Full Technique Video Here: https://youtu.be/RdkxnTwBFDo
Clients presenting with head-forward postures are vulnerable to increased stress not only in the neck, but the jaw as well. When the head and neck move forward in the sagittal plane, the brain’s visual proprioceptors cause the occiput to backward-bend on atlas. This remarkable proprioceptive reflex (Law of Righting) will cock the head back to level the eyes against the horizon even if it means ravaging the neck.1 Sustained isometric contraction in the suboccipitals and other capital extensor muscles places the entire nervous system in a heightened state of alert.
In long-term forward-head TMJD sufferers, the effects of jaw retrusion may begin to impact the 11th cranial accessory nerve. Since this nerve directly innervates the upper trapezius and sternocleidomastoids, prolonged irritation can neurologically shorten these muscles initiating a “Catch 22” pain cycle. As the upper traps cock the head back and the SCMs pull it forward, excessive tension mounts in the hyoid, digastric, masseter, pterygoid, and temporalis muscles, which, in turn, cause even greater TMJ compression.
Neck Assessments
Cervical Rotation:
Client is asked to stand and rotate the head to the left. The movement criteria is 80 degrees. Be sure to watch for compensations like the shoulder rising, neck extension and torso rotation. The client is then asked to repeat for the right side. Mark your findings and proceed to the Cervical Flexion Test.
Cervical Flexion Test:
Client is asked to bring the chin to the sternum. The criteria is at most one finger width from chin to sternum. Also, look for compensations like raised shoulders, torso flexion and altered movement in the neck. Mark your findings and move on to the Supine Cervical Flexion Test.
Supine Cervical Assessments
Cervical Rotation:
If the client did not fail the standing cervical rotation test, skip this step.
Client is in the supine position. Client is asked to keep the head on the table and rotate to the left as comfortably as they can. The criteria is 80 degrees.
If the client cannot produce the movement, then the therapist instructs the client to relax. Therapist grasps the client’s head and rotates to check if they can produce the movement.
If the client had adequate movement actively, then there is a stability dysfunction with cervical rotation to the left. If the client could not meet the criteria passively, then there is a mobility dysfunction with cervical rotation to the left.
Repeat for the right side.
Cervical Flexion:
Client is in the supine position. Client is asked to lift the head up and bring chin to the sternum. Therapist should also look for the upper back to not come off the table. Remember, maximum is one finger width of space between the chin and sternum.
If the client cannot produce the movement, therapist grasps the client’s head and checks to see if they can produce the movement.
If the client met the criteria actively, then there is a stability dysfunction with cervical flexion. If the client could not meet the criteria passively, then there is a mobility dysfunction with cervical flexion.
Cervical Treatment
Chin Jutting:
Client is in the supine position. Therapist places their hands over each other with their palms facing up. Therapist reaches under the client’s neck and palpates with their thumb to reach C7/T1. The therapist’s thumbs should be on both sides of the client’s spinous process.
Therapist then jerks the thumbs down into the cervicothoracic junction while slightly pushing up with the thumbs. At the same time, the palms holding the head rotate the head back into extension.
Repeat this technique for 1 min.
Cervical Sidebending:
With the hands and thumbs in the same position as the chin jutting, therapist now braces one side of the spinous process with the left thumb and sidebends the client’s neck to the left. Then, repeat sidebending to the right making sure to brace the spinous process so it does not sidebend with the neck. Test both sides left and right feeling for a lack of movement to one side.
Therapist checks up and down the spine. When restriction is met, therapist sidebends the cleints neck to the first restrictive barrier. Client is asked to gently push against the therapist’s hand to a count of 5. After 5, client relaxes and therapist sidebends the neck to the next barrier. Repeat 3-5 times, then sidebend again left and right to check for improved mobility.
Cervical Translation:
The same hand position applies here to this technique.
Instead of sidebending, shift the entire neck and head to the left and right. This resembles the movement of an Egyptian neck dance or breakdancer doing the robot. Use the hands and arms to help cradle the head and neck to shift the head left and right.
Repeat the same process as above if resistance is felt.
Eventually, you will want to incorporate both together, sidebending and translation switching between the two.