Stretches for the Neck and Torso Chapter 6

Muscles of the Neck Cervical area is a storehouse of muscular tension. Many people have discomfort or pain because of postural stress, job-related activities, or trauma. Stretching the neck muscles can provide great relief from tightness and pain but can also create pain if done too aggressively. Be sure that the stretcher is pain free at all times. Work cautiously with someone who has had a neck injury. Sometimes the stretcher may not realize he is overworking and will have increased pain a day or two later. Muscles of the cervical region include the upper trapezius, sternocleidomastoid (SCM), suboccipitals, scalenes, and levator scapulae. (continued)

Muscles of the Neck (continued) When upper trapezius muscles are tight, they can cause headaches and pain. SCM is a complex muscle with sternal and clavicular parts. Divisions merge into a common attachment on the skull. Four suboccipital muscles comprise two pairs: two rectus capitis and two obliquus muscles. Rectus capitis posterior major and obliques form suboccipital triangle. Vertebral artery crosses through triangle, which is filled with dense, fatty tissue and covered by more superficial semispinalis capitis and longissimus capitis. Muscles hold much tension and benefit from stretching. (continued)

Muscles of the Neck (continued) Scalene muscles have three sections: anterior, middle, and posterior. They’re implicated in thoracic outlet syndrome, carpal tunnel syndrome, and other painful conditions of neck, shoulder, and arm; brachial plexus (bundle of nerves) and subclavian artery pass between anterior and middle scalenes and can be entrapped if muscles are hypertonic. Levator scapulae is implicated in neck stiffness, especially when rotation is limited. Postural stress may cause the muscle to be hypertonic or eccentrically stressed, so it may need strengthening, not stretching.

Muscles of the Neck: Review Origins, Insertions, and Actions Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human Kinetics), 132, 129. (continued)

Muscles of the Neck: Review Origins, Insertions, and Actions (continued) Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human Kinetics), 130.

Movement of Head and Neck Cervical spine can move in 6 directions: flexion, extension, lateral flexion, rotation. Head moves independently on cervical spine in flexion, extension, rotation, and tilting (figure 6.1, p. 113). Movement of head and neck is more complex than movement around other joints. It’s difficult to isolate one muscle. Focus is on upper trapezius, SCM, suboccipitals, scalenes, and levator scapulae, but synergistic muscles that contribute to the same motion are also affected. (continued)

Movement of Head and Neck (continued) ROM for head on neck: Flexion: 10 degrees (tucking chin to neck) Extension: 25 degrees (looking up) Rotation: 45 degrees ROM for neck (values include motion of the head on the neck): Flexion: 85 degrees Extension: 70 degrees Rotation: 80 degrees Lateral flexion: 40 degrees

Normal ROM for the Head

Normal ROM for the Neck

Muscles of the Torso Thoracic and lumbar areas maintain chronic muscular tension, which can be alleviated through stretching. Many people have pain in these areas from trauma, job-related injury, or postural stress. Be sure that the stretcher works in the pain-free zone. Work cautiously with someone who has had a back injury. Sometimes the stretcher may not realize he is overworking and will have increased pain a day or two after stretching. Back extensors, trunk rotators, quadratus lumborum, and latissimus dorsi support the thoracic and lumbar spine. (continued)

Muscles of the Torso (continued) Back extensors: erector spinae (iliocostalis, longissimus, spinalis) and transversospinalis (semispinalis thoracis, multifidus, rotators, interspinales, intertransversarii). Muscles act bilaterally to extend spine. Acting unilaterally, they assist rotation. When hypertonic, can create back pain and limit flexion and rotation. Trunk rotation involves thoracic and lumbar spine. Muscles of rotation are internal and external oblique abdominal muscles, assisted by the erector spinae, semispinalis thoracis, multifidus, and rotators. External oblique angles downward and medially from the ribs. Internal oblique angles upward and medially from lateral and posterior iliac crest. (continued)

Muscles of the Torso (continued) Quadratus lumborum (QL) is a component of a strong, healthy low back. When it’s hypertonic, it develops trigger points that refer pain to hips, to gluteal area, and down leg. QL is always involved in low back pain, even that resulting from disc problems or misalignment of lumbar vertebrae. Latissimus dorsi forms part of the posterior axillary border and is used in activities in which the arm moves from overhead downward (e.g., chopping wood, swimming, rock climbing). Often overlooked as a source of back pain.

Muscles of the Torso: Review Origins, Insertions, and Actions Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human Kinetics), 135. (continued)

Muscles of the Torso: Review Origins, Insertions, and Actions (continued) Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human Kinetics), 135, 132.

Movement in the Lumbar and Thoracic Spine Trunk motion is a combination of movement at the lumbar and thoracic spine (figure 6.14, p. 122). Six directions are possible: flexion, extension, rotation to each side, and lateral flexion to each side. Movements can also be combined to create a greater variety of motion. Movement in the lumbar and thoracic spine is a complex combination of motion at each vertebra. (continued)

Movement in the Lumbar and Thoracic Spine (continued) Many muscles contribute to every motion, and it’s difficult to isolate one muscle. Therefore, smaller muscles that contribute to the same motion are also affected. Thoracolumbar ROM: Flexion: 90 degrees Extension: 30 degrees Rotation: 45 degrees Lateral flexion: 30 degrees

Normal Thoracolumbar ROMs: (a) Flexion-Extension, (b) Rotation, and (c) Lateral Flexion