Editor's Note: Part 1 of this article ran in the November issue. Part 3 (scheduled for January 2019 issue as of press time) concludes this series on exercise therapy for MVA trauma and includes additional exercises you can incorporate into your therapy regimen.
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit." The patient is progressed with regard to exercise volume and intensity carefully. Each exercise builds upon the next, and at least some are performed on a daily basis at home.
The following plan can fit into a trial of treatment over six weeks – e.g., you schedule the patient two times a week for six weeks. Implementing exercises is part of your treatment plan and the goal is to increase range of motion, increase strength and decrease pain. The approach includes progressions for activation of the deep neck flexors as well as stabilization; and progressions for range of motion, core activation and sessions in which you just need to review previously taught exercises.
In part 1 of this article, I reviewed the deep cervical flexor tests and the importance of resolving deep flexor weakness. Cervical retraction exercises are effective for chronic neck pain, motor vehicle trauma (especially rear-end collisions), cervicogenic headache and postural dysfunction.1-3
Initial Recommendations
If you recall from part 1, the day-one exercise progression with a resistance band was performed standing. During the course of this treatment plan, you will be dealing with soft-tissue issues and should integrate range-of-motion (ROM) drills. I always suggest using whatever manipulation / mobilization technique you have championed. If you and your patient are so inclined, you can integrate other upper-body and core activation exercises as well. My clinical outcomes are better when I also get the patient on at least a five-day-a-week walking program.
Your hands-on approach should include a) joint manipulation / mobilization, particularly to stiff areas of the thoracic spine and when you are not sure whether it's OK to adjust the cervical spine; and b) releasing and stretching of the sternocleidomastoid (SCM), scalenes, levator scapulae, cervical extensors and upper trapezius muscles prior to activation exercise. These are the same muscles I would check if it's a shoulder dysfunction, too.
Exercise Progressions for Whiplash-Related Injuries
1. Standing deep neck flexor activation with resistance bands
Notes: Don't allow the patient to laterally flex or rotate the head. Don't allow the patient to overactivate the SCM. Don't allow excess scapular elevation.
2. Supine Cervical Retraction
Notes: While maintaining the above, let's get the patient to increase the hold time to 30 seconds. This helps increase the endurance of the deep neck flexors. Obviously the number of reps will decrease accordingly; I like to target five reps with 30-second holds.
3. The next exercise integrates shoulder girdle movements. Our job is to coach the patient without compensation (i.e., SCM and scalene activation). Patient is in the supine position above while performing:
Notes: This posture is likened to a supine Brugger relief position and can help activate the posterior chain. It is best performed with active exhalation. Patients with lack of thoracic spine extension, tight lats, tight pectoralis major and minor, and poor postural stabilization of the diaphragm may have difficulty with this exercise and need hands-on therapy to stretch muscles or increase joint motion.
References
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
