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Neck Pain #7 – Cervical Spondylosis – Treatment 3 - Mobilization Exercises

Updated on April 18, 2014

Introduction

Even when the acute phase has subsided, there may be muscle spasm, pain and joint limitation. The intervertebral disc is not a direct mechanical factor that contributes to the limitation of movement of cervical spine by virtue of annular protrusion, tear or nuclear herniation. A herniated intervertebral disc, whether it is internal nuclear or external annular, does not have any considerable role in immobilizing a cervical functional unit. But a herniated cervical disc may cause the cervical muscles to go into protective muscle spasm. The protective muscle spasm cause pain and restrict the cervical movements. Gentle mobilization is indicated. The goal of mobilization is to regain pain – free movement.

Mobilization of Soft Tissues

As we have already discussed, we can proceed to mobilization once the acute stage has subsided. The movement and the range of movement of the cervical spine is restricted mainly due to the protective muscle spasm. The range of motion of the cervical spine may also be restricted because of the tightness of the cervical musculature and its fascia, tightness of the cervical ligaments, tightness of the cervical joint capsules etc. The mobilization exercises aim at stretching of the tightened soft tissues already mentioned above. That is, the mobilization exercises benefit the impaired cervical functional unit by stretching the tight soft tissues in the cervical region. But the effect of mobilization upon the bulged nucleus or annulus with the entrapment of nerve roots is not scientifically proved.

Forceful manipulations to increase the range of motions can possibly cause further damage to the herniated disc.

In the recovering cases of herniated disc with nerve root entrapment, the mobilization restores normal physiological motion of the cervical spine and assists in preventing relapses and recurrences.

The tightness of the soft tissues in the cervical region causes tightness of the soft tissues in the shoulders and upper body regions because they are all inter related to each other. Hence mobilizing exercises must also be given to the shoulder and upper body soft tissues in addition to those in the cervical region.

Mobilization Exercises

Points to remember

  1. Mobilization Exercises can be given only after the acute stage has subsided.
  2. Mobilization Exercises must be within the limits of severe pain.
  3. Avoid the Mobilization Exercises which aggravate the symptoms.
  4. Avoid the Mobilization Exercises which are strenuous.
  5. Need not do all the Mobilization Exercises. Consult a physiotherapist to choose.
  6. Suitable starting positions must be chosen. Hence the patient is relaxed.
  7. Do not get exhausted while doing exercise. Proper intervals must be given in between.
  8. Forceful Manipulations must be avoided.
  9. Mobilizing and stretching exercises must be given to the shoulders and the upper body also.
  10. Hot water fomentation may be given prior to Mobilizing Exercises.

Mobilization Exercise - 1

Sit on the floor or on a bed with crossed legs in a relaxed position as shown in the figure. This exercise can also be done with the patient standing. Turn the head gently and slowly towards right till a stretch is felt on the neck at the left side. Turn the head further till a maximum stretch is felt. Hold the neck in the maximum stretched position for 5 seconds. Now slowly and gradually bring back the head to the starting position. The exercise is done in the opposite direction also. Repeat the exercise 10 times, twice a day.

Mobilization Exercise - 2

Starting position same as above. Flex the neck slowly and gently and try to touch the upper chest with the chin. This movement is continued till a stretch is felt at the back of the neck. Bend the neck further till a maximum stretch is felt. Hold the neck in the maximum stretched position for 5 seconds. Now slowly and gently bring back the head to the starting position. This exercise is done in the opposite direction also. Repeat the exercise 10 times, twice a day.

Mobilization Exercise - 3

Starting position same as above. Bend the neck slowly and gently sideways towards the right side and try to touch the right shoulders with the right ear. This movement is continued till a stretch is felt on the neck at the left side. Bend the neck further till a maximum stretch is felt. Hold the neck in the maximum stretched position for 5 seconds. Now slowly and gently bring back the head to the starting position. This exercise is done in the opposite direction also. Repeat the exercise 10 times, twice a day.

Mobilization Exercise - 4

The patient stands with feet apart in a relaxed position. Bend both the upper limbs at the elbows and hold them in the bend position with the hands facing forwards. Slowly and gently pull back the upper limbs in such a way that both the shoulder blades are pulled back and touch each other at the back. Do this till a stretch is felt. Continue this movement further till a maximum stretch is felt. Hold in this maximum stretched position for 5 seconds. Now slowly and gently bring back the upper limbs to the starting position. Repeat the exercise 10 times twice a day.

Mobilization Exercise - 5

The patient stands with the feet apart in a relaxed position with the upper limbs dangling down. Lift the shoulders up as if to touch the ears with the shoulders. This is continued till a stretch is felt. Lift the shoulders further till a maximum stretch is felt. Hold in the maximum stretched position for 5 seconds. Now slowly and gently bring back the shoulders to the starting position. Repeat the exercise 10 times twice a day.

Mobilization Exercise - 6

Lie supine with face upwards on a hard bed in a relaxed position. The head rests on a small pillow. The head is turned towards the right and then to the left with the assistance of the hand. This exercise should be completely pain free. Care should be taken that the movements are done only with the hands without any muscular activity. This exercise is continued till a complete relaxation is felt in the cervical region. Once the relaxation is felt the movements of the neck is done actively without the assistance of the hands. Repeat the exercise 10 times twice a day.

Mobilization Exercise - 7

Lie supine with face upwards on a hard bed in a relaxed position. The head rests on a small pillow. Imagine that your head rests on a clock with the nose at the centre, forehead at the marking ‘12’ on the clock and the chin at the marking ’6’on the clock. Now move the head in such a way that the forehead and the chin touch the markings ‘1-7’,’2-8’, ‘3-9’, ‘4-10’,’5-11’ and ‘6-12’respectively. Do the exercise 3 times, twice a day.

Mobilization Exercise - 8

Lie supine with the face upwards on a hard bed in a relaxed position. The head rests on a small pillow. Turn the head and neck towards the right side and turn the trunk and the lower limbs in the opposite direction. This type of twisting of the body is continued till a stretch is felt. Hold the body in the maximum stretched position for 5 seconds. Now slowly and gently come back to the starting position. Repeat the exercise towards the other side. Do the exercise 5 times, twice a day. To get maximum stretch, keep the chin downwards and keep the feet on the bed throughout the exercise.

Mobilization Exercise - 9

Sit on a chair with the legs hanging down and the feet resting on the floor. Raise the extended right upper limb and bring it above and behind the head. Now bring it further behind the head towards the left side. This is continued till a stretch is felt on the right side of the body. Hold the hand in the maximum stretched position for 5 seconds. Slowly and gently bring back the upper limb in the starting position. Repeat the exercise with the left upper limb. Do the exercise 10 times, twice a day. The exercise with the right and left upper limbs may be done alternatively.

Mobilization Exercise - 10

Sit on a chair with the legs hanging down and feet resting on the floor. Keep both the hands locked behind the head so that the head rests on the hands. Now the head is stretched back as if to look at the ceiling. The backward stretching movement continued till a stretch is felt at the front of a neck. Hold the head in the maximum stretched position for 5 seconds. Now slowly and gently bring back the head to the starting position. Do the exercise 10 times twice a day. The exercise can also be done by bending the head forward and holding the head in the maximum stretched position (stretch is felt at the back of the neck) by holding the locked hands on the forehead.

Mobilization Exercise - 11

Stand with the legs apart and relaxed with the hands dangling down. Bend both the upper limbs at the elbows and keep the finger tips at the respective shoulders as shown in the figure. Now rotate the shoulders in the clockwise and then in the anticlockwise directions. Repeat the exercise 5-10 times, twice a day.

Mobilization Exercise - 12

Starting position same as above. Stretch out both the upper limbs sideways and hold them at the level of the shoulders with the hands facing forward as shown in the figure. Rotate the upper limbs in the clockwise direction and then in the anticlockwise direction. Repeat the exercise 5-10 times, twice a day.

Mobilization Exercise - 13

Starting position same as above. Stretch out both the upper limbs sideways and hold them at the level of the shoulders. Now bend the right upper limb at the shoulder and elbow and bring it across the chest and touch the front of the left shoulder with the fingers of the left hand as shown in the figure. Then slowly and gently bring back the right upper limb to the starting position. Do the exercise alternatively with the left upper limb. Repeat the exercise 5-10 times, twice a day.

Mobilization Exercise - 14

Stand with one leg forward as if about to walk with the upper limbs dangling down. Swing both the upper limbs up and down alternatively as shown in the figure. While swinging care must be taken that the upper limbs reach the extreme end positions so that a stretch is felt. Repeat the exercise 5-10 times twice a day.

Mobilization Exercise - 15

This exercise is aimed at increasing the flexibility of the neck, shoulders and the upper body musculature. Sit on a stool with both buttocks rest on the stool and the feet flat on the floor. Now slowly and gently raise the left buttocks off the stool so that the body weight is transferred to the right buttocks. Now turn the neck and the upper body towards the left side and try to look behind over the left shoulder. This movement is continued till a stretch (twist) is felt. Hold the body in the maximum stretched position for 3 seconds. Now slowly and gently bring back the body to the starting position. Do the exercise with the other side. Repeat the exercise 5 times, twice a day.

This exercise can be made more efficient by making slight modification. The extended right upper limb is stretched out and is brought across the chest towards the left side along with the head and neck. In this case the head and neck may turn more.

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