Neck Muscles Stretches

Quite often when patient complain of constant neck pain, the root cause can be traced back to a stiff C7-T1 junction. However, the muscles around the neck—sternocleidomastoid (SCM), scalenes, upper trapezius—will tighten up and get locked in as well when C7-T1 becomes stiff over time. Therefore, once the C7-T1 junction is mobilized, the surrounding neck muscles must be stretched and loosened up, otherwise the head will end up stuck in a forward position and the neck pain will return.

(1) When both SCM muscles contract, the head is flexed forward, so tightness on both sides exacerbates forward flexion of the neck at rest. When the SCM on one side contracts, the face is turned to the opposite side. Therefore, when stretching out the SCM, it’s important to remember to tilt the head back and anchor the SCM while moving the clavicle and upper ribs downward (inferiorly) to release the muscle.

(2) While the scalenes are responsible for forward flexion of the neck, they also elevate the ribs. Therefore, if these muscles remain tight, they not only pull on the cervical vertebrae back into flexion, but also elevate the first two ribs. Since the first two ribs attach to T1 and T2, respectively, chronically tight scalenes will lead to stiffness in the C7-T1 junction that’s likely to spread down the upper back. During this mobilization, Dr. Letgolts anchors the inferior portion of scalenes and uses the upper rib rotation caused by the arm movement to increase the stretch.

Scalene stretch

(3) Since the upper traps are primarily involved in the elevation of the scapula, an upper trap stretch is fairly straightforward. However, keep in mind that the scapula should be kept in a retracted position (against the ribcage) as shown, to get a more effective stretch—this would also hit the levator scapulae.

 

Key takeaway: the root cause of someone’s pain is often multi-faceted. It isn’t enough to simply deal with joint stiffness or muscle tightness. As both are very closely related, it must be important to address both issues in order to achieve longer-lasting results.

Psoas Stretch

A common contributor to low back pain is tight hip flexors. The psoas originates from L1 – L4 and inserts on the lesser trochanter of the femur (thigh bone). Therefore, when they get tight, they tend to pull the lumbar spine closer to the femur, which drops the pelvis into anterior tilt. Chronic anterior pelvic tilt forces the back to hinge excessively at the lumbar segments, which contributes to the low back pain. In order to get out of it, those hip flexors must be stretched out!

Hip Flexor Stretch How-To Video

What to do:
(1) Start off in a kneeling position, with one leg in front of the other. If kneeling hurts, something underneath to take off some pressure
(2) Tuck the pelvis into a neutral position. If you have trouble with this, place one hand in front of and behind your hips. Think of a hip thrust motion and remember to squeeze the glutes!
(3) Gently shift the torso forward, keeping it upright and perpendicular to the ground. You should feel a stretch in the front of your upper thigh from just moving slightly forward
(4) Hold for 30 secs
(5) Shift your weight backwards to come off of the stretch, then repeat for another 30-second hold
(6) For additional stretch, reach overhead and side bend to the opposite side OR lift up the lower leg (this will also stretch out the rectus femoris, one of the quad muscles)

Standing variation for those who have trouble kneeling altogether:
• Place the knee on a flat surface (chair, stool, coffee table, etc.) with the foot hanging off the edge
• The opposite foot is placed slightly in front of the torso, similar to a lunging position
• The surface on which the knee rests should be just below knee height in order to accommodate for the leading foot, so the hips remain level when shifting the weight forward

Things to remember:
• Avoid having the hips tilt forward and overarching the low back. This means you’ve lost the neutral position and are not getting an effective stretch
• Keeping the hips parallel (i.e., not rotating one side forward) will result in a better stretch
• If you have trouble maintaining a neutral pelvis, do this in front of a mirror and focus on your pelvic positioning