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Neck Pain #9 – Cervical Spondylosis – Treatment 5 - Strengthening Exercises

Updated on May 7, 2014

Introduction

In the case of Cervical Spondylosis and other Cervical Disc Degenerative Conditions there may be certain bodily changes in the cervical and shoulder regions which may lead to impairment, discomfort and disability. Once the acute stage has subsided, one can proceed to strengthening exercises along with mobilization exercises. There will be weakness of the muscles around the cervical region as well as around the shoulders and shoulder girdles. The weakness of the muscles around the cervical region will directly lead to instability in the cervical spine. Similarly the weakness of the muscles around the shoulders and the shoulder girdles will also lead to instability in the cervical spine. An unstable cervical spine is exposed to further degenerative changes. Hence it is very essential to stabilize the cervical spine by restoring and regaining the strength of the weak muscles. It is very important to include the strengthening exercises also in the regime of exercise program prescribed. It is to be pointed out that most of the mobilization exercises which we have already discussed are also strengthening exercises.

Please refer my earlier article on mobilization exercises.

Points to remember while doing the exercises

  1. Hot water fomentation may be given prior to the exercises, so that there may be relaxation of muscles, relief of pain and increase of blood circulation.
  2. Need not do all the exercise. Choose suitable and convenient exercises. May seek the advice of a physiotherapist.
  3. Choose pain free exercises.
  4. Do the exercises within the limits of severe pain.
  5. Don’t get exhausted while doing exercise.
  6. Prepare a regime of exercise which includes mobilization exercises, postural correction exercises and strengthening exercises. May seek the advice of a physiotherapist.
  7. Do the exercises slowly and gently. Quick movements must be avoided.

Strengthening Exercises to the Muscles of the Cervical Spine

Usually the strengthening exercises in the cervical region are done isometrically, though isotonic and active exercises are also good value. Isometric indicates attaining contraction of the muscles and holding that contraction in tact with no active range of motion. The muscles contract and then relax without causing any movement of the neck. Isotonic indicates attaining contraction of the muscles with active range of motion. Active exercise indicates the exercises actively done by oneself without giving any resistance to the movement.

Isometric Exercises to the Neck

  1. The patient sits comfortably and relaxed in a chair with the feet flat on the floor. The head is held in a neutral horizontal position with the chin not lifted up or lowered. Keep the palm of the right hand on the right side of the head (as shown in the figure) and try to push against the head. But the head gives resistance to the push from the right side. As a result the head remains in the same position without any movement. Hold the head in the maximum contracted position for 5 seconds. Now slowly and gently release the right hand so that the neck muscles get relaxed. Do the exercise towards the other side. Repeat the exercise 5-10 times twice a day.This exercise can also be done in the standing position.This exercise strengthens the side muscles (side flexors) of the cervical region.

2. The patient sits comfortably and relaxed in a chair with the feet flat on the floor. The head is held in a neutral horizontal position with the chin not lifted up or lowered. Keep the palm of the right hand on the forehead (as shown in the figure) and push against the forehead. But the head gives resistance to the push from the forehead. As a result the head remains in the same position without movement. Hold the head in the maximum contracted position for 5 seconds. Now slowly and gently release the right hand so that the neck muscles get relaxed. Do the exercise in the opposite direction (as shown in the figure). Repeat the exercise 5-10 times twice a day. This exercise can also be done in the standing position. This exercise strengthens the muscles of the front and back (flexors and extensors) of the cervical region.

3. The patient sits comfortably and relaxed in a chair with the feet flat on the floor. The head is held in a neutral horizontal position with the chin not lifted up or lowered. Turn the head towards the right side till the end point is reached. Ensure that the movement is pain free. Place the palm of the left hand on the left side of the chin and push it further towards the right side. But the head gives resistance against the push. As a result the head remains in the same position without movement. Hold the head in the maximum contracted position for 5 seconds. Now slowly and gently release the left hand so that the neck muscles get relaxed. Do this exercise in the opposite direction (as shown in the figure). Repeat the exercise 5-10 times twice a day. This exercise can also be done in the standing position. This exercise strengthens the ‘rotator’ muscles of the cervical region.

Active Exercises to the Neck

  1. The patient lies supine on a hard bed with the face upwards. He must be relaxed and comfortable. Keep both the extended arms by the side of the body. Bend both the lower limbs at the hips and knees with both the feet flat on the bed (as shown in the figure). Now raise the head from the bed with the chin slightly lifted up. Hold the head in the maximum lifted up position for 5 seconds. Slowly and gently bring back the head to the starting position. Care should be taken that when the head is lifted up the upper body must be retained flat on the bed. Repeat the exercise 5-10 times twice a day. This exercise strengthens the muscles in the front (flexors) of the cervical region.

2. The patient lies on his left side on a hard bed with the face facing sideways. Keep the upper limbs and lower limbs flexed and hold them in a comfortable position (as shown in the figure). Now lift the head from the bed and hold it in the maximum lifted up position for 5 seconds. Slowly and gently bring back the head to the starting position. Do the exercise on the other side also. Repeat the exercise 5-10 times twice a day. This exercise strengthens the muscles on the sides (side flexors) of the cervical region.

3. Stand on your hands and knees (as shown in the figure). Keep the knees directly under the hips and the hands directly under the shoulders. Keep the abdomen slightly firm so that the spine is in a neutral position (not arched or sagging). Keep the neck relaxed so that the natural curves are maintained and the ears are aligned with the shoulders. Now lift the head up as if to look at the ceiling. Hold the head in the maximum lifted up position for 5 seconds. Slowly and gently bring back the head to the starting position. Repeat the exercise 5-10 times twice a day. This exercise strengthens the muscles on the back (extensors) of the cervical region.

Isotonic Exercises to the Neck

  1. The patient stands comfortably and relaxed on the floor with the legs apart. Bend the neck sideways towards the right side and try to touch the right shoulder with the right ear. This movement is continued till an end point is reached. Now the palm of the right hand is placed on the head and the head is pulled further towards the right side with optimal pressure (as shown in the figure). The head is held in this stretched position. Now the head is slowly and gently brought back to the starting vertical position while the optimal pressure towards the right side is still on. Do the exercise towards the other side also. Repeat the exercise 5-10 times twice a day. This exercise can also be done in the sitting position. This exercise strengthens the muscles of the side (side flexors) of the cervical region.

2. The patient stands comfortably and relaxed on the floor with the legs apart. Bend the head forwards towards the chest and try to touch the upper chest with the chin. The forward bending movement is continued till an end point is reached. Now the hands are placed behind the head on the occiput (as shown in the figure) and the head is pulled further downwards with optimal pressure. The head is held in this stretched position. Now the head is slowly and gently brought back to the starting vertical position while the optimal downward pressure on the occiput is still on. Do this exercise in the opposite direction also. Repeat the exercise 5-10 times twice a day. This exercise can also be done in the sitting position. This exercise strengthens the muscles of the front and back (flexors and extensors) of the cervical region.

3. The patient sits comfortably and relaxed in a chair with the feet flat on the floor. The head is held in a neutral horizontal position with the chin not lifted up or lowered. Turn the head towards right side in the horizontal plane till an end point is reached. Now place the palm of the left hand on the left side of the chin and the head is pushed further towards right side with optimal pressure (as shown in the figure). Now the head is slowly and gently brought back to the starting vertical position while the optimal pressure towards the right side is still on. Do the exercise towards the other side also. Repeat the exercise 5-10 times twice a day. This exercise can also be done in the standing position. This exercise strengthens the ‘rotator’ muscles of the cervical region.

Strengthening Exercise to the Muscles of the Shoulder Girdles

  1. The patient stands with the legs apart on the floor and assumes a comfortable and relaxed position. Bend both the upper limbs at the elbows and hold them in the bend position close to the body with the hands facing forwards (as shown in the figure). Slowly and gently pull the upper limbs back in such a way that both the shoulder blades are pulled back so that they touch each other at the back. A stretch is felt in the front of the chest. Hold the upper limbs in the maximum stretched position for 5 seconds. Now slowly and gently bring back the upper limbs and the shoulder girdles to the starting position. Do the exercise in the opposite direction by bringing the upper limbs and the shoulder girdles forward. Repeat the exercise 5-10 times twice a day.

2. The patient stands with the legs apart on the floor and assumes a comfortable and relaxed position with the upper limbs dangling down. Shrug or lift both the shoulders up and try to touch the ears with the respective shoulders (as shown in the figure). Now a stretch is felt. Hold the shoulders in the maximum ’lifted up’ position for 5 seconds. Now slowly and gently relax and bring back the shoulders to the starting position. Repeat the exercise 5-10 times twice a day.

3. The patient stands with the legs apart on the floor and assumes a comfortable and relaxed position with the upper limbs dangling down. Bend both the upper limbs at the elbows and then keep the finger tips at the respective shoulders (as shown in the figure). Now rotate the shoulders slowly and gently in the clockwise direction 5-10 times. Do the exercise in the anti- clockwise direction also.

4. The patient stands with the legs apart on a floor and assumes a comfortable and the relaxed position with the upper limbs dangling down. Now lift the shoulders up and hold it in the maximum lifted up position for 1-2 seconds. Now bring the shoulders gently and slowly backwards and hold them in the maximum stretched position for 1-2 seconds. From this position bring the shoulders downwards and hold them in the maximum stretched position for 1-2 seconds. Now slowly and gently bring the shoulders forwards and hold them in the maximum stretched position for 1-2 seconds. In short the shouldersare rotated slowly and gently in such a way that brief ‘stays’ are given at regular intervals. Do the exercise 5-10 times twice a day. This exercise is done in the anti-clockwise direction also. Please refer the figure.

5. The patient stands with the legs apart on a floor and assumes a comfortable and relaxed position with the upper limbs dangling down with identical weights (2-3kgs) in both hands. Proper posture, with tilted pelvis and flattened cervical lordosis is maintained (as shown in the figure). Elevate both the shoulders simultaneously and rhythmically and hold them in the maximum elevated position for 5 seconds. Now slowly and gently bring back the shoulders to the starting position. Do the exercise 5-10 times twice a day. As a progression, the weights in the hands may be increased.

6. The patient is seated with the back to wall, head and neck pressed against the wall. The upper limbs are dangling down with identical weights (2-3kgs) in both hands (as shown in the figure). Elevate both the shoulders simultaneously and rhythmically and hold them in the maximum elevated position for 5 seconds. Now slowly and gently bring back the shoulders to the starting position. Do the exercise 5-10 times twice a day. As a progression, the weights in the hands may be increased.

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