Favourite Therapeutic Aquatic Exercises for the Neck

• Cervical Stretch and Alignment Protocols
  

This communication will outline a variety of practical strategies for decreasing pain, improving alignment and increasing strength in the cervical and upper-thoracic region.  Neck pain and dysfunction can be caused by a variety of factors including:

• Injuries such as whiplash; sports or workplace injuries.
• Conditions such as stenosis, arthritis, scoliosis, disc or bone degeneration.
• Alignment issues in the cervico-thoracic spine and shoulder girdle (ie: poor posture, repetitive strain).

Research tells us that neck pain is ultimately best solved with improvements in strength:

• Andersen L.L, et al., Effect of two contrasting types of physical exercise on chronic neck muscle pain. Arthritis Rheum. 2008 Jan 15;59(1):84-91
• Ylinen J. et al, Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003 Aug 27; 290(8):1027).  

Below, I will describe a variety of practical suggestions for soft tissue release and stretches to reduce pain and improve alignment, as well as strengthening exercises that can be used in the clinic or the pool. 

Ultimately, clients need to take responsibility for their postural re-adjustments and on-going exercise program.  Therefore, it is worthwhile to establish the paradigm of self-responsibility by teaching:  pain management techniques, relaxation and re-alignment strategies, as well as self-soft tissue release techniques.  Clients can use these strategies in the pool, at work, and at home on a daily basis.  With practice, this can result in client-based problem solving and empowerment to resolve minor issues related to mis-alignment, stress or work-pacing.

Teaching Power Posture 

This is always the first step with my clients. Please visit www.FortheLoveofFit.com, “Workshops & Courses” Tab and look for the video clip: ‘Teaching Power Posture in the Pool’.  There you will find clear, visual instructions for achieving Power Posture.  Here is the written script:

• Standing with equal weight on the feet, unlock the knees. Rock the pelvis until you achieve neutral, level pelvis, then stabilize this pelvic alignment by activating the pelvic triad (see below).  

Activate the pelvic ‘triad’ to stabilize neutral, level pelvis:

• Attempt to pull the anterior superior iliac spines (ASIS) together – to tighten transversus abdominis without creating posterior pelvic tilt; without restricting breathing.  Note: “Pull the navel toward the spine” is not used because this cue can result in posterior pelvic tilt and restriction of breathing.
• Activate the pelvic floor muscles: 3/10 activation intensity of pubo-coccygeal musculature.
• Lift the anterior ribs slightly away from the ASIS – activating multifidus and other low spinal extensors a comfortable amount.

Establish scapular ‘set’:
o Roll the shoulder blades up, back & down a few times.
o End with the scapulae in the ‘down’ position.
o “Pull the armpits downward toward the hips” is a useful cue to help clients maintain scapular set.  Note: This is different from pulling the shoulder blades together, which tends to create an undesirable increase in upper thoracic tension.


Retract the cervical spine:
o Place the index finger in front of the lips like saying “shhhhh”.
o Breathe out making the ‘shhhh’ sound while pulling the lips / head straight back from the index finger.
o Relax 10%.


Ears-over-shoulders-over-hips, breathe!

Creating Better Postural Habits
Ultimately, posture is a habit.  Postural habits depend on a variety of factors, including: genetics, health history, ergonomics, social norms, and mood.  Through experience with clients, I find posture can be re-trained to decrease pain and optimize function.  I have witnessed many patients reduce or eliminate headaches and resolve related shoulder and arm issues by retraining their posture.  After learning Power Posture, here are some tips to help clients re-learn better alignment:

1.     Pre / Post Posture Pictures:  With the client’s permission, a lateral shot is taken on their phone showing their alignment before and after achieving Power Posture.  I suggest they put a print of these pictures in a prominent place where they will see themselves daily.  

2. Post small stickers:  From the dollar store or office supply, get ~10 small, brightly coloured stickers you can post at eye level, where you spend your day:  corner of computer screen & rear-view mirror; fridge or cupboard where you prepare meals; filing cabinet; TV console; bathroom mirror...     When your eye sees that little sticker, quickly do your Power Posture check, re-adjust your alignment as required, and go about your business.  This will take only a few seconds, but will build the Power Posture habit!