Fulcrum, Lever, Neck: A Case Study
Numerous authors (McGill, Boyle, and Cook, to name a few) have demonstrated the mobility - stability continuum that exists within the human body. In a nutshell, this continuum is that starting from the ground up, with the foot, and going joint by joint through the body, there is an alternating pattern of stability and mobility that is the ideal for optimal function and minimal injury.
From this, we can see that the neck (cervical spine) is designed to be more stable than mobile on this continuum. This may be a challenging concept to embrace because we think of the great deal of movement that our necks have on a daily basis. We are quite often most aware of our neck when we do not have adequate mobility and feel stiff, tight and/or limited range of motion. We seek treatment (Chiropractic, Massage, Yoga, etc.) in an attempt to decrease this stiffness and tightness and strive to be able to move our neck more freely.
This feeling can often be misleading, however. If the neck is designed to be more stable than mobile, when it is not stable, we may experience the “reactive muscle guarding” that feels stiff and tight that occurs as a protective compensation mechanism. From there, we may continue to work on loosening up this stiffness and tightness through more treatment aimed at increasing the mobility. The problem arises in that we are then undermining the compensation which leads to further compensation, in this situation, further “reactive muscle guarding” and resultant more stiffness and tightness. This serves the exact opposite of the outcome we are expecting and wanting.
This scenario was exemplified in a patient who came in to my office. He had gradual neck stiffness and tightness that had developed slowly over a few months. He reported no injury or trauma to his neck or shoulders. Prior to coming in to my office, he had been to a reputable Chiropractor numerous times and had a handful of massage therapy sessions. After all of these appointments, he reported short term feeling of relief that went away within about 24 hours following the visits and quite a few times felt worse, including feeling more stiff and more tight than before his visits. He was given static stretches to perform regularly, which he also experienced no relief from and often felt as though it made his neck worse.
Keeping in mind the definition of insanity, “…doing the same thing over and over, while expecting a different outcome…”, I did not want to have him do more Chiropractic adjustments and massage. Referring back to the stability - mobility continuum, I approached his situation from what I believe is a novel approach.
(As a side note. An interesting finding during range of motion testing, was that when he extended his neck, we were able to increase his limited range of motion with applying significant resistance against him. His “active & resisted range of motion” was greater than his “passive range of motion”. So clearly, he had range of motion, it was just limited by some muscular based mechanism.)
The novel approach that I took was to have him specifically work on stabilizing and strengthening the muscles of the his neck (see below for one example). I also instructed him to minimize, if not remove completely, any static stretching of his neck. Initially, both immediately after his visit, as well as for a few days following, he experience more feeling of stiffness and tightness with a feeling of decreased range of motion in his neck. On the follow up visit I measured his range of motion, active, resisted, and passive, and all were the same as upon his initial examination. I advised him that this initial increased stiffness and tightness feeling may be due to a training effect of historically untrained muscles. He continued, and still continues, to train the stability and strength of his neck muscles.
An example of some of the neck stability and strengthening exercises
At a 3 week follow up, he reports feeling “more comfortable and more mobile” throughout his daily activities. He also reports that he has not done any of the stretching that he was given previous to his visit with me.
He is feeling less stiffness and less tightness in his neck.
At first glance, it may seem a bit paradoxical that by training the stability and strength of the area, that we would see improvements in mobility and range of motion. But, when you look deeper into the biomechanics, muscle physiology, and function it makes complete sense. A more stable system is a more ‘relaxed’ system under a load.
I will post a follow up at his 12 week appointment. The plan between now and then is to have him continue to progress on stability and strengthening exercises of his neck and shoulders. The expectation is not to see significant results until at least the 12 week mark, as it took him months to get to this point it would seem logical that it may take equally as long to resolve. (“If it takes a mile to hike in, it takes a mile to hike out.”)
Stay tuned,
Michael Ross DC, CSCS, DACRB