Head & Neck Injuries/Conditions - PT after ACDF C5-7

PT after ACDF C5-7

Printed From: CyberPT - Your Online Physical Therapy Resource
Category: Patient Forum
Forum Name: Head & Neck Injuries/Conditions
Forum Description: Patients can post questions and experiences about head & neck injuries/conditions.
URL: http://www.cyberpt.com/ptforum/forum_posts.asp?TID=834
Printed Date: Jan 19 2025 at 3:32am
Software Version: Web Wiz Forums 11.03 - http://www.webwizforums.com

Topic: PT after ACDF C5-7

Posted By: jh
Subject: PT after ACDF C5-7
Date Posted: Mar 28 2011 at 3:35pm

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.

Replies:

Posted By: Ask a PT
Date Posted: Mar 29 2011 at 1:08pm

Can you tell me where you saw the research? I looked at the Physical Therapy Journal July 2010 issue and didn't find an article on this topic. http://ptjournal.apta.org/content/90/7.toc - http://ptjournal.apta.org/content/90/7.toc

Anterior vertebral flexors of the neck include the longus capitis and coli and the rectus capitus anterior. Sternocleidomastoid, anterior scaleni, suprahyoids and infrahyoids also may aid with anterior vertebral flexion. The platysma will attempt to aid when flexors are very weak.

The primary function of SCM is cervical flexion, lateral flexion, rotation to the other side and extension: http://www.exrx.net/Muscles/Sternocleidomastoid.html - http://www.exrx.net/Muscles/Sternocleidomastoid.html . Are you utilizing biofeedback to determine if SCM is being activated with the attempt of cervical flexion?

For my patients who have undergone cervical disc fusions, for cervical strengthening I would normally have them start off with cervical isometric strengthening, progressed to cervical flexion against manual resistance in sitting, to cervical flexion strengthening in supine.

Posted By: jh
Date Posted: Mar 30 2011 at 3:06pm

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...

Posted By: Ask a PT
Date Posted: Apr 07 2011 at 11:28am

Sorry for the delay in getting back to you - I've been out of town. Thanks for sharing the article. The study was carried out very well, although it would have been useful to know the age range of the participants as age may play a part in changes of the structures in the neck (ie. facet joints, discs, ligaments, etc.). It would have been interesting to see if similar results would be obtained with a male sample as well. Their findings of low level training being more effective than strength training when targeting the deep cervical flexors appears to be right on as the superficial cervical flexors are more easily activated vs the deep flexors. They make a valid point that incorporating coordination between the superficial and deep flexors should be corrected in the first instance to avoid masking or substitution of the deep cervical flexors by the superficial flexors.

Yes, to both your questions. Strengthening with manual resistance can be done in supine as well. With the strengthening, I usually instruct my patients to perform a submax contraction to minimize the kicking in of the superficial flexors.

The site of maximum motion in flexion and extension occurs between C4 and C6. Given your discectomy and fusion you will lose some of that motion. Since you have a decrease lordosis at your cervical spine (flattening), I believe that you are correct that you the sensor/gauge may not be as accurate for you.

Yes, you are correct that you would want to increase the activity of the deep cervical flexors. Increasing stability and strength of the deep cervical flexors along with the scapular stabilizers & retractors will promote better posture and function of the neck. Incorporation of manual therapy along with gentle stretching of the upper traps, pecs and levator scapulae may help with coordination and posture as well.

Yes, I would agree that it may take awhile to see significant progress, but it sounds like you are definitely on the right track.