In my last post we talked about making sure that you address a mobility problem with a mobility measure. This seems obvious when you think about it, but very often it can be overlooked. If you haven't read this, you can take a look here.
What I want to cover here is a little less obvious. The mistake of performing a mobility measure to compromise engine control. The easiest way to see this is with a patient example.
You assess a patient and determine that the cervix has restricted freedom of movement when the patient is seated. You can choose to prescribe some routes. Or maybe your job is soft tissue work or some mobilizations and manipulations are the recipe of choice. Whatever it is, you want to increase freedom of movement through procedures that increase the suppleness of the tissue. But what if that isn't the problem?
We often miss a step here. How can you tell it is a mobility impairment without passively checking? If you had a patient who couldn't get over their head, you would lay them down and evaluate the passive movement of the shoulder to see if it was an active or passive problem, right? However, we rarely do this with the cervical spine.
What if, before you subjected the patient with your cervical spine to your mobility measures, you passively checked the movement in the supine position? Sometimes the patient's freedom of movement is suddenly fine! This is not a mobility problem! It is a problem of their inability to relax the global muscles sufficiently to allow full range of motion. Only when they are unweighted and the global muscles relax, the full range is permitted.
When you find this, your intervention is no longer focused on mobility. Instead, you need to intervene with education and a motor control approach! In these cases, my approach is usually to change the forces that the neck is subjected to. You can relieve it, increase the axial load, and increase the drag. There is no way of doing this that works for every patient, and every patient seems to react differently. If one option doesn't work, try the next. Here are some ideas on how to change forces to improve your patient's motor skills.
Flexion and rotation shown : initially unweighted (typically supine position), then with increasing progression of the garden chair towards increasing gravity 
Additional Resistance : Add a Theraband to resist movement or a Theraband on the head that is pulled down to increase axial load. 
Ari Kaplan is the CEO and Founder of the Association of Clinical Excellence (ACE). ACE strives to provide excellent results for ALL clinicians. They focus on a cohort model that has been independently pursued and has shown significantly improved clinical outcomes. You can find more about ACE and its cohort model here.
