Don't Forget About Training The Cervical Extensors!!
Mike is currently in China learning from the godfather of the Clinical Practice Guidelines himself, Joe Godges. Here a great exercise for your patients with neck pain, especially those with whiplash induced neck pain, that targets not just the deep cervical flexors, but also the deep cervical extensors! Pay close attention to the cueing, as activation of the deep cervical extensors should be emphasized at selected spinal levels for the management of segmental dysfunction.
In our opinion, within the rehabilitation community there is TOO HEAVY OF A FOCUS on training the deep cervical flexors (longus colli and longus capitis). The CERVICAL EXTENSORS ARE EQUALLY AS IMPORTANT FOR THE REHABILITATION OF PATIENTS WITH NECK PAIN. The deep cervical extensors (semispinalis cevicis, multifus, and rotators) along with the cranio-cervical extensors (rectus capitis posterior major/minor and obliquus capitis superior/inferior) are KEY MUSCLES for cervical spine segmental support due to their relatively small moment arms, attachments to adjacent vertebrae, and high proportion (~70%) of slow twitch fibers.
Here some key facts about the cervical extensors that CLINICIANS NEED TO KNOW:
- Cervical multifus, unlike thoracic and lumbar, origination directly from the capsules of the facet joints, and may partially explain their role in neck pain and injury
- Non-uniform activation of different fascicles of the semispinalis muscles suggest that it may be possible to selectively activate different fascicles during exercise, ie targeting the site of greatest pain where structural or functional changes in the muscle may be more evident. When manual static resistance is applied to the vertebral arch of C2, the semispinalis cervicis (recorded at C3) was selected activated relative to the splenius capitis!
- Fatty tissue infiltration of the multifidus and the semispinalis cervicis has been observed in patients with whiplash induced neck pain
- Transformation from type I to type II fibers is observed for both cervical flexor and extensor muscles in patients with neck pain
- The superficial cervical extensors typically showed increased activation in patients with neck pain, as well as delayed offset after activity. On the other hand, the deep cervical extensors show reduced activation.
In conclusion, start with low load exercises like this one with the aim of inducing neurophysiological adaptations by specifically activating deeper muscles it the cervical spine. Then, progress to high-load exercises with the aim of inducing morphological adaptations in order to increase the strength and endurance of the selected muscles and movements.
Citation: Schomacher and Falla 2013. "Function and Structure of the Deep Cervical Extensor Muscles In Patient's with Neck Pain".