Neck Exercises

Neck Exercises :Triaxial Treatment of the Neck

 Description of the History of Occupational Therapy Video

We have all had patients that have presented to us with increased kyphosis of the thoracic spine, neck flexion, and forward head. The weight of gravity is a tremendous primary external force that leads to a series of muscle malalignments that can be corrected by working on the synergistic muscle networks in charge of creating an effective class one lever of the skull.

Where do start?

  1. Assess posture! Can you do exercises standing, or should you do neck stretches and postural training while seated….or lying in bed?
  2. Write it down!
    • Anterior or Posterior Pelvic Tilt?
    • Increased Lordosis (lower back curve) or Kyphosis (upper back curve)?
    • Shoulders rolled too far forward “hunched”? Chest pointing toward the ground instead of straight forward? 
    • Neck flexed? Forward head? 

3. It’s not about the neck…it’s about the ‘everything’. Think about the muscles in both the front and the back that are involved in neck mobility. Everything is connected! You must address the overly tight muscles anteriorly, the deconditioned muscles posteriorly, and the underleveraged muscles laterally in order to increase neck mobility for your client. 

4. What can you do?

  • Stretch! Use gravity–working on the mat table is OKAY for an occupational therapy practitioner! Give it time! I will have someone lying supine using noodles and wedges for up to 30 minutes! This greatly improves posture and aids in muscle correction. This is occupational therapy and we can bill for this! [Ther Ex]
  • Neck Mobility stretches/AROM targeting triaxial degrees of freedom (flexion/extension, lateral flexion, rotation)
  • Posture against gravity upright 30 second to 3 minute sets, rest, do it again. You don’t have to dress it up! Posture and neck correction is a neuromuscular response and requires neuromuscular re-education, this takes undivided attention. You can’t distract your client with an activity if you are seeking to improve these movements or they will not be able to focus their attention on true motor correction and repair. [ANY DIAGNOSIS – including generalized weakness, regardless of age].
  • Once your patient has increased neck and posture to typical presentation for at least 3 minutes against gravity, progress to transitional movements. Have your patient do sit to stands while maintaining this posture. 
  • Once your patient has improved during transition movements, have your patient static stand against with typical posture, slowly moving neck into lateral rotation, flexion, and extension. At this point, maintain neck position and posture with dynamic activity. 

**It’s important to note that it is PERFECTLY reasonable to spend WEEKS of time JUST stretching and maintaining neck and posture against gravity. Your treatments do NOT have to be exciting to be purposeful. In fact, if you superimposed these important therapeutic exercises and neuromuscular re-education activities onto random activities, you WILL NOT see results! Your patient MUST concentrate on what they are doing when it comes to neck and posture strengthening and repair. Gravity is all the resistance you need, especially when working with the frail elderly! 

Another helpful video on posture: