PT after ACDF C5-7

Hello,

I am 9 months post surgery, which went fairly well.  The reason for the surgery was severe foraminal stenosis affecting my arms.  The problems had been building for a number of years due to computer work.  My neck has no curve now.

PT exercises given are for the deep neck flexors - nodding while supine, trying to avoid using the SCM muscles.  I am aware of the research (Jull) that shows improvement with these exercises, although it was done with participants who had moderate neck pain and who had not had surgery.  I suspect that their neck curve was normal or nearly so.

I have been unable to progress to lifting my head using just the cervical flexors - the SCMs are still activating, although I think I can do the nodding without the SCMs firing. 

What has been your experience with similar patients?

Does the lack of curvature affect which muscles tend to activate during this exercise?

Thanks in advance.

Thank you for your reply.

Here is a link to Jull's research:

http://docs.google.com/viewer?a=v&q=cache:3D7afx-T3HsJ:www.neckrx.com/pdfs/Man_Ther_Jull_2009.pdf+cervical+flexor+muscles+strengthen&hl=en&gl=us&pid=bl&srcid=ADGEESintUYWk2WKaAxdBPJi5aFYP8Gb5q1LzJfdmsBrjwJYYRIg001VQaenhIQEiqdga-i05-NBCSx_mgxRhomVRlRx4w--8dkj2CqzRAb_LG6jU6qZ2zbwx0SZZmdOrHPeTO3Wt4aJ&sig=AHIEtbTLxuycDqfBYomyy758DGCdUEKGHA

If by cervical flexion strengthening in supine, you mean tucking the chin and lifting the head off the table, that I can't do without the SCMs firing.

Is this what you mean by cervical flexion against manual resistance in sitting - not quite halfway down page under Cervical Spine, see sixth article "Cervical Muscles":

http://www.marchellerdc.com/pro_resources/Articles/

I do this exercise supine.  As shown in that article, using one hand to feel if the SCMs and scalenes are activating is the only biofeedback available to me. Can/should the platysma be monitored as well with this method?  

My PT did allow me to borrow (for two days) an inflatable device with a gauge that would provide some feedback, and I tried to follow her instructions, but since I have no curve in my neck, I believe I would be pressing back with my head to cause the gauge to register (retraction).  I believe if you have a curve, then flexion will cause the neck to straighten a little, the head will slide up in response, the space under the neck decreases and the gauge will register.  Does this make sense to you?

I can do the nodding exercise without pain - however, on days when I do it, I will wake up in the middle of the night with discomfort in the neck and shoulders that requires painkillers to get back to sleep.  On days when I don't do it, I sleep soundly.  Thus there is a disincentive.

I believe we are not doing isometric strengthening while sitting/standing because the scalenes/SCMs seem to take over while doing them; also there is some slight retrolisthesis at the level above the fusion.  It's uncomfortable to do them as well, especially pressing forward and back.  I can do some supine - pressing against the temple, or rotating and pressing.  
My PCP told me not to bend my neck to the side (ear to shoulder).

My understanding is that with upper crossed syndrome and forward head posture, the scalenes/SCMs tend to take over and the longus capitis and coli become dormant.  So we are trying to reverse that to stabilize the cervical spine and prevent the retrolisthesis from worsening.  Yes?

I have a feeling that it will be quite a long time before I see progress, but I have to proceed gently so as not to make the discomfort worse.  Would you agree?

Thanks again...