfort or stiffness that doesn't really go along with pronounced neck weakness in this office. It gives them some relief. And I do stuff like this myself for my own neck. So this is kind of a higher level activity, right? It's not as, I wouldn't necessarily give it to my first time person or my person who had a lot of neck weakness. But if it's somebody with some neck strength who just has nagging pain or even occasional pain, these kinds of movements can be really helpful.

Chapter 5

Pilates Movement Protocols

Hi everybody.

We're back and I'm here with Amy and we're going to start looking at some movement protocols that are going to fit into, uh, the way we move our cervical spines during potties. Um, so the first thing we're going to do is Amy's gonna lie on her back and, um, we're just going to be talking about how we can identify if somebody had an knack or at a relatively neutral position, right? So how do we know? Basically, if we need a pillow, how can we identify if they're over tucking, um, or overextended? It can be a little bit tricky. So a couple of ways to sort of note. Number one is that if Amy reaches back under the back of her skull, like Jeremy described to us, she should feel that indentation between the base of her skull and her atlas. Right? And if that's very pushed out, she's probably already in cervical flection and capital flection, right? Like that.

So one thing I often do is I just get my finger under there and these ponytails are real hazards. So already I have to adjust Amy's ponytail because it's making her flex her neck. So we're just [inaudible]. There we go. So now she can bring your head back a little bit now. Right? So that's actually really a true life moment. Um, so you want to be able to feel that a little divot there. Another way to really landmark that is to give her, again, that tap on the crown of the head.

You want to make sure that she has a sense of that, that um, alignment, right? And then we need to look and say, oh you know, is her head below her trunk or in ahead of her trunk? And that often depends on somebody's girth, right? So if Amy was a really girthy individual, her head might likely be quite behind her. And that might be a place where I would give her a little bit of a pillow. But in Amy's case, she's actually fine. She doesn't need that.

So I wouldn't do that with Jeremy. Actually I have to put a little pillow cause his chest wall is larger than his skull. So you can see how that would become true. The other thing is that I often do here is I often will put a towel roll underneath like a little cervical pillow underneath. She gave a big smile. She liked that. Right. And what this is going to do is once we start working to lift the head, once we start working to capitally make Qapital flection and cervical flection, thoracic flection, this tower's going give her feedback to not do that.

Pressing back in her neck that I was demonstrating when Jeremy was doing the isometrics. Right? So we are going to always first and foremost, no matter where we're starting, we're going to make sure that before we move into the sequence of Capitol flection, cervical flection, thoracic flection or extension or actually side bending a rotation, we want to start from some position of neutrality. Now for language for us, we, Kathy grant always referred to this as bringing your head to the level of your sternum. So we just call it bringing your head to the levels. If you hear us saying that, um, you'll know that's what I'm talking about, but it's this neutral place. So that's the first thing that has to be established. You know, you can imagine if you're in something like poles, traps and t or you're getting ready to come into teaser or you're in short box and you've gone all the way back, that we're gonna make the argument that getting the head to come to the level prior to articulating from that first capital flection or extension or side bending or rotation moment is a really good idea.

And it will help you in developing the strength you need and the coordination you need to be successful in your plug. These protocols. Okay. So this is a me demonstrating very beautifully and quietly her head to the level in Supine, right? And it's pretty easy to establish and maintain in this position, but it gets more complicated once we start changing planes in space. So I always like to make sure my person knows how to do this and that they know how to do that head lift, that isometric contraction that Jeremy just did with me. So we would support her and just knowing how to pick up the weight of her skull and put it back down. Right.

And we want to make sure when our person does this movement that they're not flexing or extending, right? So they're still staying parallel to the table. Right. And then we want to go ahead and make sure that Amy knows how to establish that neutral or head to the level position in other planes. So we're going to go ahead and sit her up. Right. And a lot of times, yeah, good. Sit facing that way. Amy, just so we can look at you from a side view.

A lot of times in a person's sitting up, they'll start, they'll start to establish some of their normal postural patterns. So you may see that neck really pulled back, right? That's actually something you see people do a lot cause they're correcting their necks or you might see that had really far slung or something. Right. And again, we can use that crown of the head awareness to make sure that she knows where her head to the level is w when she's vertical. Now one of the things I'll do is I'll often take my finger and go up into that also put area and make sure that I feel that con cavity right. And you, your, your tendency Amy is to kind of push that con cavity out a little tuck that chin. Yeah.

So stay on the side view for a second cause nobody can really see that and I'm just going to encourage you that that's right. Right. You feel that difference. So this is about her knowing the difference. Right? So I can say to her, yeah, go ahead and push that back out a little. Yeah, no, that's tucked in there it is. Now we're head to the level. Okay, let's take that into a quarter pet. Now the stakes get higher when she starts to come into positions where gravity is gonna pull that head forward. So she's going to have to, her awareness is going to have to be stronger. Her strength is going to have to kick in more. Um, but again, so we're going just to find the fact that when you're in a quadruped position, you're not in a tabletop. It's a very popular way of describing it. But this is actually a diagonal.

So if Amy is being true to her quadriped head because her arms are longer than her legs in this position, her head to the level position would match up my arm. And this is often how I help people start to find this position, right? It's more likely that she's going to have her have tucked down to create that table feeling. Right? So we're going to allow for that neutrality because if I were then going into something like cat, I would want that to start with that capital flection, cervical fluction. But if she's already in this fluxion, she's actually not going to be able to perform that and she's going to end up going s resorting to something lower on the chain and therefore not really giving us that sequential experience that we're looking for. So this is generally how I'm going to ask you guys to coach your person to find neutral or head to the level in quad repaired. Right?

And then she could take that into plank as well so she can just slide one foot out at a time. And the stakes get higher. Guys, it's hard to know where your head is and playing can I'm, it's hard to know where your booty is too, so you could get that under a little bit there. Yeah, there we go. And then right and then we want to still have that divot, that crown of the head and we're going to turn here to side plank with her back to me. And we want to make sure that she can also, yeah, you don't have to be fancy. You can, yeah. Fix the right. And then we also want to make sure that we can find that here. Right? So good and come on down. So basically this first round of coaching is about motor control, right?

Where is your head relative to your trunk? And it's about, and remember when we're doing a motor control activity with somebody, it's an educational moment. So we need them to also language it, feel it. [inaudible] it's also often good to say, you know, how does that feel? They'll say, oh, that feels like my head is really far back. Okay. Right. That's cause you're almost always going like this. So, so getting people to know because we want to be able to start from this place of neutrality before we get going. Does that make sense? All right, great.

So let's head to looking at the way we're going to coach the cervical spine into capital fluxion, cervical flection, sternal, thoracic, and, and, um, get us into thinking about how we move through potties.

Chapter 6

Flexion

Okay. So now we're going to look at how we get going into flection. Okay? Now remember the, the, a lot of what we're talking about in this course right now is really being able to access the sequence of things capital cervical, right? So we want to get those deep flexors really coming to the party here, right? So again, let's remind you that it's our belief and we feel like, you know, it's, it's supported, um, that when you start getting people to strengthen these deep, deep two flexors, right behind the trachea, these muscles way back there, the chairman was showing us that's actually the correction for postural issues, right? It's not, you're not going to correct some of these posture by telling you to pull this like back like this. You're going to correct it by starting to tone up, right? So that's where we're headed. Okay, so now we're going to look at how we take Amy from her head to the level of position and supine into, um, capitol flection, cervical flection, thoracic flection. Right? Now remember this, this is the sequence that we're going to want all the time when we're doing our plug, these protocols in deflection from the head down, but also this particular series is, is our beginning series also for just true strengthening, right?

So now we're going to be actually moving in to those movements. So she's got her head to the level, we've got this towel under here. And partially what I'm going to be making sure is, is that she's, she's honoring that cervical curve when she does that isometric lift that Jeremy went over with us, right? So the first thing Amy's going to do is get that cervical, I mean that had left, right? That isometric lift. And then from there she's going to do capital flection one.

And then that cervical flection, right? That's the nat rest of the, the cervical vertebra. And we're going to really hold back not adding any, um, thoracic flection yet, and she's going to really keep that position. And I'm going to have her hold that for a couple of beats. And what I'm doing here is I'm feeling that little, um, that little Khan cavity back there should be nice and brought to the stretch, right? So it will really be like really a big stretch back there.

And then when she comes down she's gonna reach back over that towel and come back to head to the level neutral, right? So we want to go into that flection and come back. So here she goes and Amy's very familiar with this work cause we've worked together a lot, right? You're going to the show fatigue pretty quickly here, right, too. Sometimes I actually might have to help a little bit, right? And she'll come back down. Now for some of you, this will seem surprising cause you're going to be like, Oh my God, my chin is touching my sternum. Where are the polarities police? Well actually just, just let that go. If you want to touch, engage something, what you want to do is touch and engage the back, your skull and your atlas here and see if they are on the stretch.

That's what you want in this position. You're going to feel a lot of deep work in the front, but oftentimes people are also going to complain of feeling a lot of sensation back here. And what we're going to remember is that that's not because they're overworking their neck, right? Those muscles aren't working when you're in this position, they can't pick up your head. They're actually on the stretch. So the feeling that the prison's having is an unfamiliar feeling of stretch, right? So then we're going to move on, and I'll just say this also in Kathy's work, what we often did when somebody had a hard time maintaining that head lift is we would take a small ball, usually a spongy, and we would put it right there and we would just hold it under the neck for a while and that head lift. So that can also be a nice thing to do at home. So then we're going to take this just to that again, that had lift that one too.

And now we're going to have her picking up the sternum, almost like in a one lift, right? But she's not gonna lose that capital flection one. And then she can come into her upper abdominal curl. Right. Okay. And that's really that sequence and that she's got a fight to keep that networking the whole time and you can see, see how much effort that is for her and coming back down. Right. That is a completely undangerous movement.

So don't worry about that again, if you had somebody with a, an issue like a fusion or something that obviously is not going to be available for most people, you can build up the strength to make that available. Right. Okay. So let's see how we're going to coach this in a couple of other positions. Right? Much like we did head to the level of, Amy came up to a seated position, right? So you're thinking about something like spine stretch forward or anything that moves forward in place on your push shoe bar or whatever. Right.

We're gonna want to have that same experience that she does that capital flection one cervical flection two and then she would move through her thoracic spine. Right now, she doesn't have to use her neck flexors at quite the same level, but what she does have to do is control them enough so that her head doesn't start to forward glides. So let's just look at how oftentimes in something like spine stretch, she would go forward, right? And her head would fall off of her spine here, right? Can you fall off a little more than, yeah, there you go. Right? So, so again, if she didn't use that capital fluxion, she would still be in capital extension, which are going to be able to feel with your finger back here. Right? And that's where often you get that kind of slumped looking head in something like spine stretch forward or even an open lake Rocher rolling like a ball, right? You see that, that wanting to occur there. Right?

So let's go into or pad and articulate inflection. So this is a sequence that I recommend you teach so that people know how to control this cervical flection series in all planes. So she's going to have, again, head to the level. And then what happens here is she goes to cervical or capital one, her head is going to slide in my hand, right? Just like the ball demonstration.

And then her neck will take over and then we'll see the movement through the thoracic spine. Beautiful. Right? And again, she's still controlling her head with her deep neck flexors and then she's going to come back out of that. And then she obviously has to use her extensors to hold her head back up so we can look at that again to see if she's doing it right. She's going to be sliding into my hand at first and then when she goes to cervical flection, her head will go away from my hand. She'll go into thoracic flection, she'll come out of the thoracic flection, and then she'll, as she's coming back out, her skull will slide back up into the palm of my hand. And I just think this is a really useful way to teach that.

Okay, great. Thank you. So I want to do now, so now let's take you through the progression again, right? We did some isometrics, right? We talked about the way that that's going to tone, it's going to help strengthen, it's going to help people with pain because just doing the contraction alone is often a pain reliever. Now we're adding the movements that we're going to be strengthening concentrically right? We're using concentric contractions there, get those muscles up. And now I want to just pick a few exercises where we add some force to that.

So now we're adding a little bit of load. So we're going to look at a few exercises where we're doing that flection activity, same sequence, same skills, but with a little load.

Chapter 7

Load Bearing Exercises on the Cadillac

Okay? So now we're gonna, like I said, we're going to look at some load bearing exercises, working particularly capital flection right now. So I love this exercise. This is something that, um, actually I see in the pictures of Mr Pleiades doing, I have the Cadillac pictures at my studio, um, that I inherited from Cathy. And um, I love this exercise, right? So again, Amy's going to whoever you are and in this case, Amy, you're going to have to step in quite a bit so you're not poking her head forward to get the position.

She has this under her chin and she's using her arms to assist, right? I have one finger in the crown and one finger in the divot, right? Again, I need to know she's starting in that neutral position and then she's going to do a small bit of movement that's capital flection and coming back out right now. I could also do what Jeremy told us earlier is putting these vertebra in the space hold by touching them and making sure that I don't feel them changing. Right. And there's a really nice execution going on here where you see as she keeps doing that, she is truly using that exact deep neck fluxus we looked at to produce this movement of capital fluxion and it's heavy, right?

So she's strengthening that. She's using her hands to help. She can take more or less of the load of the spring depending on what she can tolerate. Good. And we'll let her rest for a moment here. Okay. So again, our technique was there to start had to the level and then make sure we knew that she was only tipping that cap. Remember that way that the, the skull slides and glides on that atlas. We want to really promote that movement and get those shorter muscles in the front deep. Stronger. Okay. Now we're going to look at stabilizing. So she's going to pull this down.

She's going to hold that. Um, you can go into like a little bit of a first position, I guess you are in a first position and um, she going to be holding that bar under her chin. And now what I want her to do is take a small plea, a or knee bend, right? And I want her not to change her cervical spine, right. And back up. So what she's doing here is stabilizing, right? She's getting those circles to um, manage the change of the spring load, right? So she has to work more the lower she goes to keep that, that Chin from getting pushed up by the spring. Right? So she's increasing, I guess we would call this also an isometric contraction of those deep neck flexors.

Good and rest, right? Love. I love these exercises. I think they need to come back into the protocols. Um, I've found great success taking people from whiplash into like small sequences of these. So, um, let's carry on to the next series.

Chapter 8

Head Press on the Low Chair

Two more things. Uh, just just to note in case you don't have a Cadillac at home, you can also do that same movement that we were doing with Amy. Um, on the Cadillac with the magic circle.

Okay. Doing the same queuing, you know, space hold on those vertebra, getting that capital fluxion so just wanted to point that out. I want to really teach out though the head press of the low chair. I think this is one of the greatest exercises for the cervical spine awareness, all of it. Um, and um, so I'm just going to show you how I teach it. Amy's going to kneel down and um, you're going to be on one light spring. I don't, you know, as light as you can get this machine, you do not need a lot of pressure.

She's going to, we're going to use a pad on most machines. So we're going to go ahead and just pad this up. We don't want your head to slip and then she's going to get that crown of the head down. And when I touch back here, I want to feel that that dent, right? That Khan cavity is on.

The stretch has been pushed out cause she should be in full capital flection here. She's also in cervical flection. I'm going to have her bring her hands back, right just to hear like way on miss touching the chair. Elbows narrow, right? So she's got a base of support here and the biggest thing that'll happen is people are going to put let their weight Gove towards their heels. So she needs to shift your weight over her head and as she begins to lift the pedal, she needs to keep the crown of the head contact. So she's going to keep coming up, but she's going to have to keep shifting her weight over her head.

Keep coming up, keep coming up, shifting your weight over your head, keeping that capital fluxion and then push it back down. Yeah. That's hard to keep, isn't it? Yeah. Slide your head back a little bit. Amy, your your, yeah, there you go. Now go over this. This paddle on the goths chair. It's a little bit narrow. So depending on what chair you're on. So again, I need her to stay over her head.

There it is over her head, over her head, right? And then pushed back down. So it doesn't really matter how high you come. What really matters is that you keep that same point of contact right there she goes. Beautiful. Right? So I'm looking for that sequence back here. She's going to come back. Now I'm gonna ask her to put her hands on the pedal and just sit back on her heels, pick her pedal up, and then just come, just let her self come back to that neutral.

And she's going to feel a lot of kind of levity in the head after that. Yeah. You feel that, right? So in this whole fluxion series, right? We go from the isometric, the concept trick and now we're adding a load and um, I think ultimately we, we'd like everybody to be healthy enough in their neck to be like completing all three of these sections. It's time to talk about extension of the cervical spine. Okay,

Chapter 9

Extension

so now we're going to look at some extension, capital extension, cervical extension, thoracic extension. I'm not going to go overboard about this, so we're just going to look at this in a very simple entree into swan.

But this would be true for all things moving into extension from above. So your pull straps, your t, your swans, your, your breaststrokes, your all things in this family. So we're going to just put Amy on her tummy and we're going to be thinking about number one, our first concept had to the level because in this position where Amy's lying like this, she's are already in neck flection. Can you see that? Because her head is below because she has more girth in the front body. So we're going to make sure she learns how to bring her head to the level first.

Right? That was tricky. You see, cause she brought that up with her thorax. So it's gonna be real alien to people at first head to the level. She's got a d rotate out of that flection. Then we're going to coach her to do capital. Yeah, right there. Let's just do that a couple times and back out.

Capital extension, back out. Right. And then she's going to do capital cervical and really close after that cervical, she's going to come in to adding her breastbone and her third ACIC spine and back down. So this is where this is going to become complicated for some of you, right? A lot of us have this of like that. It's dangerous. We have the head back too far. We don't want to, like Jeremy said, wrinkle the neck too much.

So the difference in coaching extension is going to be about timing. We're going to be still thinking about capital, cervical, thoracic. But we're going to go thinking wise and moving wise, we're going to go capital, cervical and thoracic together. So we're going to be thinking that more as a one moment. So head to the level capitol and then cervical and thoracic altogether keep coming up. And what you want to do is have that crown of the head awareness or move up into a swan and allow yourself, right?

But what we want to know what you're in is one is that she's in Kapital extension and cervical extension, right? And she's going to have to have some control of that and she's going to come back down. And as she comes back down, she's going to come out of that. Right? So good. Beautiful. Amy. Thank you. So come on up to seated and let me just try to explain this. This becomes the part where students have of ours are like, oh my God.

Right? Because everybody's been like doing swan with their head kind of frozen, right? But again, that's sort of the point. It's like, wait, you have a knack, it needs to do these motions. And when you're laying down, it's actually quite safe, right? Because gravity, you're resisting gravity. So it's not like it's gonna like drop your head off. Right? So, um, but you do want to have, you just want to make sure that you, you get that chest wall moving through a little, um, more with the cervical spine, whereas in the, you can really isolate that a little bit more. So that's going to be the best way I want to talk about it. If that's confusing, we can be in contact in the forum about that. Um, cause I know it's a little bit, um, I'm, I'm breaking some rules here so it's all going to seem a little woo at first. But if you know me at all, it'll be okay. Um, alright, here we go. So now let's talk about what we do when we're on the vertical axis is support because then the game really changes here.

So remember what Amy was lying down and doing capital cervical extension, right? She's moving against gravity. So she's actually using her extensors or her sub occipital muscles that Jeremy pointed out, right? But when she's standing,

Chapter 10

Finding a Vertical Axis of Support

okay, so now we're going to talk about what happens when we're doing extension and the vertical access of support. Totally different jam. Okay. Because when we go into capital cervical, thoracic, this way, my, my extensors aren't working right? Because gravity's assisting that movement. Now my flexors are working east centric load, right? So this is when you're starting to practice things.

This is gonna come up in your plots like on thigh stretch. When you go back or back bend or water wheel, you guys have lots of exercises where we start to do this, right? It's that, that toning here. And what I actually noticed in my practice, Amy, is that when we, if people don't do these stepping stones that we're just laying down here, they are completely incapable of controlling their head on the vertical axis to support. So they'll start, they'll be like, oh, you know, and you'll be like, Tuck your chin. You know? And that's not really what we want. We actually want to be able to do a fabulous, I'm standing swan or Dropbox. So let's talk about how we coached this. So again, we're in the vertical access support we want had to the level.

So Amy likes to Tucker Chin when she's standing. She's trying to be a good girl, but we're going to let her liberate that a little bit, right? And then I'm going to coach this the same way. It's going to be capital extension, but when we start doing the cervical, she's gonna add the thoracic immediately. So now we're going to think of the cervical and the chest as one. Okay? So here we go. Come on back out for a second. She's eager. Here we go.

So we're going to do capital and then cervical. Thoracic, right. Beautiful Amy. And what I want to know is that she can hold that, right? She's not collapsing. You see the bulging, beautiful, Sternocleido and mastering, controlling her there. And she's going to come back up, right?

So I'm going to do this parallel to her so you can see a couple bodies doing this. We're going to go, we're going to go capitol, cervical, thoracic, and we can keep going back. We can look all the way back controlling that and coming back up. And I'm using, we're using those deep flexors in the front, right? Can you really feel that? Right? Really controlling that. Right? But if we've never used them right in these like steppingstone moments from the moment where Jeremy taught us that isometrics, then I can promise you nobody's going to be able to control their head with the weight of their head being accelerated by gravity.

Your head is like eight to 10 pounds. We're going to up the ante. Last piece here doing some like really difficult east centric controlling stuff off the Cadillac. Okay? So what I'm gonna do is have Amy lie down and you're going to hang off the Cadillac chest around the the bra line ish. I know everybody who doesn't wear a Bra, but like somewhere here, uh, at the tips of the shoulder blades, right? And this is already so hard. So as I chat, I'm going to hold her. Okay?

So what we're going to be doing is something that comes up for you and like stuff like short box, right? So we're going to go from supine. She's going to have her arms down by your side. Yeah, she's going to start at the level. So first thing she's got to do is learn how to control this, right? This is hard. Then she's gonna go one, two, three, four, and then she's going to go four, three, two, one. Then she's going to go into flection. One, two, three, four, coming out. Four, three, two, one. Okay.

This is like super powerhouse cervical moment here. Last time. One, two, three, four, coming back for three, two, one at the level. One, two, three, four, unraveling, four, three, two, one. Head to level. Great. And up she goes really? Like this is a workout. And not only is it your powerhouse circles, but at that point you're going to feel that connection between the powerhouse of your circles all the way into the powerhouse of your abs.

Okay, here we go. Last part. We're going to put her forward and she's going to do the same sequence prone. Yep. So head to the level. Right now we're going to be going into flection. One, two, three, four, four, three, coming back into cervical extension, neutral. And then she's going to go into extension two, three, four, four, three, two, one. One more round. She goes into capital, cervical, sternum thorax, thorax, sternum, cervical capitol, capitol, cervical, sternum thorax.

And she's looking great and down and now we've got that whole neck and rest connected to the rest of her trunk and behaving in the true sequence that it is, which is that your head is like the first vertebra, your your vertebra. Don't start here, they start up here. So, um, that's sort of the apex there. That's uh, a pretty powerful series. Um, so you're going to build up to that more slowly.

Chapter 11

Rotation and Lateral Flexion

So we're going to switch gears a little bit here in this last couple sections right now I want to talk a little bit about how we help people maintain good rotation and lateral flection of the cervical spine. Right? So this is a little bit less about sort of strengths, maybe in more about mobility and about motor control. Right? And the rotation and the water will function are, are easily lost, um, in the aging process along with different pathologies that can get really kind of tough. And, um, I sort of talk about this a lot where I say, you know, my, I have an aging mother, right?

And if she couldn't turn her head anymore, she wouldn't be able to drive, right? And if she couldn't drive, she would probably have to live with me. So the stakes get kind of high here, right? We want people to be able to be independent moving on their own for a multiple reasons, right? So I'm just gonna have just give you a couple little magical exercises that we like to use in this course. Um, Kathy grants, um, listening ears and uh, number 14 had only we'll do, and then we'll look at lateral flections. So we're just gonna start with the listening ears. Um, and this is a imaged based movement exercise, right?

So Amy's going to imagine that she has a ring around her head, kind of like the ring of Saturn, right? She's going to close her eyes. She's going to make sure her head is to the level to start. And, and, and frankly, just so you guys know, when somebody is not had to the level, right? Good head alignment here, they're already going to be thwarted in their ability to rotate their cervical spines, right? So just that alone becomes huge. She's going to imagine that she's listening to a band of sound with her left ear coming forward and her right ear coming back. And she's just going to follow her ear holes to that sound as it moves around. This is the axis of rotation here, Jeremy pointed out earlier, right?

And then she's going to bring that listening back around and back over. And as you're watching her do this, I want you to remember how Jeremy taught us about the way that the atlas and the axis rotate on each other here, right? So you can imagine that that dens coming up and that beautiful, right? And we want to really train people to keep as much of that spiral as they can, right? And so that's quite excellent. Beautiful work. Okay, the next exercise I'm going to teach comes from the Kathy Grant Repertoire.

It's called number 14 head only to really long story. So you'll have to meet me at the heritage training to learn that. But she's going to lie on her belly. She's going to turn her head to the left, arms down by her side, palms up. Okay. So in this exercise, what's going to happen is we're going to let her really work her cervical extension and her rotation, right? We're going to only be working the cervicals.

We're not going to be picking up the chest wall. She's going to start by picking her shoulder blades up. Just the level of her side body. This is so that that weight doesn't drag on her neck. She's going to bring her head to the level and prone, right? So your Chin is tucked there, so head to the level. There you go.

And then from there she's going to go into full extension of her cervical spine as much as she can possibly do. No, probably Ma and come back to the head to the level and then full spiral listening ears spiral to the other side and release. Okay. Right. And she's gonna come up and she's going to come head a good work. Great.

You don't have to pick your chest wall up and then she's going to go into full cervical capitol, cervical extension. She's going to go for it. Right. Really exercising those extensors coming back and rotating. Cool. Yeah. Good. Okay.

Okay. So there's a lot going on here. There's motor learning, there's neuro motor control of the head in gravity's line, right? And there's also this like very um, very specific use of the extensor muscles. Um, it is the go to exercise for me when I have that net cramp where you can't turn your head, you get out of the shower, you wake up and you're like, oh, this really takes care of that for me every time. So this is a real secret recipe from Kathy Grant, so I highly recommend it. Okay, good. Come on up Amy. And let's just finish this section with talking about how we confront lateral flection, right? Of the cervical spine. So again, what I see is that this movement is kind of trained out of us during side bending. He's like, we're often like side bending, right? But we're forgetting that we have all these vertebra appear that can also be part of that sequence.

So I'm just going to recommend that we are always thinking about that capital cervical sequence inside bend in rotation, fluxion and extension. So I'm just going to teach Amy side Benz on the Cadillac kneeling just to see how I would see. So you can see how I would coach her neck there. Okay. So she's going to kneel up, right? And we're going to have her facing you and my guess I'll come around this way actually. So there she is. Um, and what I want to happen is I want Amy to feel her, her capital flection, right? Lateral flection starting the movement, right?

She can take her arm up and she's going to truly let her neck side bend. So if she was really being honest with herself and she was doing assignment, the crown of her head would face the side and then she would come back up and the crown of her head would face the ceiling, right? And she's going to get really a lot more bang for her buck in her side bending. Right? She's also exercising her neck and exercising her neuro motor awareness of her neck, which is like really a huge piece of this. Good.

And coming all the way up. Right? So now you are going to have clients who have limited access to lateral flection and rotation for sure. You see it in the aging population, you see with arthritises, et cetera. So everything is to scale based on the individual individual in front of you. Like Jeremy said, one size doesn't fit all right. So even my clients who hardly have lateral flection left, it's doesn't mean that I can't still give them that image or that sense of keeping what movement they have alive there. Um, a lot of times they're going to have a little bit of movement at that, that skull meeting, the atlas joint that they might not have down there.

So we really want to keep that head spinning on the atlas and all directions, particularly during that aging process. Um, you know, so there's PyLadies, there's performance, there's the things that we want to do that are really high scale. And then there's also the clients we work with daily who just need to drive their car and move around and, and we know you, you see all of those types of people. So we want to address that. So, given that the last section here today in this workshop, Jeremy's going to take us through a couple of functional things that he does and his PT practice that I think all of us could really learn a lot from in terms of like how are you going to address that individual who is like really compromised at this point? Right? And I know I have them. I know you have 'em I'm guessing audience that you have them too. So let's look at these last protocols, functional stuff from Jeremy and um, and then we'll call it a day.

Chapter 12

Functional Protocols

All right, so now as Kara said, we're going to look at some kind of non polities stuff that I do with my patients to work on their head and neck. Um, and you might use these strategies for a variety of reasons.

One is sometimes people have pain or apprehension about PR in particular turning their head right. Kara was talking about the importance of maintaining cervical rotation for our daily function. We use a rotation quite a bit. You should notice as you go through your day, one day, how much you're turning your head as compared to how much of a noun you're doing and also how big the range of motion that you use your rotation in is for functional stuff. So we might have to sort of trick a patient who's afraid to do neck rotation into rotating their head and neck while we sort of directed their attention elsewhere. Um, another reason we might do this is that we just want to put some like the stuff that we've done already today into a functional context, just in the same way that we might work on leg strength with one of our clients, but then want them to do sit to stands or going upstairs or something really functional. Um, lastly, there's a relationship that turns up in research between, uh, the neck extensors and balance, right? So there's some studies that have shown that people with neck pain, uh, in the, the study that I read, it was whiplash related neck pain will, uh, overuse their neck extensors during balanced tasks.

And then there are other studies showing that as people's neck extensors fatigue, their balance gets worse. So sometimes because of those kinds of relationships, I just want to work on balance and neck and head movement and control as a single task. So I'm going to give you kind of a grab bag of some of my go to stuff for working with patients. Now, Kara just gave you a really lovely technique for working on improving cervical and sort of capital rotation, right? The listening ears and but she also said that sometimes because of Abe really age-related changes to the spine, people simply won't have that much rotation or side betting. It is one of the movements that tends to really diminish.

So in order for Kara's mom to continue to drive her car, right, I don't want to just focus on how much cervical rotation can I get out of her. I might have to teach her different strategies for actually getting her head around enough to see into our blind spot. Right? That uses more of her trunk. So I might actually have to teach somebody how to do that. So Kara is going to play the role of my patient, right? And we have probably already done stuff like listening ears as a way of getting her to use their circle quotation that she's got.

But then I want to encourage her to use more of her trunk. So I'm going to say a Cara, just cross your arms just comfortably to get them out of the way. And then you're going to start your look over your left shoulder and as you to turn your head start to turn your chest and shoulders as well, right? So your pelvis and legs will stay basically still, but anything above the hips can turn to help you turn your head to look behind you, right? So it's as though someone was behind you and they were calling your name and you want to turn around and look to see who's there. Great.

And she does that very beautifully. Now, very often I have patients come to me and they say, oh my neck, I can't turn my head. And what they're really talking about is pain at the end of their range of cervical rotation, which I think we all sort of have. If we, if I push into my, the end of my range of rotation, it's a little uncomfortable, right? But I seem to see people, uh, getting, uh, so apprehensive about moving their head and neck that they're actually not moving very comfortably in their middle of their range. Either everything gets kind of stiff and Jerky and not very functional. So I might want to get them to just become more comfortable moving in that middle part of the range rather than trying to increase their range by pushing them into it. So for Kara, I'm going to have her just, I'm going to say, you know, we're not going to go to the end of your range where it's uncomfortable.

We're going to leave out maybe the last 25% at this end and 25% of this end, and we're just going to turn your head just comfortably in that middle range. And I would expect someone to pretty easily be able to do one turn per second. But you'd be surprised how stiff and slow some people's neck gets. And then I might have a little thing where I'm going say keep your eyes on my finger as you're turning. So we're also working on differentiating the eyes in the head, and then I want to look at a different tempos. Maybe I'll say carry.

You're just going to pretend that you're vigorously disagreeing with me and you're just going to say, no, no, no, no, no, no, no, no, no. Staying in that comfortable range. So she wants to be able to move. That's right pretty quickly, at least in her comfortable range, because you need to move your head quickly in daily life, right? I live in New York City. People have to cross the street. If you turn your head this way and it takes you three seconds to turn your head to look the other way, by the time you're looking this way, you don't know what's on this side anymore, right? Likewise, when you're driving, you have to turn to look in your blind spot pretty quickly so that you can keep your eyes on the road.

So there's an argument to maybe be made for increasing the range of motion, but we can also work on the quality of the movement, the speed of the movement, and the ease of the movement. Right now, this next bit, uh, um, I'm taking these next few things sort of from this a wonderful book called aches and pains by the great physiotherapists or physical therapists, Louis Gifford. Um, and he calls this stuff, um, stalking and window shopping. So I'm going to have Kara stand here and we're gonna pretend that she has a mirror in front of her. So you guys are inside the mirror and I'm gonna say, Kara, keep looking at your face in the mirror. Keep your head turned towards your face. But I want you to turn your body to the side and then to the, and then to the side right into the front. So she's turning her head.

She's doing cervical rotation, but she's not thinking about her cervical rotation. She's thinking about turning her body. And this is also a way that we use our head in daily life, right? So I'm walking down the street and I have to turn my head to look while I continue to walk. And that's actually another exercise I'll do. So in the clinic I would take a posted and I would put it on the wall over there and I'm going to have Kara walk back and forth and she's going to keep her gaze on the post that the whole time as she goes from side to side.

So she's having to go more into and then out of that cervical rotation in both directions without thinking too hard about it. And it's functional. She's practicing the skill of continuing to walk in a straight line while looking at something which you need while you're walking down the street. And she does that so elegantly. Right. One more thing along those lines. I could do that exact same task. I've got the posted on the wall.

I'm just going to have Kara get up out of this chair, walk over to the other chair and turn around. Right? So she's putting it again, sort of into a functional context. You can do this going up and down stairs, you know, all sorts of different things. Lastly, I alluded to how those sort of a relationship that shows that between neck extensors, overuse of neck extensors, fatigue of neck extensors and balance. So sometimes I'll just put my patient in a challenging balance task but not too challenging. I don't want them to immediately go into their sort of seized up neck and shoulder pattern. Right? So I have a continuum of challenging positions. So we start with a feet together as sort of the least challenging. Although some pipe people will find this narrow base of support. Um, tough already we've got a narrow but one foot a little ahead of the other.

We've got feed completely one in front of the other Laker on a tight rope. And then lastly, we've got standing on one leg now Cara's um, a very capable mover. So she could probably do standing on one leg, but I'm gonna back it up one notch for her. So she's doing something that's challenging but doesn't require all of her attention so she can keep sort of a relaxed operate pasture. See it is challenging and she's just going to turn her head and look to the right, tried to turn 90 degrees and the others you can go slowly. And I always liked the person to stop in the middle so that they get in the habit of knowing where the middle is. I might also have her do up and down, right? She's going to look up and she's gonna look down good. And with people who have you put them in too challenging with positioning, you'll see them right away starting to default to, they're sort of more uptight posture, right?

So then you might want to back them up one, one degree of difficulty. So we can start to kind of uncouple those back of neck postural issues, right from these balance tasks.

Chapter 13

Conclusion

We're finishing up, um, today's workshop, the cervical powerhouse. Um, and I just wanted to take a minute just to kind of chat for a second. Um, I think there's a lot of kinds of questions that come up around here and I have like great opportunity to ask Jeremy questions all the time. So I thought I would just ask you a couple of questions that I think might come up and, and one of them is set, you know a lot of times you, you hear people complaining about like their upper traps being really tight or being really like causing that kind of neck pain and that they're goto sort of ideas that they need to stretch that. And from sort of everything I'm, I've learned with you and that we're discovering, it really seems like that maybe is not like the course of action. Can you just speak to that a little bit?

Yeah, I think that comes up with the upper traps specifically and with the neck and shoulder muscles in general. And there's a couple of things in there. One is there's this feeling of sort of tightness, but I definitely see people come in to me and they say, oh my neck is so tight and they can move their neck and head all around. So it's not objectively tied in any sort of mechanical sense. I, and I think based on my experience, what they're complaining of is actually a feeling of fatigue or soreness. I mean, you know, tightness is a very subjective sensation, but the thing that seems to help those people most most of the time is actually building up the strength and the endurance of their neck muscles and their upper traps or upper upper traps get a super bad rap all over the place. And I'm here to say most people do not have tight traps.

They have weak and traps with poor insurance and they would benefit from strengthening them. I mean certainly when people have really pronounced postural issues and the the neck, um, that can contribute to that feeling of soreness and also like fatigue. Great. And the, the deep neck flexors and the traps actually sort of have a role to play together, right? Your upper traps, if you don't keep your head and neck fixed, right, we'll pull you into, into capital extension and into upper cervical extension. So when we use our traps to even just carry the weight of our arms, we need to stabilize against that and we need to have our deep neck flexors holding our neck and head and positions, or are traps in, in our shoulders actually altogether are kind of suspended from our, our neck. So I would certainly almost always advocate for less stretch, stretching of the neck and shoulders and more strength than endurance training.

And the other thing that's in there for me is, you know, there's a, I think people sometimes go like, oh, it really hurts if you press on my muscles in a particular place. And I think there are sort of characteristic places in the body where that's the case. And for sure if you came over and you your thumbs into my traps, I would say, oh, that really hurts, but I don't have neck or shoulder pain. Right? So we need to really distinguish between that kind of muscle tenderness and actual pain that happens in our daily lives with movement. And there's, there's not really a good relationship between those two things if you look at their research. Yeah. And I think, you know, um, we've spent a lot of time in the last few years together reading research, going to workshops and listening to different physios talk about new ways of thinking about strengthening the neck.

And one of the things that's been so amazing and so shocking is to hear how many people are sort of coming to this discovery that it's like not about relaxing the muscles or stretching them or babying the muscles, but it's really about loading them. It's really about exercising them, getting them stronger, and that, that, that relationship to that and less pain seems to be, um, really, uh, exaggerated right now. Our, our, you know, really being called upon for us to look at. Yeah, absolutely. We use x. We said we use our neck in our head all day long, right? Uh, every day. And if we're having like, problems up there or, you know, it would be like saying, oh, well you're, you have arthritis in your knee, so we're just gonna stop using your knee. That's not gonna work. Functionally, it doesn't actually improve the situation, right? You have to strengthen the muscles around the knee. It's the same, right? The neck and shoulder. Yeah. Right. And I think really, you know, we get it. It's, it's the neck is, is much more, we're, we're taught to think much more delicately about the neck than other body parts.

Um, so, you know, part of this is also just encouragement to say like, it's okay, let's, let's treat it like the powerhouse that it is. It's full of muscles. It's full of movement, and it should last as long as the rest of your parts. Excellent. Great. Thanks Jeremy. Thanks Cara. And thank you everybody for watching and thank you for today's anytime for having us.