Strong Extension-Based Exercise of the Cervical Spine - A Case Series

Don Meyer, DC

Private Practice Huntington Beach, CA

President Circular Traction Supply

CBP Instructor

INTRODUCTION

            In a recent paper published in the Journal of Rheumatology, the Cervical Overview Group conducted a large-scale meta-analysis of existing literature concerning the management of mechanical neck disorders, including radiculopathy(1).  The categories of evidence ranged from strong evidence, to moderate evidence, to limited evidence, to evidence of no benefit.  The only regimes that managed to make it into the highest level of evidence were [combined] stretching/strengthening exercise and mobilization/manipulation.  Medical prescriptive interventions failed to make the cut.

            So now that we know that along with manual manipulation, a stretching/strengthening exercise program is one of the most evidence based therapies we can provide a post-acute or chronic patient with mechanical neck problems.  But what is the best method to apply these exercises?    

            Applying a strong anterior load into the posterior cervical region while the patient actively performs extension-based range of motion neck exercises is a relatively new and unique concept within the healing arts.  Exercise straps have been invented that recommend a “gentle” resistance to various neck range of motion exercises and assist in stretching the neck (2).  These devices were not designed to provide a strong progressive anterior load into the user’s neck.  A more recent exercise device uses a spring-like design to apply a strong extension load to the posterior neck muscles, but again recommends only a mild anterior load (4-6 lbs.) be applied into the posterior cervical region (3).  In fact, it is designed to prevent a strong anterior pull from being applied into the neck by the posterior spring assembly.   

            In the early 2000’s, Deed Harrison, D.C. started instructing Doctors of Chiropractic at CBP®  seminars how to take a padded strap and forcibly pull the upper thoracic and lower cervical spine into flexion while actively extending the head and upper cervical spine.   

            I took Doctor Deed Harrison’s idea of extension exercising of the neck with a padded strap and extrapolated upon it. I added Theraband™ resistance tubing offered at three different resistance levels, padded hand grips and a rehabilitative program of eight isotonic ranges of motion and posture corrective exercises.  See Picture One.  I first used this new exercise device on myself and then offered it to six of my chronic neck pain patients to try out at no cost.  Three of these patients had completed postural/structural corrective in-office treatment and were on monthly maintenance care.  What follows are the result with my own cervical condition as well as the six other participates.   Pre and Post pain questionnaires, lateral cervical radiographs and computerized range of motion findings are provided with most cases.

 

Picture One – Pro-Lordotic Neck Exerciser

DISCUSSION

            The Table in Picture Two illustrates that of the seven cases, four had severe DJD, one moderate, one mild and one had no DJD.  One patient was in their early thirties, two were in their late forties, two in their early fifties and two were in their sixties.  There were two males and four females.  All the individuals had chronic neck pain.

In two of the cases, pre/post ROM studies were not performed.  But in the five cases where pre/post studies were performed, they all showed improvement with regular use of the Pro-Lordotic Neck Exerciser.  Case five achieved higher than normal ROM values even with severe degenerative joint changes.

All of the cases experienced some degree of pain relief from regular use of the Pro-Lordotic Exerciser.  Case one and two experienced a complete relief of their pain.  Case three denoted a 98% reduction of arm paraesthesia and a complete relief of neck pain.  Case four and five had a complete resolution of their shoulder/arm or hand pain and notable reductions of neck pain.  Case six and seven also related having notable reductions of neck pain to minimal levels.  Five of the cases that had performed in-office traction, exercise and manipulative rehab achieved higher levels of pain relief through the continued use of the Pro-Lordotic Neck Exerciser.

Four of the seven cases reduced their ADL restrictions with the regular use of the Pro-L Neck Exerciser.  One case had no ADL restrictions and two cases ADL restrictions did not reduce.  Two of the cases that were on monthly maintenance care of spinal manipulation only saw their ADL restrictions further reduce with regular Pro-Lordotic Neck Exercises.

All seven of these chronic cases achieved some degree of cervical curvature correction with regular use of the Pro-Lordotic Neck Exerciser.  Cases two and four achieved more correction with this home exerciser than what they were able to accomplish in-office with expensive cervical curvature traction devices.  Case three started his curvature correction in-office and was able to continue correcting it with the home exerciser.  Case five and six had lost some of their in-office corrections over time and were able to retain some of this lost curvature with the home exerciser.  Case seven achieved all of her correction with the home exerciser.

Cases three and four were the only two cases to have true radicular symptoms all the way into their hands.  Both of these cases were able to either completely or almost completely resolve these symptoms with regular use of the Pro-Lordotic Neck Exerciser.

Most importantly, all seven of these cases received enough relief of pain and increase function to what to continue their home use of the device for long periods of time.  All of the cases reported being able to control their condition, to some degree, with regular use of the Pro-Lordotic Neck Exerciser.

Picture Two

Category	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6	Case 7
Sex	Male	Female	Male	Female	Female	Female	Female
Age	53	62	68	54	49	47	32
DJD Stage	Moderate	Severe	Severe	Severe	Severe	Mild	None
Increased ROM with Pro-L Neck Exercises?	Unknown	Unknown	Yes	Yes	Yes	Yes	Yes
Increased ROM with Pro-L Neck Exercises after Active In-Office Rehab.?	N/A	Unknown	Yes	Yes	Yes	Yes	N/A
Pain Relief with Pro-L Neck Exercises?	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Pain Relief with Pro-L Neck Exercises after Active In-Office Rehab.?	N/A	Yes	Yes	Yes	Yes	Yes	N/A
Decreased ADL Restrictions with Pro-L Neck Exercises?	Yes	N/A	Yes	Yes	No	No	Yes
Decreased ADL Restrictions with Pro-L Neck Exercises after Active In-Office Rehab.?	N/A	N/A	Yes	Yes	No	No	N/A
Improved Cervical Curvature with Pro-L Neck Exercises?	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Improved Cervical Curvature with Pro-L Neck Exercises after Active In-Office Rehab?	N/A	Yes	Yes	Yes	Yes	Yes	N/A
Relief of Radicular Symptoms with Pro-L Neck Exercises?	N/A	N/A	Yes	Yes	N/A	N/A	N/A
Long Term Relief of Symptoms with Pro-L Neck Exercises?	Yes	Yes	Yes	Yes	Yes	Yes	Yes

References

1. J Rheumatol