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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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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Hold this position for ____ seconds Hold this position for ____ seconds
Repeat ____ times, ____ times per day Repeat ____ times, ____ times per day
Hold this position for ____ seconds Hold this position for ____ seconds
Repeat ____ times, ____ times per day Repeat ____ times, ____ times per day
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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 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
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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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"IDEAL" Posture
“POOR POSTURE”
The “ideal” posture is characterized by a well balanced
alignment. The spine consists of four primary curves.
Poor sitting posture is consided to be a major These are located in the neck (cervical), mid-back (tho-
cause of both neck and low back pain. Failure racic), low back (lumbar) and sacrum. The head is
to maintain the low back in its’ proper position aligned over the trunk and the pelvis is level in all di-
results in increased stress on the supporting rections.
structures, especially the discs and muscles.
Poor posture is characterized by a rounding of Proper posture requires good strength and flexibility
the shoulders with the head positioned forward, in all the muscles of the trunk. Tightness or weakness
a reversal of the lumbar curve and an accentu- of any muscle group can lead to poor alignment,
ated curve in the mid-back. thereby resulting in chronic pain or dysfunction.
Proper sitting posture produces less stress The kyphotic posture is characterized by an exces-
on all of the spinal structure, and, requires sive forward curve of the thoracic spine and an in-
less energy expenditure. crease in the curve of the lumbar spine. The pelvis
is tilted forward and the head is shifted in front of
Generally, it is suggested that you sit with the body placing stress on the neck.
both feet flat on the floor or a small foot
stool. The low back should have a slight This malalignment may result from structural
curve (lordosis) and this can be maintained changes in the bones of the spine as is commonly
with the use of a small pillow or “towel roll.” observed in osteoporosis. In addition, limited flex-
Lumbar
The head and shoulders should be aligned ibility in the low back or hip flexors and weakness
Roll
over the hips. in the abdominals may contribute to this posture.
Individuals who sit for long periods of time Postural correction through stretching of the low
may benefit from well designed chairs that back and hamstrings and strengthening of the
provide both comfort and support. abdominals is the preferred course of treatment.
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Postural correction through stretching of the In addition to the providing “traditional” therapy services, the
abdominals and hamstrings with strengthening facility also offers Functional Capacity Evaluations (FCE’s)
of the hip flexors is often an effective course of and a work conditioning program for those individuals trying
treatment. to return to gainful emplyment following an injury.
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