Happy Thursday, everyone. And welcome to the next episode of the Redefining Physical Therapy podcast. I’m your host, Dr. Scott Gray.

And so today in this quick episode, we’re going to talk about neck pain and how to treat patients that have neck pain.

And I’m actually going to simplify it for you. This is just one strategy of things to look at.

We see clinically back in motion and where are our therapists are being trained. And so obviously when a patient comes in with neck pain, you need to discern is it the joint? Is it a disc injury? Is it fascial? Is it a pastoral pain?

And that’s going to help you decide your strategy. But from a biomechanical standpoint, there are really two places that we want to address, and so that is the subcranial spine and that is the upper thoracic spine.

And so think about that for a second. So the majority of patients that come in with mid-cervical pain, those joints above and below are adjacent to the mid-cervical spine.

And so these are places where things get locked down, and so our body is going to move in the path of least resistance. So think about that for a second.

If my sub-cranial spine is locked down, my upper thoracic spine is locked down, where am I going to rotate? So I’m going to rotate primarily at the mid-cervical spine.

So over time, these muscles are going to become irritated. The joint may become irritated. The disc may become irritated.

There’s a time and place to treat symptoms, so once you really have locked in what is going on, the impairment’s typically at the upper subcranial spine and the upper thoracic spine.

So now in regards to your subcranial spine, you want to check OA and AA. So we know OA’s primarily more of a sagittal plane, chin nod, so a lot of these people are going to be stuck in subcranial hyperextension with a forward head posture.

So when you’re stuck in subcranial extension, it can limit also rotation. So we know AA is primarily where 50% of the rotation should occur.

So these are just a few things you want to test and in a future episode, I’ll talk about the biomechanics of that.

Now, similarly, your upper thoracic spine has a ton of rotation. And if you’re not rotating there, you’re going to be resonating at A, the mid-cervical spine.

And so a quick test that you can do is when you’re sitting with the patient, you want to hold their head and you’re standing behind them, you’re going to palpate C7 down to about T3, T4.

And literally, you’re going to just watch and see if the upper thoracic segments can rotate. So as I rotate right, I should see my spine’s processes move to the left.

That’s how I know that that’s part of the spine that’s getting motion.

If they’re not moving then A, I to mobilize them.

So, that’s how you would go about it. So I think a lot of times we get caught up in the neck is hard to treat or we have a lot of these impairments, but if you look at the subcranial spine first and the upper thoracic spine, and you get them moving, I think you’ll be impressed with your outcomes because you’re going to have a normal potential range of motion.

You’re going to then take stresses and strain off of the mid-cervical spine area, so you’re going to take pressure off those facet joints.

You’re going to take pressure off that disc potentially, and you’re going to reduce some activity of muscles that are working overtime to move and stabilize the mid-cervical spine, but also get muscles that are adjacent to the upper thoracic and subcranial spine moving normally rather.

So, there you have it. That’s my clinical pearl for today and my advice for today. Implement this into your practice and post a comment below and let us know how it went.