cervical centralization - continuing ed thoracic tmd exercise han… · cervical centralization...

CERVICAL CENTRALIZATION Flex with Rotation Sit up straight. Drop the chin down towards the chest. Glide the neck back. Rotate the head to the _______. Perform this exercise as needed to decrease pain. Hold______seconds Repeat______times Cervical Retraction Sit up straight to bring the head in line with the shoulders. Place your finger against your chin. Retract the neck straight back, moving your chin away from the stationary finger. Perform this exercise as needed to decrease pain.

Hold ______seconds Repeat _______ times

Cervical Protraction Sit up straight to bring the head in line with the shoulders. Place your finger out in front of your chin. Keeping your chin down, move the neck forward, toward the stationary finger. Perform this exercise as needed to decrease pain.

Hold ______seconds Repeat _______ times Towel Traction Fold a towel to a width of ~ 3”. Place the center of the towel at the base of the head. Grasp the edges of the towel and extend your arms overhead, creating a gentle pull on the neck. If you are unable to sufficiently relax your neck and shoulders, have someone pull for you. Hold_____seconds/minutes.

CERVICAL EXTENSOR TRAINING

HEAD PRESS

Maintain the chin in proximity with the Adam’s apple. Keeping the face horizontal, bring the head straight back, moving at the base of the neck. Keep the shoulders relaxed. Try to localize the effort to the center of the neck as much as possible. Hold______second(s). Repeat______time(s). Total time ____ mins.

Maintain the chin in proximity with the Adam’s apple. Keeping the face horizontal, bring the head straight back, moving at the base of the neck. Turn head to the side, maintaining chin tuck, as if pivoting the head on skewer. Try to localize the effort to the center of the neck as much as possible. Hold______second(s). Repeat______time(s). Total time ____ mins.

HEAD LIFT

HEAD TURN

Lie down or sit up as directed by your therapist. Place your hands behind your head. Be careful not to press your head forward with your hands. Gently push your head back into your hands. Turn head from side to side as directed by your therapist. Try to localize the effort to the center of the neck as much as possible. Hold______second(s). Repeat ______time(s). Total time ____ mins.

CERVICAL FLEXOR TRAINING

Chin Tuck:

1. Lie down on your back, knees bent. Focus on relaxing your head, neck, and shoulders. Slowly and carefully elongate the neck by sliding the back of the head away from the shoulders. You might also think of this movement as looking down at your knees, tucking your chin, or making yourself taller. Do not lift your head or press it down into the supporting surface as you perform this motion unless instructed to do so by your therapist.

2. It is very important that you avoid tightening the muscles on the sides and back of the neck as you perform this motion. The target muscles for

this exercise are located in the front of the neck, behind the throat. That is the only place you should feel muscle exertion. Keep in mind that the level of activation for these muscles during this movement is 10-25% of a maximum contraction, so this exercise should not feel like a lot of effort. If directed, add resistance to this motion by applying pressure from your thumb as shown in the picture.

3. Hold this gentle contraction for ____ seconds. Repeat ____ times, or for a total of _____ minutes.

Head Lift:

1. Assume the chin tuck position as described above. Ensure that you are keeping the shoulders and sides/back of the neck relaxed before proceeding. Very slowly, while maintaining the chin tuck, begin to curl your head up from the supporting surface. Think of gliding your neck vertebrae backwards as you lift. Once you have cleared your head from the surface, stop and hold. 2. It is very important that you avoid tightening the muscles on the back of the neck and in the shoulders as you perform this motion. You will feel some tension in the front and sides of the neck with this exercise, as

this exercise requires more effort than the chin tuck. If you feel tension developing in any other areas, lower your head down and rest. 3. Hold position for _____ seconds. Repeat _____ times, or for a total of _____ minutes. Arm Lift:

Perform chin tuck/head lift as previously described. Once in position, slowly raise one or both arms from the supporting surface as shown. Maintain tension in the front and sides of the neck. If you feel tension developing in the top of the shoulders or back of the neck, lower your head and arms and rest. Add ____ lbs per arm. Hold______seconds. Repeat______times, or for a total of _____ minutes.

CERVICAL-LUMBAR EXTENSOR TRAINING FOR THORACIC EXTENSION DYSFUNCTION

HEAD PRESS

Maintain the chin in proximity with the Adam’s apple. Keeping the face horizontal, bring the head straight back, moving at the base of the neck. Keep the shoulders relaxed. Keep the sternum tucked in (mid back pushed to the ceiling) as you perform this motion. Hold______second(s). Repeat______time(s). Total time ____ mins.

Allow head and upper back to extend over the edge of a firm supporting surface. Tuck your sternum into your chest, rounding out your middle back. Maintain your position using your low back muscles. Hold______second(s). Repeat______time(s). Total time ____ mins.

HEAD LIFT

TRUNK RAISE

Lie down or sit up as directed by your therapist. Place your hands behind your head. Be careful not to press your head forward with your hands. Gently push your head back into your hands. Keep your sternum tucked in as your perform this motion. Hold______second(s). Repeat ______time(s). Total time ____ mins.

CERVICAL-LUMBAR FLEXOR TRAINING FOR THORACIC FLEXION DYSFUNCTION

HEAD LIFT

Perform head lift as directed in first exercise. Hold this position. Lift arms off supporting surface. Do not allow mid back to press down (round) into table while performing this motion. Hold______second(s). Repeat______time(s). Total time ____ mins.

Pre-tighten lower abdominal muscles. Use lower abdominal muscles to support both legs a few inches away from the table. Do not allow mid back to press down (round) into table while performing this motion. Hold______second(s). Repeat______time(s). Total time ____ mins.

HEAD LIFT WITH ARM LIFT

DOUBLE LEG RAISE

Tuck the chin down toward the neck about 50% of the available range. Then, perform a curling motion of the head, leading with the forehead. Lift the head no more than one inch from the supporting surface. Do not allow mid back to press down (round) into table while performing this motion. Hold______second(s). Repeat ______time(s). Total time ____ mins.

CT SPINE MOBILIZATION

Place a foam roller or a firmly rolled large sheet down the middle of the spine. Maintain head, shoulders, mid and low back in contact with supporting surface. Tilt shoulder blades back and down, until a stretching sensation is felt in the upper part of chest.

Hold_____second(s). Repeat______time(s).

TENNIS BALLS

Position yourself at the edge of a firm supporting surface. Place 2 tennis balls next to each other at the base of the neck/upper thoracic spine. Extend your head back, using your arms for head support as needed. Try to keep your chin tucked while extending.

Hold______second(s).

Repeat______time(s).

TENNIS BALLS WITH HEAD TURN

PEC STRETCH

TENNIS BALL WITH HEAD EXTENDED

Place 2 tennis balls next to each other at the base of the neck/upper thoracic spine. Allow the head and back to relax, letting the pressure of the balls push into the spine. To increase ball pressure, place your hands behind the head. Relax. Sustain______minute(s).

Place 2 tennis balls next to each other at the base of the neck/upper thoracic spine. Turn your trunk and shoulders to the _____ side. Turn you head to the opposite side. Pressure should increase on the ball that your head is turning away from. .



UPPER CERVICAL MOBILIZATION TOWEL TURN Place the center of a towel at the base of the head/upper cervical spine. Fix one end of the towel. Turn your head in the direction of the fixed end of the towel. Once you have reached the end of your range of motion, use the free end of the towel to pull your neck into more rotation. You should feel a light stretch at the top of the neck. Perform this exercise sitting up or lying down, as directed by your PT. Hold______seconds Repeat______times TOWEL PULL Wrap a towel around the top of the neck. Pull the towel forward while tucking the chin. You should feel a light stretch at the base of the skull. Hold______seconds Repeat______times HEAD TILT Sit up straight, chin slightly tucked. Wrap your hands around your neck to keep the neck immobilized. Lift your ____ ear up toward the ceiling, as directed by your therapist. You should feel a light stretch, near the base of the skull, on the side that is lifting. Hold______seconds Repeat______times

Place your arm behind your neck on the side to be stretched. Look down and away from your arm. Apply gentle overpressure as tolerated with the opposite hand. The stretch should be felt on the back/side muscles (see X)


Repeat time(s).

LOWER CERVICAL MOBILIZATION

SCALENE STRETCH

Use the outer aspect of your pinkie finger to press into the back/side of the neck at the level of soreness. Press in the direction of the arrow. Allow the head to tilt toward the hand applying pressure as you press in. Hold______seconds Repeat______times

Sit up straight (slight chin tuck) with the hand of the involved side anchored under hip. Let head side-bend away. Add slight over-pressure with the opposite hand. The stretch should be felt on the outside muscles of the side you are bending away from. Hold______seconds Repeat_______times

LEVATOR STRETCH

HEAD TILT

UPPER TRAP STRETCH

Sit up tall and use your hand, or a long sheet, to anchor the collar bone and rib on the side to be stretched. Tip head away and back, as if you’re lifting your head off your body. The stretch should be felt on the front/side muscles of the neck (see X). Sustain______minute(s).

UPPER TRAPEZIUS TRAINING

Maintain an upright spinal posture as you bring your arms above shoulder height. Use bands or weights for resistance. Shrug your shoulders up at the end of the motion. Lift from the tips of the shoulders, not the base of the neck. Hold______second(s). Repeat______time(s), for a total of ____ mins.

Stand about one foot away from a wall or door. Place forearms on the wall in a vertical orientation. Slide forearms up the wall until movement in the shoulder ceases. Do not lean into the wall or allow the forearms to leave the wall. At the top of the motion, shrug the shoulder blades up. Lift from the tips of the shoulders, not the base of the neck. Progression: Hold arms off the wall. Press ___ lb weights into air as you shrug. Hold______second(s). Repeat time(s), for a total of mins.

Wall Slide

High Row

MID AND LOW TRAP TRAINING

Assume the arm and shoulder blade position described in the retraction exercise at the top of the page. Once in position, slowly raise your arm overhead. You should feel tension primarily in the area of the white arrow. Avoid tension in the neck or top of the shoulder.


Repeat______time(s), for a total of ____ mins.

RETRACTION

Stand with your back to a door, shoulders and elbows flexed to 90degrees. Using your shoulder blades, create an arching motion of the arms, moving them up the door until motion ceases. You should feel tension primarily in the mid back.



RETRACTION WITH LATERAL RAISE

RETRACTION WITH OVERHEAD RAISE

SNOW ANGEL

Hang the arm over the edge of a supporting surface. Keeping the arm relaxed, pull your shoulder blade across (toward the spine), or down (toward the hips), as directed by your therapist. You should feel tension between your shoulder blades with this exercise. Avoid tension into the neck or top of the shoulder.

Hold______seconds.

Repeat______times, for a total of ____ mins.

Assume the arm and shoulder blade position described in the retraction exercise at the top of the page. Once in position, slowly raise your arm out to the side. You should feel tension primarily in the area of the white arrow. Avoid tension in the neck or top of the shoulder.



Prop up on your elbows and knees. Using the muscles below your armpits, lift your chest away from the floor. Think about tucking your sternum into your chest, and rounding out your upper back. Keep neck and top of shoulders relaxed. Hold ____seconds. Repeat _____ times. Total of ____ mins.

SERRATUS TRAINING

Hold one arm at shoulder height in front of body, elbow flexed to 90˚. Using the muscles below the armpit, reach the arm diagonally, across the face, until the crease of the elbow is around eye level. Do not allow the head or back to move.

Hold _____seconds. Repeat _____ times. Total of ___ mins.

Lie on back with arm extended out in front of you, palm up. Imagine that you are holding something heavy that you need to place on a shelf in front of you. Slowly extend your arm away from your body. Try to make this motion come from the bottom edge of the shoulder blade, below the armpit. Keep the top of the shoulder, neck, and chest as relaxed as possible. Use your opposite hand to resist motion at the shoulder blade to improve performance.

Punches

Progression: Elevate arms above shoulder height while reaching out (see arrow in picture) Hold ____seconds. Repeat _____times. Total of ______ mins.

Push-Up Plus

Overhead Raise

THORACIC MOBILIZATION

Reach one arm up toward the ceiling. If directed by your therapist, use opposite hand to anchor ribs down on the side of stretch. Encourage the movement to come from the middle back. Breathe in as you reach up to encourage additional rib movement.

Hold______second(s). Repeat______time(s).

Maintain head, shoulders, mid and low back in contact with supporting surface. Bring hands and elbows together at the midline of body. Maintain full elbow to hand contact as arms flex back overhead. Do not allow low back to break contact with supporting surface. Hold_____second(s). Repeat______time(s).

Lie down cross-wise over a ~3” firmly rolled sheet or foam roll. Localize the roll to your middle back as directed by your therapist. Extend your arms toward the ceiling. Rock your trunk back and forth on the roll, or extend your arms overhead, as directed.

Repeat _______ seconds/minutes.

RIB ROLLER Lean onto a 6” foam roller or firmly rolled sheet/ball. Try to sidebend your body over the roller. For additional stretch, raise your top arm overhead. Roll forward/backward on the roll as directed by your therapist. Repeat _______ seconds/minutes.

SIDE STRETCH

LAT STRETCH

SPINE ROLLER

THORACIC CENTRALIZATION

Lie down flat on your stomach with your hands resting on either side of your head. Use your arms to push up, allowing your elbows to fully extend at the end of the motion. Allow your middle back to sag in at the top of the motion. Keep the back and hips relaxed at all times

Hold_____second(s). Repeat______time(s).

QUADRUPED FLEXION

Sit in a chair with a backrest that comes to your mid back. Elevate the knees above the hips. Assume hands behind head position and lean back to stretch middle back.



PRONE ON ELBOWS FLEXION

PRONE PRESS UPS

SEATED EXTENSION

From a hands and knees position, rock your hips back onto your heels. Arch your middle back up at the end of the motion.



Prop up on your elbows and knees. Tuck your sternum into your chest, rounding out your middle back. .



THORACIC EXTENSOR TRAINING

CHEST RAISE

Lie down on your stomach, hands behind your head. Slowly lift the chest off the supporting surface with emphasis placed on the muscles of the upper back, between the shoulder blades and closest to the spine. Avoid over-activation of the neck or lower back. Hands can be placed at the sides instead of behind the head if the exercise is too difficult. Hold______second(s). Repeat______time(s). Total of _____ mins.

SCAPULA LIFT

TRUNK LIFT

Lie down on your back with your knees bent. Arch your middle back (between your shoulder blades) away from the supporting surface. Your sternum should raise up to the ceiling. You should feel tension in the muscles along your spine, between your shoulder blades. Do not let your low back tense or arch off the table.


Repeat______time(s). Total of _____ mins.

Support the head and chin with rolled towels to ensure that the neck stays relaxed throughout this exercise. Pull the collar bones back away from the table. Think of flattening your middle back as you perform this motion. Initially, keep your hands in contact with the table, and your arms away from the sides of your trunk, while performing this motion. Progress to lifting the hands off the table 1 inch. Tension should primarily be felt between the shoulder blades. Hold______second(s). Repeat ______time(s). Total of _____ mins.

THORACIC FLEXOR TRAINING

QUADRUPED FLEXION

Tuck your sternum into your chest, rounding out your middle back. Use your upper abdominal muscles to lift your chest off the bed.


Repeat______time(s). Total mins.

TOWEL CURL UP

CURL UP

Prop up on your elbows and knees. Tuck your sternum into your chest, rounding out your middle back. Use your upper abdominals and the muscles below your armpits to complete this motion. Hold your head straight as you perform this motion.


Repeat______time(s). Total ____ mins.

Place a towel under your upper back and head. Reach your hands back to the towel and hold the top edges. Tuck your sternum into your chest, rounding out your middle back. Use your abdominal muscles to lift your chest off the bed. Keep head and hands back, in contact with the towel. .


Repeat______time(s). Total ____ mins.

University of Texas Southwestern Medical Center Physical Therapy

6011 Harry Hines Blvd. Dallas, TX 75235

214-648-6562

Rocabado 6X6 Exercises

1. Tongue “Cluck” – make a clucking noise with your tongue. Use this to remind yourself of the proper rest posture.

Tongue tip on ridge behind top, front teeth. Lips closed gently. Teeth parted slightly. Breast bone elevated (imagine a string tugging up-

ward) Head over shoulders Shoulders relaxed

2. “Turn the knob and open the door” – controlled rotation on opening and closing your jaw. Remember to: Place tongue tip on roof of mouth Monitor joint with one finger

3. Jaw Stabilization - place your jaw in its proper rest position and apply resistance in a variety of directions to promote normal positioning of the jaw.

Comments:

Press up Press down Press to left Press to right

4. Upper Cervical Distraction - relieve pressure at the base of your skull.

Hug your neck with your hands Nod your head to feel a stretch at the base

of your skull

5. Cervical Retraction - correct forward head posture and align head, neck and jaw.

Sit up tall Draw head back, chin level

6. Shoulder Blade Squeeze - pull your shoulder blade back toward your spine and shrug down.

Poor position Good position

University of Texas Southwestern Medical Center Physical Therapy

6011 Harry Hines Blvd. Dallas, TX 75235

214-648-6562

Jaw Mobility Exercises

“Turn the knob and open the door” – controlled rotation on opening and closing your jaw.

Comments:

Phase I Phase II Phase III Phase IV Hold ____seconds. Repeat ____times.

Controlled Motion with Tongue Blade

Opening and closing Slide jaw left Slide jaw right Hold ____seconds. Repeat ____times.

Passive Stretching

Thumb pads behind canine teeth, middle fingers on central jaw. Relax facial muscles and allow your fingers to do the work. Hold maximum opening for ____seconds. Repeat ____times.

cervical centralization - continuing ed thoracic tmd exercise han… · cervical centralization...

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