THE CERVICAL SPINE: Getting the Whole Story
Andrea Wasylow PT, FAFS
A few years ago I had the opportunity to play a round of golf with some people I greatly admire. It was a fairly typical golf outing until one of my opponents took his tee shot on the 7th. It was one of the most amazing shots I have ever seen.
The paragraph above, in and of itself, is a story. But, doesn’t it leave you wanting more? Who are these golfers? And why was that shot so amazing? Basically some information has been provided, but not enough to show exactly what was happening. The same can be said for conventional techniques used for evaluation, treatment, and training of the cervical spine.
More than a few clients and/or patients have crossed our paths with complaints of “a pain in the neck.” The stack of seven vertebrae at the top of the spine is an amazing structure. Yet, the truth behind how this region functions the majority of the time is often overlooked.
Conventional evaluation may have an individual perform a big “yes” sagittal plane nod, a big “no” transverse plane rotation of the head and a big “I don’t know” frontal plane lateral flexion of the head. But, as in the paragraph above, only part of the story is being told.
Function of the cervical spine is driven both from the top down and from the bottom up. The demands on the cervical spine depend entirely on the functional task being performed. To complete the task, does the individual need to look in a particular direction by turning the head while the body stays still? Does the person need to keep their gaze fixed while the body moves below? Or, most likely, is there some combination of head movement with simultaneous body movement below needed for the task? (In FVD “Cervical Spine: Both Ends of The Chain,” there is a great example of this given by Gary Gray PT in his demonstration and explanation of cervical function while swimming.)
If a functional task drives the system, then it stands to reason that our cervical evaluation, treatment, and training techniques must reflect that task. For example, when walking and taking a step forward with the left foot, the right arm swings forward. In order for this to happen and allow the gaze to remain straight forward, there must be adequate right cervical rotation. But this right cervical rotation is created by the head staying still while the thoracic spine below rotates to the left. Rather than asking the individual to turn and look over their right shoulder, a better cervical ROM test for this task could be to have them fix their gaze straight ahead while performing a right hand, anterior at shoulder height reach. Another example of cervical motion driven from the bottom up is seen when playing golf. A left handed golfer needs tremendous right cervical rotation during his/her backswing. If that bottom-up driven rotation isn’t available it could create tremendous problems with his/her shot.
This brings us back to the incomplete story above. The golfer being described was none other than Dr. David Tiberio. And the tee-shot he made was so amazing because it actually went backwards (really). As it turns out, he was experiencing some cervical spine motion limitations. Though his motion appeared fine using head active ROM testing, when he kept his head still and drove his arms in all three planes, it became evident that his cervical spine was limiting his ability to move below. Thankfully, he recognized what was going on and was able to improve the limitation fairly quickly; allowing the rest of us to wait for our turn at the tee-box, safely, for the rest of the round