We received an email from a customer dealing with “severe Clinical Instability of the Cervical Spine” or CICS, who wanted to know how to use The Iron Neck in her recovery process. This customer is not alone in her quest to find a resolution to a serious spinal cord condition for which there are too few assessment and rehabilitative options. This can lead to many debilitating injuries and a lifetime of pain.
What is a Clinical Instability Cervical Spine?
CICS occurs when the cervical spine can no longer support itself under physiological loads and maintain normal displacement patterns that keep this delicate portion of the spine from developing deformities, neurological damage and incapacitating pain. Common causes include one sudden trauma or repetitive microtrauma (e.g., car accident or sports collision), Inflammatory Arthritis (e.g., Rheumatoid, Spondylitis or Ankylosing), or a congenital collagenous compromise (e.g., syndromes including Down’s, Ehlers-Danlos, Grisel or Morquio).
On the other hand, common symptoms and consequences include an intolerance to prolonged static postures, fatigue accompanied by difficulty holding the head up without external support (e.g., the hands or collar), a feeling of instability, shaking, or lack of control and frequent episodes of acute attacks of sharp pain especially with sudden movements. Furthermore, some sufferers of CICS experience a heaviness in their head, a locking sensation in their neck with movement, muscle stiffness, and a catching, clicking, clunking, or popping sensation.
Alarmingly, trivial movements can provoke symptoms, creating an unwillingness, apprehension, or fear of movement among CICS patients. Typically, many only experience a temporary improvement in symptoms with clinical manipulation. We understand that people want to fix their problem without making it worse in the process. In order to correct an instability problem, one must train for joint stability through muscular strength & coordination.
In any joint instability, it's crucial for the surrounding musculature to be able to create isometric forces prior to other more demanding muscle actions (e.g. flexion & extension of that joint through concentric & eccentric contractions). This is where the Iron Neck comes in. The Pro and Starter models both can utilize only isometric movements that are essential to the rehabilitation process and help create joint stability.
CSIS Patient Training Plan
Here is a training plan and guide we sent a recent customer dealing with “Severe Cervical Instability.” We shared these training concepts with her after she was cleared by her physician and after she completed a Digital Motion X-Ray to diagnose her CSIS.
“Since the body operates on a negative feedback loop (i.e. meaning what you do today, you feel tomorrow), we can't assume that acute training will be tolerated. These progressions are meant to sort of “poke” the muscles and Central Nervous System to see how they react and then we adjust from there. The issue is, poking too many times or too hard yields the same results - PAIN - and that's what we want to get rid of.
The big issue is that your CNS is now very active and aware that there's an issue with the neck. Therefore, it will do a lot to protect that area. An analogy I use for this is when you get in trouble with your parents for hanging out with the bad kids and now you've asked to go out and play after getting busted. Your over protective Brain Parent isn't going to just let you play again. It will supervise and set restrictions and if you demonstrate you have control and follow the rules, you'll once again be free. If you don't, it drops the hammer on you.”
Below are some basic exercises that we assigned this customer. To start, we wanted to limit the time under tension and stay in control of the body under resistance.
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Iron Neck Training Concepts
Be Mindful of Pain - If symptoms are aggravated during training, stop and consult with your doctor or therapy practitioner to diagnose next steps. It's important to identify what "type" of pain it is that you are feeling. It could simply be mechanical pain from a prolonged period of underuse and compensation, or it could be a sign of something more serious. Consulting with your medical professional can help identify the next course of action. We can reduce band tension, adjust the anchor point, modify the exercise, or pursue other avenues of rehabilitation, but we shouldn't push through too much pain in the beginning. We are showing the CNS it's ok to work these muscles out. Soreness is OK, pain isn't.
Short & Specific - There's no reason to test your resilience just yet and it may seem like you're not doing anything if you're only holding isometric tension for 3-5 seconds but we don't want to overload the system. We want to gradually ramp into dynamic muscle control and normal pain management cycles. Every muscle action requires isometric tension at some stage of its contraction and elongation so we must become very good at Isometrics (where there is no muscle length change but it is under tension) first.
Frequency - The Delayed Onset of Muscle Soreness (DOMS) occurs in humans after 48 hours and subsides after 72. It is best to train a maximum of 3 days a week with a frequency of 5 to 10 min each session until more training can be tolerated.
Exercises with the Iron Neck:
Walkouts - Set up the Iron Neck and walk away from the anchor point holding a comfortable amount of tension for 3 to 5 seconds. Walk back in after the time is up, turn and walk out in a different direction. If you think of looking at the anchor point as NORTH, do a walkout facing North, then East, West and South. This will engage all sides of the neck and torso. Maintaining great posture is a must so if you can't, then there may be too much tension and the drill may be wrong for you.
Walkouts + Hold - Hold a weight, baby, water jug, or anything you have just to add some load to your body so the pieces (Neck & Torso) now have different requirements and we can start to separate the pieces by job category. We don’t want the back and shoulders to take over the neck’s job - which they may be very used to doing. Instead of a “load,” we could also use isometrics such as pushing the hands together to create some tension in the arms, shoulders and chest. This would be a great starting point to work up to external resistance.
Foundational Movements - The F6 movements would be a great way to add some variety to your routine. It is important to modify them so that your work to rest ratio is very high, meaning for every 1 second of work in a “Look Left, Look Right” you'd rest for 2 or 5 seconds (i.e. 10 seconds of L.L. and L.R. followed by 20 to 50 seconds rest). This allows the body to recover completely between sets and reduces the amount of metabolic fatigue that could lead to soreness or stress in the muscles beyond the scope of this rehab process.
Practicing these cervical muscle actions under resistance will help not just the muscles in your neck, but also the posture zone in your upper back, glutes and hamstrings to realign the spine and reduce stressors from posture. Obviously, the neck strength will help with issues occurring at C1 and C2 and where the Cervical Spine interacts with the Thoracic Spine.
With these exercises, our mission was to bring this customer to a proactive resolution and in time, see real life progress in ending her daily neck pain and returning to normal daily activities.