Whenever possible, we must separate movement dysfunction from fitness and performance. Aggressive physical training cannot change fundamental mobility and stability problems at an effective rate without also introducing a degree of compensation and increased risk of injury.

Movement pattern corrective strategy is a form of exercise that focuses more on improving mobility, stability, basic motor control and whole movement patterns than the parameters of physical fitness and performance. Once established, the movement patterns create a platform for the general and specific parameters of fitness, including endurance strength speed agility power and task specificity.

Patterns and sequences remain the preferred mode of operation in biological organisms. Patterns are groups of singular movements linked in the brain like a single chunk of information. This chunk essentially resembles a mental motor program, the software that governs movement patterns. A pattern represents multiple single movements used together for specific function. Storage of a pattern creates efficiency reduces processing time in the brain, much as a computer stores multiple documents of related content in one file to better organize and manage information.

Common strengthening programs applied to muscles with the stabilization role will likely increase concentric strength but have little effect on timing and recruitment, which are the essence of stabilization.

Stabilizer training goes far beyond isometrics found in popular stability exercises such as side plank. In this isometric exercise model, conscious rigidity and stiffness are the goal, but true authentic stability is about effortless timing and the ability to go from hard from soft to hard to soft in a blink.

Stability is also confused with strength, where concentric and eccentric contractions build massive endurance. The muscles do become stronger and shortening lengthening, but again they lack the timing and control needed for true functional stabilization. We should train muscles in the way we use them. Stabilizers need to respond quicker than any other muscle group to hold position and control joint movement during loading and movement.

Gray Cook, PT

Neck

Neck Pain and Whiplash

Chiropractors are specialists in treating non-surgical spine injuries and commonly treat whiplash injuries from car accidents. The job of the chiropractor in helping his or her patients overcome the pain and disability associated with whiplash is to:

The process of rehabilitation requires a concerted effort between the chiropractor, the patient and any other professional assisting in the case. The likelihood of success is enhanced by a continued focus on restoring normal function. Ninety-three percent of whiplash patients improve with chiropractic care.

The “whiplash” syndrome is a collection of symptoms produced as a result of soft-tissue injury of the cervical spine. The accumulated literature suggests that 43 percent of patients will suffer long-term symptoms following whiplash injury. If patients are still symptomatic after three months then there is almost a 90 percent chance that they will remain so. No conventional treatment has proven to be effective in these established chronic cases.

Twenty-eight patients with chronic whiplash pain were referred to the chiropractic physician an average 15.5 months (range: 3-44) after the accident, and were interviewed before treatment by both an independent chiropractor and orthopedic physician. The patients were assigned to one of four classification groups: A – No symptoms; B – Symptoms are a nuisance; C – Symptoms are intrusive; and D – Symptoms are disabling.

The initial evaluation placed 27 of the 28 patients in groups C or D. Following treatment, 26 (93%) of the patients had improved – 16 by one symptom group and 10 by two symptom groups. This improvement was independent of whether it was assessed by an orthopedic surgeon or a chiropractor.

Woodward MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury: International Journal of the Care of the Injured 1996; 27(9):643-645

The patients were assigned to one of four classification groups: A – No symptoms; B – Symptoms are a nuisance; C – Symptoms are intrusive; and D – Symptoms are disabling.

The initial evaluation placed 27 of the 28 patients in groups C or D. Following treatment, 26 (93%) of the patients had improved – 16 by one symptom group and 10 by two symptom groups. This improvement was independent of whether it was assessed by an orthopedic surgeon or a chiropractor.

Woodward MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury: International Journal of the Care of the Injured 1996; 27(9):643-645.

Cervical Herniated Disc

Arm pain from a cervical herniated disc is one of the more common cervical spine conditions treated by spine specialists. It usually develops in the 30 to 50-year-old age group.

Although a herniated disk may originate from some sort of trauma or injury to the cervical spine, the symptoms commonly start spontaneously. The arm pain from a cervical herniated disc results because the herniated disc material pinches or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present.

The two most common levels in the cervical spine to herniate are the C5 – C6 level (cervical 5 and cervical 6) and the C6 – C7 level. The next most common is the C4 – C5 level, and rarely the C7 – T1 level may herniate. The nerve that is affected by the disc herniation is the one exiting the spine at that level, so at the C5 – C6 level, it is the C6 nerve root that is affected.

Symptoms: A cervical herniated disc will typically cause pain patterns and neurological deficits as follows:

It is important to note that the above list comprises typical pain patterns, but they are not absolute. Some people are simply wired up differently than others, and therefore their symptoms are different.

Since there is not a lot of disc material between the vertebral bodies in the cervical spine, the discs are usually not very large. However, the space available for the nerves is also not that great, which means that even a small disc herniation may impinge on the nerve and cause significant pain.

The pain is usually most severe as the nerve first becomes pinched. The majority of the time, the pain from a cervical herniated disc can be controlled with conservative (non-surgical) treatments alone, which is enough to resolve the condition.

Once the pain does start to improve, it is unlikely to return, although it may take longer for the weakness and numbness/tingling to improve. If the pain gets better, it is acceptable to continue with conservative treatment, as there really is no literature that supports the theory that surgery helps the nerve root heal quicker.

All treatments for a cervical herniated disc are essentially designed to help resolve the pain and neurologic symptoms, and improve function.

Mechanical Neck Pain

Mechanical neck and back pain implies the source of pain is in the spine and/or its supporting structure. This occurs when one of the joints in the spine loses its normal joint play (resiliency and shock absorption). It is detected through motion palpation, a procedure in which the doctor gently moves the joint in different directions and assesses its joint play. When a joint develops dysfunction, its normal range of movement may be affected and it can become painful. In addition, joint dysfunction can lead to a muscle imbalance and muscle pain and a vicious cycle:

Any joint of the spine, from the neck all the way down to the sacroiliac joints, can cause mechanical pain. Joints are designed to move and when they do not, pain and degeneration occurs. Conservative treatment is designed for maximizing motion, improving flexibility and finally maximizing muscular coordination, endurance and strength.

Mechanical neck pain can not only create local neck symptoms but also symptoms into the shoulders and upper extremities, as well as headaches. Most people with mechanical back pain experience pain primarily in the lower back. The pain may radiate (spread) to the buttocks, thighs, or knees. Many people may also experience spasms with mechanical back pain. Conservative management and changes in physical activity behavior will typically resolve this condition and can prevent future episodes. 

Arthritis and Neck Pain

Arthritis has been used to describe chronic irritation, inflammation and degeneration of a joint. However, arthritis is broken up into two groups: inflammatory and degenerative. Inflammatory arthritis produces excessive swelling of the joint and can lead to pain and erosive changes in the joint if left unchecked.

Degenerative arthritis, as the name implies, is a wearing down of the cartilage used to protect the joint. While this does not produce any significant swelling, pain will occur through the friction that occurs when the cartilage has worn away and liberation to the joint is lost.
The degenerative changes will cause stiffness in the joint, which is worsened with waking up in the morning due to lack of movement to the area overnight.

The goal of treating degenerative arthritis is therefore to increase flexibility, joint mobility, and improve surrounding musculature function to the area without further irritation. The goal of treating inflammatory arthritis is, first and foremost, to temporarily reduce inflammation to the area, followed by a plan for helping to prevent the inflammation from re-occurring. As arthritis patients will have pain in the surrounding tissue, a therapeutic plan should be addressed to lend relief and support of the affected area. Conservative treatment can have profound effects on decreasing symptoms and improving function.