Neck pain Treatment |Techniques to Increase Axial Extension (Cervical Retraction)

Scalene Muscle Stretch

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Scalene Muscle origin ,Insertion,Innervation , Action,blood supply

CLINICAL TIP

Because the scalene muscles are attached to the transverse processes of the upper cervical spine and the upper two ribs.

 scalene muscle contract bilaterally  flex the cervical spine or elevate the upper ribs . Unilaterally scalenes side bend the  cervical spine to the same side and rotate it to the opposite side.

To effectively stretch this muscle, stabilize the head and apply the stretch force against the upper portion of the rib cage.

Manual Stretching

 Patient position and procedure:⏩
 Sitting. The patient first performs axial/ neck extension (bucks the chin and straightens the neck) and then side bends the neck opposite and rotates it toward the tight muscles.

Stand behind the patient and stabilize the head with the one hand around the side of the patient's head and face, holding the head against your trunk or shoulder. Place the other hand across the top of the rib cage on the side of tightness

Instruct the patient to inhale and exhale; apply a (resisting elevation of the rib cage) as the patient inhales again. As the patient relaxes (exhales), take up the slack. Repeat. This is a gentle, hold-relax stretching menuver. This technique can also be done in supine.

 Unilateral active stretching of the scalene muscles manual stretch The patient first performs  Neck/axial extension, then side bend the neck opposite and rotates it toward the tight muscles The therapy stabilize the head and upper thorax as the patient breathes
Contracting the muscle against the therapist's resistance As the patient relaxes, the boage lowers and stretches the muscle

Self-Stretching Patient position and procedure: ⏩
Standing next to a table and holding onto underside. The patient positions the head in axial extension, side bends opposite, and rotates toward the same side as the muscle being stretched. To stretch, he or she leans away from the table, inhales, exhales, and stretch position

Techniques to Increase Upper Arms Flexion: Short Suboccipital Muscle Stretch ⏩

Manual Stretching Patient position and procedure:
 Sitting. Identify the process of the second cervical vertebra and stabilize your thumb or with the second metacarpophalangeal joint and the thumb and index finger around the transverse process. Have the patient slowly nod, doing just a tipping motion of the head on the upper spine Guide the movement by placing the other hand across the patient's forehead.

 Stretching the short Suboccipital muscles. The therapist stabilizes the second cervical vertebra as the patient slowly nod the head

Self-Stretching ⏩
 Patient position and procedure: Supine or sitting. Instruct the patient to first perform a chin tuck (axial extension, then nod the head, bringing the chin toward the larynx until a stretch is felt in the suboccipital area.

Have the patient put a light pressure under the occipitale region with the palm of his or her hand while tipping the head forward to reinforce the motion.

For a unilateral stretch, instruct the patient to first perform a chin tuck, rotate slightly (up to 15") to the left or and then nod

NOTE: The weight of the head is enough stretch force in exercises the patient should not pull on the head when is cervical pathology  

CLINICAL TIP

Shoulder girdle posture is directly related to cervical and thoracic posture Techniques to increase flexibility  in the shoulder girdle muscles are described in 

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⏩Pectoralis major 

⏩Pectoralis minor

⏩Levator scapulae 

⏩Shoulder internal rotator muscles