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PT Crab 🦀 Issue 139 - Necking

PT Crab 🦀 Issue 139 - Necking

This week in PT Crab, we’re talking necks, neck pain specifically. We’re looking at self-management added to standard PT, an easy test for head-trunk coordination and the effectiveness of cranio-cervical flexion exercises vs. other exercises for neck pain.

This week in Richmond, where I live, it’s Hot Tomato Summer brought to you by Duke’s Mayonnaise! And while that’s not very helpful to you if you don’t live in Richmond, I’m very excited about it, so there’s that. A bunch of restaurants are making special tomato dishes, many of which feature mayonnaise too. Last year, my favorite pizza place, Pizza Bones, made a BLT pizza with mayonnaise that was fantastic. So if you’re in Richmond, do check out Hot Tomato Summer. And if you’re not, keep your eyes open for similar stuff in your area, it’s really fun.

With that, let’s dive in!

Craniocervical Flexion vs. Other Exercises. It’s a draw.

The Gist - This systematic review and meta-analysis looked into two methods to go after non-specific neck pain, craniocervical flexion exercise (AKA deep neck flexor exercise) and other, non-specific exercise. The point was to compare both types to no treatment and to each other to determine which is a better way to take out neck pain. And if you read the headline here, you won’t be surprised to learn that it was a draw. They found 16 articles for a qualitative synthesis and 9 for a quantitative one. 11 of the 16 used the same low-load craniocervical flexion protocol from a Jull study from 2004 that is unfortunately from a book chapter so it’s hard to access online. But from reading through the other studies that used the protocol, it seems that people were taught to do craniocervical flexion and than taken through a 6 week process where they progressed it through different ranges of pressure and neck flexion using one of those Chattanooga stabilization air bladder thingies(tm).

To go back to our study, “regardless of the type of active exercise adopted to treat neck pain, it seems that the CCF protocol offers results comparable with other exercise protocols. These protocols involve high- load exercises (head lift exercise in the supine position) and generic progressive resistance exercise programs for the neck muscles performed on a daily or weekly basis for a duration of 4 to 12 consecutive weeks.”

The researchers say that this is good because it allows for a shared decision-making process with patients to find what types of exercises they believe will work best.

Tell Me More - Let’s dig into the exercise protocol a bit more. Using a description from this Gallego Izquierdo paper from the Journal of Rehabilitation Medicine in 2016, we can get the details of what they did. It was a low load training protocol that taught the CCF movement in supine with the head and neck in neutral via a gentle nod while ensuring SCM and anterior scalenes were turned off. Once they figured out the motion, patients held progressively increasing pressures against the neck Stabilizer over the course of six weeks. They didn’t use the stabilizer at home, but attempted to replicate the pressure they were using there instead, then got checked on twice per week at a PT clinic.

Since the results in this paper were a bit muddled, the authors went on to discuss further research in this area to help elucidate things further. One of those papers showed that motor control exercises for the neck are helpful, but not more helpful than other active exercises, like general strengthening, yoga, and Pilates. Overall, we don’t yet have evidence to show that anything is especially helpful for non-specific neck pain, we just know that pretty much everything helps, but it doesn’t help a ton. So, yay? I guess? We need more work on this.

Paper? Yupp.

And that’s our week! I’m going to go out and engorge myself on tomatoes this evening and I hope you do the same wherever you are. Unless you don’t like tomatoes, in which case, I’m sorry for you. But I’m sure you like other stuff, so it fine.

Have a good week,



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