Southtowns Physical Therapy Spine Care Manual Southtowns Physical Therapy Spine Care Manual

EXERCISE GUIDELINES
The spine is constructed of 29 bones, called vertebrae that
The exercises in this book are used to stretch and strengthen
provide rigid support and protection for the spinal cord and
your neck. This will help to relieve pain and increase your
its nerve roots. The bottom five vertebrae are fused to-
motion. Your physician or physical therapist may recom-
gether to form the sacrum.
mend some of these exercises as treatment for a specific
injury or condition.
The remaining vertebrae, seven in the neck (cervical), twelve
attached to the ribs (thoracic) and five in the low back (lum-
Mild discomfort may be noted whenever a new exercise is
bar) are separated by semi-rigid, cartilage structures called
started. When performing these exercises, you may expe-
intervertebral discs. These “discs” have a hard outer shell
rience a “pulling” or “stretching” in the area that is being
and contains a gel-like interior which thickens as you get
worked. This is normal and should not last more than 30 -
older.
60 minutes.
Trauma, poor posture** and repetitive motion can cause
If you experience any intense pain (sharp, stabbing, etc.),
weakening of the disc wall. If severe, the wall can crack or
or if your symptoms extend into your arms or legs, stop
tear, allowing some of the gel to leak out. This is referred to
immediately and consult with your physician or physical
as a disc “protrusion” or “herniation.” If the gel contacts a
therapist. In addition, if you develop nausea or dizziness,
nerve root, it can give rise to a variety of symptoms, includ-
stop the exercise immediately and contact your physician
ing numbess, tingling or weakness in your arms or legs. If
or physical therapist.
you develop these symptoms, you should bring them to the
immedaite attention of your physician or physical therapist.
When done correctly, all of the exercises presented within
this book are safe and effective for a healthy individual
There are a variety of conditions and diseases that can also
with no history of back or neck pain. However, if you
lead to pain or dysfunction in the spine. Osteoporosis,
have suffered an injury, and specific exercises have been
scoliosis, arthritis and spinal stenosis are a few of the more
prescribed, do not deviate from them, as further injury may
common problems that exist.
be possible.
** See the section on “Posture” at the end of this booklet
Before starting any exercise program, you should consult
for additional information.
with your physician or physical therapist!

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 Southtowns Physical Therapy Spine Care Manual Southtowns Physical Therapy Spine Care Manual

The exercises listed below are all found within this booklet. Your CERVICAL RETRACTION
physician or physical therapist may select specific exercises that (“chin tuck”)
will be most helpful to you. While seated comfortable in a
straight-backed chair, gently tuck
EXERCISE NAME PAGE # your chin so that your head moves
o CERVICAL RETRACTION (sitting) 4 backward. Avoid tilting your head
o RETRACTION with EXTENSION (sitting) 4 up or down. If done correctly, you
o CERVICAL RETRACTION (supine) 5 should produce a “double chin.”
o RETRACTION with EXTENSION (supine) 5
o FLEXION STRETCH 6
o FLEXION STRETCH (upper) 6 Hold this position for ____ seconds
o SHOULDER SHRUGS 7 Repeat ____ times, ____ times per day
o SHOULDER ROLLS 7
o SCAPULAR RETRACTION 8
o SCALENE STRETCH 8
o CERVICAL SIDEBEND 9
o ROTATION STRETCH 9 RETRACTION with EXTENSION (sitting)
o “TOWEL” STRETCH 10
o LEVATOR STRETCH 10 Starting in the same position as
o ISOMETRIC FLEXION 11
above, gently tuck your chin in and
o ISOMETRIC EXTENSION 11
slowly tip your head back until you
o ISOMETRIC SIDEBEND 12
o ISOMETRIC ROTATION 12 are looking up at the ceiling. Al-
o PECTORALIS MINOR STRETCH 13 low your head to tilt back as far as
o WALL STRETCH 13 possible.
o PECTORAL STRETCH 14
o UPPER THORACIC STRETCH 14
Hold this position for ____ seconds
o THORACIC ROTATION (supine) 15
o THORACIC ROTATION (sitting) 15 Repeat ____ times, ____ times per day

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 Southtowns Physical Therapy Spine Care Manual Southtowns Physical Therapy Spine Care Manual

CERVICAL RETRACTION (supine)

FLEXION STRETCH
Lay on your back in a comfortable While sitting or standing with
position, with a small pillow or proper posture, use one hand to
towel under your head. Slowly pull grasp the back of your head.
your neck toward the table by pull- Slowly pull your head forward and
ing your chin downward. This down so that your chin moves to-
should form a “double chin.” Avoid ward your chest. Pull until you
tipping your head up or down. feel a gentle stretch in the back of
your neck.

Hold this position for ____ seconds Hold this position for ____ seconds
Repeat ____ times, ____ times per day Repeat ____ times, ____ times per day

RETRACTION with EXTENSION (supine)

Start by laying on a bed with your
head off the end, supported by one FLEXION STRETCH (upper)
hand and your neck muscles. Slowly
While standing with your back
tuck your chin (retraction) as dem-
against a wall, tuck your chin in and
onstrated above. Gradually, allow
slowly bend your head forward. A
your head to tip backward until it is
gentle stretch should develop from
hanging off the end of the table.
the base of the skull.

** This is an advanced exercise and

should only be performed after
proper instruction by your therapist!
Hold this position for ____ seconds
Hold this position for ____ seconds
Repeat ____ times, ____ times per day
Repeat ____ times, ____ times per day
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 Southtowns Physical Therapy Spine Care Manual Southtowns Physical Therapy Spine Care Manual

SHOULDER SHRUGS SCAPULAR RETRACTION

Standing in an upright position with
your arms at your sides, slowly
Standing in an upright position
tighten your neck and shoulder
with your arms at your sides,
muscles pulling your shoulders up
slowly pull your shoulder blades
toward your ears. Hold for the re-
together by contracting the
quired time and then relax them.
muscles between them. Hold for
This exercise may be performed
the required time and then relax.
with light weights (3-5 pounds) in
each hand.
Hold this position for ____ seconds
Repeat ____ times, ____ times per day
Hold this position for ____ seconds
Repeat ____ times, ____ times per day

Standing in an upright position SHOULDER ROLLS

with your arms at your sides, SCALENE STRETCH
Standing in an upright position
slowly tighten your neck and
with your arms at your sides, use
shoulder muscles pulling your
one hand to grasp the other be-
shoulders up nad backwards.
hind your back. While holding
Hold for the required time. This
one shoulder down, slowly tilt
exercise may be performed with
your head in the opposite direc-
light weights (3-5 pounds) in each
tion until your feel a gentle stretch
hand.
in the muscles of your neck.

Hold this position for ____ seconds Hold this position for ____ seconds
Repeat ____ times, ____ times per day Repeat ____ times, ____ times per day

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 Southtowns Physical Therapy Spine Care Manual Southtowns Physical Therapy Spine Care Manual

CERVICAL SIDEBEND ROTATION MOBILIZATION

(“towel stretch”) While sitting in proper posture,
Standing in an upright position with place a towel around the back of
your arms at your sides, use one your neck. Using your right
hand to grasp the top of your head hand, grasp the left end of the
on the opposite side. Slowly pull towel and pull down toward your
your head to the side until you feel right hip. Using your left hand,
a gentle stretch. Hold for the re- pull the right end of the towel up
quired time and then relax. across your right cheek, slowly
turning your head to the left until
Hold this position for ____ seconds a stretch is felt. Repeat to the
Repeat ____ times, ____ times per day opposite side.
Hold this position for ____ seconds
Repeat ____ times, ____ times per day

LEVATOR STRETCH
ROTATION STRETCH
While sitting in a chair, grasp the
While sitting or standing with
side of the chair with your right
proper posture, place one hand
hand. Place your left hand on the
upon the side of your face. Using
right side of your head and slowly
gentle pressure, slowly turn your
pull your head to the left while
head in the opposite direction un-
turning your head slightly to the
til you feel a gentle stretch.
left until a gentle stretch is felt.
Hold for the required time and
then repeat in the opposite direc-
Hold this position for ____ seconds tion. Hold this position for ____ seconds
Repeat ____ times, ____ times per day
Repeat ____ times, ____ times per day

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ISOMETRIC FLEXION ISOMETRIC SIDEBENDING

While sitting or standing with
proper posture, place one hand
upon your forehead. Using the
muscles of your neck, push your
head into your hand. Be sure that
no movement occurs in the neck.
Hold this position for ____ seconds
Repeat ____ times, ____ times per day
While sitting or standing with
proper posture, place one hand
on the side of your head. Using
the muscles of your neck, push
your head into your hand. Be
sure that no movement occurs in
the neck.
Hold this position for ____ seconds
Repeat ____ times, ____ times per day

ISOMETRIC ROTATION
ISOMETRIC EXTENSION
While sitting or standing with
While sitting or standing with proper posture, place one hand
proper posture, place one hand on the side of your head. Using
on the back of your head. Using the muscles of your neck, attempt
the muscles of your neck, push to turn your head into your hand.
your head into your hand. Be Be sure that no movement occurs
sure that no movement occurs in in the neck.
the neck. Be careful not to apply any
force to your jaw
Hold this position for ____ seconds
Hold this position for ____ seconds
Repeat ____ times, ____ times per day
Repeat ____ times, ____ times per day

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 Southtowns Physical Therapy Spine Care Manual Southtowns Physical Therapy Spine Care Manual

PECTORAL STRETCH
PECTORALIS MINOR STRETCH
(with assistance)
Standing in a doorway, place
While lying on your back in a com- your hands on the door frame and
fortable position, have a friend or slowly lean forward until you feel
family member slowly apply pres- a gentle stretch in your chest.
sure to the front of your shoulder Hold and then return to the start-
until a gentle stretch is felt. Pres- ing position.
sure should be applied down and to-
ward the head.
Hold this position for ____ seconds
Repeat ____ times, ____ times per day
Hold this position for ____ seconds
Repeat ____ times, ____ times per day
WALL STRETCH

UPPER THORACIC STRETCH

While standing with your back While sitting upright in a straight
against a wall, slowly raise one chair, place your hands behind
arm toward the ceiling until a your neck with your fingers in-
gentle stretch is felt in the middle terlocked. Bring your elbows to-
of your back. ward each other and then slowly
Avoid arching your low back point them toward the ceiling
or bending your knees. until you feel a gentle stretch in
the lower neck and upper back
region.
Hold this position for ____ seconds
Hold this position for ____ seconds
Repeat ____ times, ____ times per day
Repeat ____ times, ____ times per day

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 Southtowns Physical Therapy Spine Care Manual Southtowns Physical Therapy Spine Care Manual

POSTURE:
THORACIC ROTATION (sitting)
Poor posture is a common cause of neck and back pain. Good
While sitting upright in a firm chair
posture is characterized by a balance in the strength and flex-
with armrests, slowly turn to the right ibility of our spinal tissues. Gravity exerts a constant force
and grasp the back of the chair with upon us, which can disrupt this balance and result in muscle
your right arm while holding the arm fatigue.
rest with your left hand. Using both
arms, slowly increase your rotation Improper or unbalanced posture places excessive stress on
to the right until you feel a gentle muscles, ligaments, and other structures of the spine. This
stretch. can lead to a variety of conditions including chronic head-
aches, low back pain, muscle soreness, and degenerative ar-
thritis.
Hold this position for ____ seconds
Repeat ____ times, ____ times per day “Poor” posture can occur during any of our daily activities.
However, it is generally most evident when we sit or stand for
THORACIC ROTATION (supine) long periods of time in a static or stationary position.
While lying on your back, place
Poor posture can include any or all of the following:
one foot on top of the other.
Keeping your feet in this align- * forward head
ment, let your legs drop to one * rounded shoulders
side while turning your head in * increased / decreased spinal curves
the opposite direction. A gentle * tilting of the pelvis
stretch should be felt in the mid- * weak abdominal muscles
back. Hold this position for the
required time and then repeat to If you have symptoms which are caused or made worse by
the opposite side. your posture, you should consult with you physician or physi-
Hold this position for ____ seconds cal therapist to receive instruction in ways to improve your
Repeat ____ times, ____ times per day posture.
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 Southtowns Physical Therapy Spine Care Manual
"IDEAL" Posture
“POOR POSTURE”
Poor sitting posture is consided to be a major
cause of both neck and low back pain. Failure
to maintain the low back in its’ proper position
results in increased stress on the supporting
structures, especially the discs and muscles.
Poor posture is characterized by a rounding of
the shoulders with the head positioned forward,
a reversal of the lumbar curve and an accentu-
ated curve in the mid-back.
“GOOD POSTURE”
Proper sitting posture produces less stress
on all of the spinal structure, and, requires
less energy expenditure.
Generally, it is suggested that you sit with
both feet flat on the floor or a small foot
stool. The low back should have a slight
curve (lordosis) and this can be maintained
with the use of a small pillow or “towel roll.”
Lumbar
The head and shoulders should be aligned
Roll
over the hips.
Individuals who sit for long periods of time
may benefit from well designed chairs that
provide both comfort and support.
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Southtowns Physical Therapy Spine Care Manual
The “ideal” posture is characterized by a well balanced
alignment. The spine consists of four primary curves.
These are located in the neck (cervical), mid-back (tho-
racic), low back (lumbar) and sacrum. The head is
aligned over the trunk and the pelvis is level in all di-
rections.
Proper posture requires good strength and flexibility
in all the muscles of the trunk. Tightness or weakness
of any muscle group can lead to poor alignment,
thereby resulting in chronic pain or dysfunction.
"KYPHOTIC" Posture
The kyphotic posture is characterized by an exces-
sive forward curve of the thoracic spine and an in-
crease in the curve of the lumbar spine. The pelvis
is tilted forward and the head is shifted in front of
the body placing stress on the neck.
This malalignment may result from structural
changes in the bones of the spine as is commonly
observed in osteoporosis. In addition, limited flex-
ibility in the low back or hip flexors and weakness
in the abdominals may contribute to this posture.
Postural correction through stretching of the low
back and hamstrings and strengthening of the
abdominals is the preferred course of treatment.
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 Southtowns Physical Therapy Spine Care Manual
"FLAT-BACK" Posture
This posture is characterized by an increase in
the upper thoracic curve with a decrease in both
the lower thoracic and lumbar curves. In addi-
tion, the pelvis is tilted backward and the head
is shifted forward. Overstretched or weak hip
flexors in association with tight abdominals and
hip extensors (i.e. hamstrings) are contributing
factors to this posture.
Postural correction through stretching of the
abdominals and hamstrings with strengthening
of the hip flexors is often an effective course of
treatment.
"SWAY-BACK" Posture
This posture is characterized by a forward shifted
head, backward tilt of the pelvis, decreased lum-
bar curve and increased thoracic curve. Weak
abdominals in conjunction with tight hip exten-
sors (hamstrings) are common causes.
Postural correction through stretching of the
hamstrings and strengthening of the abdominals
is a common course of treatment
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Southtowns Physical Therapy Spine Care Manual
Southtowns Physical Therapy Group, P.C.
The SouthtownsPhysical Therapy Group has been located at
100 Union Road in West Seneca since 1986. Since it’s incep-
tion, it has undergone several expansions with the addition of
a state-of-the-art exercise facility and therapeutic pool. A
satellite office was opened in 1996 to improve the availability
of services to the southtowns residents.
In addition to the providing “traditional” therapy services, the
facility also offers Functional Capacity Evaluations (FCE’s)
and a work conditioning program for those individuals trying
to return to gainful emplyment following an injury.
The staff of the Souhtowns Group consist of three therapist
certified by the McKenzie Institute in Mechancial Diagnosis
and Treatment of the spine, a Board Certified Specialist in
Orthopedic Physical Therapy and a therapist with advanced
training in disorders of the vestibular system. A licensed
Massage Therapist is available providing orthopedic and
medical massage.
Day, evening and weekend hours are available to insure
prompt and convenient scheduling of appointments. Most
insurance plans are accepted and the billing department is
available to answer questions regarding your coverage.
For more information, or to schedule and appointment, call
675-4444 for West Seneca or 649-0444 in Hamburg.
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