Podcast Master Instructor Roundtable

Master Instructor Roundtable: Cervical Spine – Part I

National Academy of Sports Medicine
National Academy of Sports Medicine
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In this episode, NASM Master Instructors Wendy Batts and Marty Miller detail the anatomy of the cervical spine complex to provide a comprehensive understanding of how important this region of the body is in overall human movement.
The “Master Instructor Roundtable” further explores why this is the most important portion of the vertebral column, plus much more!
 

 

 
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TRANSCRIPT:
 
Marty Miller:
Hello, everybody and welcome to this week's Master Instructor Roundtable. I'm regional Master Instructor Marty Miller. And as always here with my fellow regional Master Instructor Miss Wendy Batts. Wendy, how's it going today?
 
Wendy Batts:
Oh, it's going great. How are you?

Marty Miller:
You know this, it's always my favorite time to get to hang out talk shop, like, how can you get better than that? I am with you 100%. So and today's topic is the cervical spine. I know if you guys have been following us, which I hope that you have. Marty and I have pretty much touched on every major area of the body. Starting with the foot and ankle, we've talked about the knee, we talked about the hip talked about the shoulders. So we cannot leave out the cervical spine because there are multiple things that could go wrong with your kinetic chain, if your cervical spine isn't where it's supposed to be due to over activity and under activities. So so that's what we're talking about today.
 
Wendy Batts:
Absolutely. And I think for, for me, this is my opinion that for Certified Personal Trainers, I think that this is one of the most commonly overlooked part of the body. I think that people understand foot and ankle position and posture. And I just think maybe it's because everybody's head and neck tends to be in the wrong position that it becomes standard, or there's so much focus on everything below that they kind of leave it out. But what I can tell you is in the gym, I don't think there's anybody that's keeping their head and neck in a neutral position during almost any exercise I see. So, you know, I think that this is hopefully going to, you know, kind of get people to look at things a little differently. Remember how important the position of the cervical spine is, as, especially as we look at everyday activity as well. So it's, it's crucial. And I think that it's something that, you know, I'm happy, we're going to talk about, well, and I'm gonna pull up Marty Miller, because usually you're like when I'm at the gym today, I noticed as well last night I, I do a little meditation thing with my kid using an app before he goes to bed. And one of the ones that he had was talking about make yourself different. If you want to be different in the world, what's going to set you apart from everyone else is to look up and put your phone away. And so today's topic we're also going to discuss unfortunately, a very growing issue is text neck, we've talked about technic meaning of being looking at technology, there's not a lot of difference. However, texting is causing so many issues not only in the neck and the head, but also you know in the in the thumbs and the shoulders. It's just, it's a rippling effect and just look up, like what you see put your phone away, because you know what, you're never gonna have a day like today. You only get today once. So there you have patience. I know right? I'm becoming one with myself. 

Marty Miller:
So we look at what we're going to actually discuss, we're going to do what we normally do. So we go back to the introduction slide, you know, we're going to talk a little bit about the anatomy of the cervical spine. So we're going to talk about some of the major bones, we're going to talk about the joints, we're going to talk about the muscles, we're going to talk about the ligaments and tendons. And then we're also going to go into some information about the forward head posture, we're going to look at some research. And as I mentioned, we are going to talk about tech snacks. So those are some of the main things that we are going to cover today. And something tells me We'll get into a couple of little sidebar stories.

Wendy Batts:
Let me move on to the next slide. And let's break in to just the cervical spine itself and what influence it can have on the rest of the kinetic chain. Now as you guys know, we always talk about the five kinetic chain checkpoints. And so we started the foot and ankle, we look at the knee, we look at the hip, we look at the shoulders, but then we also look at the head. And when I used to teach it, Marty, I'm sure you're the same way I used to say make sure that your ears are in line with your shoulders. And that used to be an easy cue for people to understand proper alignment. However, as we've talked about in previous webinars, and as we're going to talk about today, a lot of people have a common compensation of a rounded shoulders, meaning their shoulders are in a forward position as well as their head. So that's really no longer the best cue. So if you're thinking about really trying to line someone up, you want to focus on keeping that you're in line with the torso and and that's how you can really determine Do they have a forward head? Or are they tilting? Or do they have some kind of flexion to one side or the other? All of these things really need to be looked at in order to truly get someone into proper alignment.

Marty Miller:
Yeah, and we'll go through again, all sidebar stories, but I'm preparing for this today. I have the office upstairs. My wife has the office downstairs, and I do my best to my computer, you know the standing desks so. The height of it so it's not so low where my head's forward, even when I'm sitting but I was I just happened to be walking by Morozov, and I noticed her screen is off to the left. So she's always going to be all day long rotating. So of course, I guarantee that there's going to be a propensity for one side of her neck to be tighter than the other because of the amount of time or how you sleep. And all these things are, you know that they absolutely have a cumulative effect and wear and tear as why it's so important. You know, I do a corrective exercise program just about every day when he's you know, and I spend more time over the last year on really my range of motion of my neck.
 
Wendy Batts:
And it's, it's made a tremendous difference. And my story for the day, I'm just going to go ahead and throw it out there. I've mentioned it before. And Marty, you know that this was an issue with me, I am so busy taking care of so many other people, not just my family, but my clients, I really do put a lot of people first I kind of started neglecting my own Prop, like my own self care. And because of that, I looked down at my job, I do a lot of manual therapy. So I'm applying pressure, I'm always in a forward position, I get home, I do my cow, you work some on the computer. And then of course, I have a little boy that likes to be picked up and held. So I was doing things in a very forward position and not enough to really bring myself back into proper alignment. And so because of neglected myself for as short amount of time, it was very quickly that I started to get more and more or have more and more problems. And so I ended up losing complete function of my right arm, complete function, meaning I could not hold on to anything, I tried to do a tricep extension laying on the ball in my elbow, no matter just with no weight, of course, I kept going down in weight. But starting really heavy what I normally could do and then go down really heavy for me, by the way, it's probably like for you, Marty. But I couldn't do it. And instead of going to nothing, I kept just going down and wait until I actually had nothing in my hand and I still couldn't do it. And so I had to get an MRI and comes to find out that I had the rebuilding discs and one that was about to blow. And they were like, whatever you're doing stop doing and you're going to have to get surgery, we're going to have to fuse your cervical spine. And I'm short enough, that was like all I needed to hear. And I started doing a corrective exercise really focusing on my overhead squat, looking at my positioning, and doing my correctives every single night along with traction, I have never had surgery, I have full range of motion, my my arm works. And so there's something to be said by identifying what the problem is. And then instead of just I'm going to go under, you know, under anesthesia, I'm going to get it fixed, I'm going to just fuse it together and call it today that you can fix your own problems. As long as you're diligent and you and it's something that I don't know, I like to challenge. They said I couldn't do it. And I did it. So they haven't you know, the way I look at it too, is, you know, we got into this industry because we were passionate about our own fitness. And then sometimes we're so busy with our life. It's you know, as you said, When did we put everybody first but, you know, I purposely, I might be different than a lot, but I am so structured and regimented. If I have a schedule, I stick to it, you know, no matter what. So I put it into my schedule, I know what time of day I'm getting up to do any my exercise or my correctives, it doesn't matter, you know, we're talking about cervical, this could be something that's more hip related for you or foot and ankle, whatever that is, you know, we're going to get into the substance of the cervical spine. But the key thing is consistency. And the key thing is to make it a priority. And you know, just stick with it. And that obviously, what I think is important is when you set that up for your day, it's so much easier to then talk to your clients about what you do, because I think a lot of them think it's just easy for us and we just magically are fit and move on don't have to put a lot of time into it. So, you know, I know that this could apply to any compensation. But I think it's just crucial that we focus on ourselves first find our weakest link, and then work on that. Oh, yeah, we are human. So we definitely need to focus on ourselves because we're only as good, you know, as we are healthy. So I always have to remind myself of that as well. So we move on to the next slide, let's kind of dig a little bit deeper. And what we're talking about when we're talking about the cervical spine itself, and that's basically the three major areas of the bones, so the vertebrae, and so we're talking about the cervical spine, it begins at the base of the skull and includes seven vertebrae. So we have C one, which is your Atlas. And then we have C two, which is your axis. And so think about what's rotating our head. Those are the primary that are going to help us move our head in the different directions. And we want to make sure that those are in as the best position as possible. And then one bone that we don't often mention is the hyoid bone, and you know, it does not articulate with any other bone, which I find interesting like this is an interesting bone for me, and you know, it's suspended in the anterior neck with the muscular sling and so

Marty Miller:
Before you ask what a muscular sling is, we actually put the definition in there. And it's a group of muscles that when contracted, they provide the stability. And so it's extremely important that we have our muscles and the proper alignment. So we have good movement throughout our cervical spine. Because if not, we get headaches, you know, people are like, Oh, I have a headache. Well, it may just be because you've got one muscle that is pinching on, you know, one of your major muscles, and it's decreasing the oxygen and the blood flow and everything to your brain. So that's often sometimes something that we, we take for granted.

Wendy Batts:
Yeah, and the positioning of the head neck is so important. And again, whatever we're saying about the cervical spine, you can drop this into any joint, it's always going to be important. But because it's so easy to have poor posture, and because when you We'll show some graphics here later about the stress on the neck, when you look at the way to the head, what's the Jerry Maguire, remember, the little kid human head weighs nine pounds or something like that seven pounds, maybe it's seven. But you know, when you look at just what happens every couple centimeters, that your head moves forward, and you're looking now but the stress and strain that you're putting on your cervical spine, and then all of the small little things that pass through there, all the nerves, and, you know, as Wendy was talking about the bones and the structure and how things are supposed to rotate, and all that fun stuff. And then you wonder why people have problems, but then think about what happens in fitness, then they start to load things. So this is where I always the way I say is the chaos starts to happen. So we'll talk more about that for sure. But it's just crucial to really focus on the range of motion of the neck. And to get people in the best position possible. Well, would you make that comment, I think it's important to when you know, when we talk about squats, and you put a bar on your shoulders, you know, you're loading your back, and people were taught back in the day to look up like, you know, find something and look up and focus on that morning, I've talked about the ocular reflex, the pelvic ocular reflex To be more specific, where when you look up your pelvis goes into an anterior tilt. So it's not ideal because it puts excess stress in the, you know, lumbar region. So you're causing more compression in that area. But if you're super tight in the front of your neck, because you're always looking down, and then you go to the gym, and you try to look up, think about everything else that's going to be affected not just with that reflex itself, but just the amount of stress that you're putting on your neck, because you're looking for range of motion that you do not have. And so it really does, you know, relate to so many things that we do in life, especially at the gym. But, you know, I think that's one of the reasons I was excited to do this. And we will have a part two, because it really is very important.
 
Marty Miller:
Yeah, and I put a video out on Instagram a little while ago, because again, I was in the gym, and I think it just kind of jumped out at me that day, maybe it's when we were starting to prep for this, that I was watching people and bicep curls, a perfect example. Every time they curl their head had to come forward. And I was looking at him like a bicep curl to me is an anti. How do I say it is anti rotation or anti movement exercise, right. So as I do my curls, I want my shoulders retracted my chin in the right position. And I want to fight that forward head as I do the curl, which means I am then strengthening the muscles that would tend to be under active, I don't need to focus on what's going on my elbow. I know how to do those things. But it's really about just keep Can you do these exercise of the keeping your head in the right position and think about the activation of those deep cervical flexors and all the muscles that you're not really familiar with. But if you just lose sight of where your head's at, during exercise, you're going to just like anything else feed into a compensation.
 
Wendy Batts:
Absolutely. Great points. And as with everything, I asked people, what do you look at? That's what I say to my clients after I know that they know the five kinetic chain checkpoints, they know what they're supposed to do. So instead of me harping on them all the time, like correct your neck or retract your chin or bring your shoulder back. I'm always like, I looked down at the ground and I'm like, What are you looking at? They're like, Oh, you know, so you got to have fun with your clients, you got to be able to talk about, you know, like, make sure that they know what they're supposed to be doing before you kind of give them that little nudge. But then it just becomes it's amusing because they start catching themselves doing it. They're like I I don't know I'm looking at my amazing biceps while I'm curling. Like I'll look at your amazing biceps. You'd look at yourself in the mirror. Okay, let's move up.
But then we have to obviously talk about the preset joint. So Marty, do you want to take us through this one?
 
Marty Miller:
Sure. So when you look at the joints here it's a typical vertebrae would have for for set joints formed by right and left a superior inferior for set. You know, both myself and Wendy have to touch licenses and Wendy has spent more time recently doing massages, but you know, when these joints get locked up, and the facet joints, you know, this is where a lot of problems come. So I'm not we're not saying that you're gonna put your hands on people and go through and do any manipulation. But when you get with a good manual therapist, what they're doing, they're really digging in. And a lot of times they're looking to see if these joints are lined up, and do they get the proper movement and or you know what's going on in the structure. So Wendy, I know from your experience, you probably work on a lot of people's cervical spine. So if you want to maybe give some insight again, this is fitness, we're not about manual therapy. But because you're a good manual therapist, you want to maybe give some insight on what you see and feel when you're working on people.
 
Wendy Batts:
Yes. And when Marty says that I'm a massage therapist, I don't do the Swedish I actually get in there, people stay completely closed. And I do right now I look at what's overactive and I focused on that area. And to your point, Marty, that's why the overhead squat really identifying those compensations, I can go in and try to manually release some of these muscles because I can't foam roll that area, I can't easily you know, get in there or use even the vibration device. Because I know for me, I can't do that because I feel like my brain is going to explode when I put any kind of vibration in that region. Plus, you have to be super careful. It's not the smartest thing to do. But usually, you know, it's this suboccipital areas that are super tight and think about the origin and insertion points to some of these muscles that we're talking about. And what can you do and doing static stretching, really looking at left to right side, I think we often forget that we look so much it just forward head. But if you're you know on the phone, and you raise the shoulder and you don't use the air pods or anything like that, and you're you know, trying to do something I know for myself being you know, a mom and I have all my jobs, I sometimes will not have my headphones available. And I've got I catch myself having my phone on my shoulder while I'm doing the dishes or doing something else or trying to type an email. And you know, you will notice over time And to your point, Marty, if you're looking at a screen always to the same side, one side will be extremely overactive, which is causing stress to the other side. And so there are specific things on each side, you want to do, just like we talked about with the asymmetrical weight shift in the hips, your head's kind of the same way, if you notice that someone's got like their chin going kind of a different direction, then look at which direction it's going to and really tried to do your best lengthening that side. And then we'll talk even next week about how to strengthen the opposing side. Because it can play without me even just digging in just doing the right stretches at the right time, making sure that it's specific to what I found in their assessment process makes such a difference. And it's easy to do, and they can do it at home, you just have to teach them.

Marty Miller:
Absolutely, and it's it's one of those things where anytime, I mean, I try to do it all the time, because I tend to sleep predominantly on one side. So I'm a left side sleeper. And I do my best to have a very thin pillow. So I'm in a neutral position. But when these you know I travel a ton and I don't get to pick the pillows. So it's not an issue. The other thing is like the airport, as much as I love, you know, flying around, they have the head position forward, your car has the head position forward. So it's something that I have to do all the time. But I was definitely rotated to one side. And then I was having issues with the shoulder nothing crazy because I was working through it. But once I really went back and identified that it was primarily from the cervical spine and just a muscle imbalance. Soon as I addressed it, why law things started to improve elsewhere. I think I told you, I turned my my car seat had like because my head rested go forward. And I know my husband's does as well. And I'm like What are they doing? Because I just felt like I was just like literally driving with my head forward because I couldn't bring it back. And so what did I do? I turned it around, I took it off, and I turned it around. So I mean, yes, if I'm in a car wreck, my head is still safe and supported. But now I can actually do retractions. And that's what I challenged my clients to do try to retract your chin for your stop sign so as to pee every time you do it or try to keep it back there. And it's really uncomfortable because it's a position that they're not used to being in because they're so used to having a forward head. So that's my story.

Wendy Batts:
If we move on to the next slide, we're going to talk about the key muscles and I think this is something that if you guys aren't really focusing on the cervical spine with your clients and you really want to get good at proper alignment, you really should have have the muscles highlighted because these specific ones, like I said, sometimes we take for granted and we think wait the traps that's not part of my cervical spine, but think about the origin and assertion and what the traps do. So looking at the cervical extensors, so when we're thinking about the entire Rector, spine a, the sub opposite occipital, which I've discussed, which is at the base of your skull, your deep cervical flexors, your levator, pec minor, rhomboids, scalings sternocleidomastoid, as well as your traps, some of them will be underactive, some of them will be overactive. However, remember, if a muscle is in an overactive state, meaning it's in a shortened position, it's still weak. If it's in a lengthened position, it is weak. So in order to get proper functioning and movement of your neck and all of your muscles, you want to get proper link tension relationship back into that that area, and then do the right things in order to maintain that alignment.

Marty Miller:
Couldn't agree more?

Wendy Batts:
If we go to the next slide, you want to take us through this morning? Yeah, I mean, you know, we You and I have made the joke of whenever somebody does an assessment, we want to see the video when somebody has overactive rhomboids, or overactive glutes, I've never seen someone walk in like that, you know, it's always versions of this, I'd almost like to see the same thing where if somebody walked in, like I call it the Pez dispenser, like they can't pull my head forward, I've yet to see that one, you know, everybody has their head forward. So again, I think the problem is we've accepted it as the norm. So I think a lot of newer personal trainers sometimes miss this slight, because they're looking for, again, I'll age myself, the ET neck, you know, child of the 80s, that it's, it doesn't have to be that far forward, anything is migrating towards forward, the sooner you catch it, the sooner you correct it the better for the client. But this is one of the ones I think a lot of people can see feet turn out these cave in. But I think the forehead as you had described, if they don't line it up properly, with the right part of the anatomy, with the shift, they're looking at the shoulder versus the spine, but this is something I would say 85% or more of my clients had a Ford had just even in a static position, let alone when I would load them, you know, if I did any type of weighted assessment, you know, it would generally only get worse.
 
Marty Miller:
So for me, I think this is something that really we need to be, you know, really focused on, everything's important, but I think this is one of the ones that gets missed the most. So, you know, when you have that forward head, it can lead to, you know, hand and neck pain, as Wendy had said her whole right arm had issues, movement restrictions, compensations above and below the cervical spine. So it's it's crucially important, and statistically, more and more people are working from home, working in on their computer more time on front of any screen, or maybe even longer commutes. So it's only going to get worse. Then next week, we'll probably talk about some of the exercises that are you know, okay, are we feeding into this compensation. But if you look at the gym between here and next week, you're gonna see a lot of people choose exercises that would feed into that. And or when they're even trying to do something that we might suggest they still allow that head to migrate forward.

Wendy Batts:
Great points. And here is here is a little nugget for you. I learned this when I went through massage therapy school, I actually stated neuromuscular therapy and my teacher was fan tastic. And one of the things that he was talking about, especially when we were dealing with issues when people came in and they said I have a headache, but it's behind my eye. What you can do is you can ask that client of yours, how often do you have this headache. And usually they'll say after a long day, it may not stay all the time, but it comes back pretty frequently. And if I get that headache, I'm like, Oh my goodness, it's behind my left eye. If it's behind your left eye, one of the muscles that you can actually go in as a manual therapist, or you can have your clients stretch, if you don't have that license is the sternocleidomastoid, which for you guys, that's this big conquer muscle right here. On that side, if you're a manual therapists, you can just pinch it and work your way out from origin to insertion. If not, you'll get them into position and stretch it correctly. If you've opened up that one muscle alone, it will really help that headache. And it's amazing for people to say oh my goodness, that headache is gone. There's your There's your nugget for the day. Don't say I didn't want to do something.

Marty Miller:
There you have it. So we move on, we're going to actually start to talk a little bit more about what ends up happening over time, we end up getting something called spinal remodeling. And this is almost reshot shaping of the spine and people I see it unfortunately, more and more commonly now. But when you notice that people's heads are forward, they get kind of this rounded back, upper back, if you will, that spinal remodeling and so it's the abnormal reshaping of the spines physiological curves do to sustain abnormal posture. Same thing as when you put your clients, let's say, in the five kinetic chain checkpoints, and you're just setting them up, and you notice that they have forward head, but you're trying to get them into proper alignment, even before you do the assessment. They're going to I tell them to retract their chin and, and they look at me, and I'm like, make as many chins as you can. And when they retract as much as they can, sometimes they're still not in proper alignment. And they're like, I feel so weird. I'm like, Yes, but you're still not in ideal posture, that's how far forward you are. And so we know that our body starts to adapt to whatever demand or whatever positioning we're putting, putting in overtime. And that becomes the new normal, the path of least resistance, we've talked about multiple times. And unfortunately, when you see this picture, this is something that's more and more common. And what ends up happening here, in this almost happened to me is you start learning, like losing the natural curve and your cervical spine, and you're putting excess pressure now on your discs and your joints. And it's really hard to get that curve back. So I'm sorry to interrupt. You know, I was just some thoughts, as you know, you know, for years, I worked in private country clubs. So I had worked with a certain population that this was common, and very few of them, could we fix completely, because it had gone 3040 years. And I even had some people that went got x rays, and you look at the arthritic changes, so we work them back to the best that they could be. But then when you look what happens when with a scab, though lack of thoracic rotation, then they can't get their arm in the right position, it was truly, you know, a full myriad of problems, because it had gone on for 3040 years for some of these individuals that, you know, we got them to improve. But when that remodeling happens, and then you start adding arthritic changes, you know, you're you may not be able to correct it fully, everything, every little degree that you can restore is going to be very beneficial, of course, but when you I'm sure you've seen those type of clients as well, it's, you know, they are going to be in some level of constant dysfunction for the rest of their life, because it just, it truly did remodel. And we've talked about this multiple times, you want your cervical spine and your lumbar spine to be stable, you want your thoracic spine to be mobile. And so what ends up happening if you start to see some of these issues, and you're not careful, or you actually start to get clients that did have that fusion that I discussed, which means they take the discount, they fuse the bones together, then they're going to end up starting to get mobility or look for mobility and stability above and below it. And before you know it, there's going to be more and more issues where people are going to be like, oh, now I've got to get this one fuse. Now I've got to get this one fused. And before you know it, you've got more fused, you know, vertebrae, just due to lack of proper alignment and to your point over time, you know, you've got it, you've got to really do your self care. And I can't stress that enough because I fell victim to it. And

Wendy Batts:
And then we get I know, then we get into text neck. So when we talk about text neck, because we're going to show you an example next, but we're talking about where the neck and the upper back, cause more poor posture due to excessive cell phone use looking down texting, doing emails, sitting down and just constantly doing something in a downward position with your phone. And unfortunately, you know, I would say maybe 20 years ago, there wasn't a text neck. I didn't hear of it very often. But now it's more and more common, which is really sad. And we're starting to unfortunately see this starting at a very young age, because more and more kids are getting phones playing games, texting with their friends doing messenger doing Tick Tock or whatever it is that the kids do. And the overuse of that is starting to now start at a younger age. So this picture right here can actually start happening before they even get into their late teens, which is really scary.

Marty Miller:
Yeah, and this last year, being stuck home did not help anything, right, the screen time only went up so we definitely need to put some interventions in there and get people all the way down to the the youngest ones back into, you know, some preventative care for sure. preventative care coming from my ATC over here.

Wendy Batts:
So we actually look at the next slide, we're going to show you some pictures and you can think you know you see the different positionings of the head. And I know it's kind of small but just a small tilt and they flexed forward flexed position you can see the amount of excess pounds and force that your poor cervical spine is having to hold up against gravity. And unfortunately, especially if you don't have very good vision, you're going to look at the last picture because people have their phones. They're looking down. And if you even do this and you have any tightness, you may feel as like a stress point or it will be very uncomfortable. And the lower part like in the upper back region, or the lower part of the cervical spine, and that's not good, because you can see that's up to 60 pounds. And you don't, we don't need that, that pressure, if it's if your head does weigh eight pounds, why add another 60 to it.

Marty Miller:
And then you know, the thing about this, you know, let's get past even the cervical spine, think about what the mid trap and the low trap and the rhomboids and the upper trap well think about what would be going on all the way with that last position. And or then people are in the gym loading that position. So when you look at all of those factors there, this is why you know, Wendy and I were very passionate about let's let's get back to some basics of a cervical spine and really focus on why it's so important. And this would be, you know, a great thing to discuss with your clients, when they either want to do certain exercises, or they still haven't changed their desk, or they still haven't changed the position of their pillows, etc. Just you know, you can get this very easily just show it to them and be like, okay, here's the why, you know, you want to get better. But we have to remove some of the stimulus that's causing this, if you come to me two times a week, and then maybe you do your stretching another two times a week, four times for 10 to 15 minutes, may not be enough to offset. I mean, I've seen numbers that people are on their phones for 20 plus hours a week, but that doesn't, that's not factoring in their car rides with the head position, how they sleep, the exercises they pick, you know, who knows, maybe they're watching TV on their laptop or other things. So it could be up to 40 plus hours a week people are in this position.

Wendy Batts:
And I know I get it, I'm sure you do it. Or you may get it as well, I have an iPhone, and every week I get a notification that my screen time went up, or my screen time went down. So then I make it you know, I tried to challenge myself if I noticed that it's going in the wrong direction each and every week, I tried to minimize my time on the phone. And it comes back to that app I was talking about with my son, my son's five. And I really want him to really start to see what's out there and not see what's just on the phone. And it's so easy for a parent to give their phone or their you know, iPad or something to their kid when they've got something going on. I am I've done it. I'm not saying that it's something that I never do, because I do. However, to your point, Marty, I think it's very important that we really watch the positioning in our kids and ourselves. It's just hard.

Marty Miller:
Big changes, would you have time to go back to being an athletic trainer, I'm either going to fix it now I'm going to fix it later, but I'm going to fix it. Right? So, you know, being an athletic trainer, we've been through it, you know, having this NSM DNA, why would I not want to fix it now because it's not a matter if you're going to have problems. If you're doing this, it's a matter of when so it's a lot easier to get ahead of it now then wait till it's the remodeling or these issues like you know, with that you have with your arm. So you're gonna you're gonna address this, it's not, like I said, let's just Which way do you want to address it? before it happens or after it happens?

Wendy Batts:
Let's just keep you healthy, and then we don't have to address it at all. How about that? Well, that's why you're doing addressing it ahead of time. Exactly. Yes, assessments will tell you everything. But Marty and I can talk all day about what you should do. But I just want you to know there is some research to back what we're saying. And when you see the FHP we're talking about the forward head posture and it can promote altered link tension relation ships, as well as the force coupled relationships within the muscular attaching to the bone. So as you can see this beautiful picture right here. And we really have we talked so much about restoring your proper alignment. And it's mainly because if you do that, you're going to reestablish that proper hyoid bone position that we talked about within that muscular sling. And then Marty talked in great detail. And he did such a fantastic job about the scapula thoracic rhythm. So if you missed that, you should go back and watch our shoulder episode because he, he really laid it out there that I thought was fantastic. And if you guys need to hear it again, just type it in the chat and I'll have him he'll do it again. But it's basically the interaction between the scapula and the humerus and then how everything's supposed to move together within its function. And then the last bullet point here. So if we look at the slide, you're gonna see that it's associated with overactivity of the upper traps and the levator scapula muscles. And this can negatively affect you know, basically scapular deacons. How we say this wrong just can be this can eat this dis added stop, I talk so fast, this kinesis and that occurs within the scapula when it doesn't move in the normal fashion during humeral elevation. And so, Marty, I mean, it's
stead of going really into the scapula thoracic rhythm because we're really focusing a lot on the cervical spine. I think one thing that people really get confused about and because we're spending more time on muscles and anatomy right now, and I know we have one more takeaway on the next slide. But before we even get to that point, can you explain because when we have overhead, our levator scapula is going to be overactive. Your sternocleidomastoid is going to be overactive. Your scalenes are overactive putting you into that position. But the deep cervical flexors are underactive. And because people think that because your head is in a flexed position, those would be overactive. So can you kind of give a little bit of a rationale on on why that's not the case.
 
Marty Miller:
Sure. Okay. So you know, we're just looking at anatomy, how it was derived, and you know, just anatomical positioning. So extension, is it more, we're looking at joint angles, so the extension of my neck is when my head comes forward, flexion would be when my head goes back, so the deep cervical flexors The problem is they're very small muscles in comparison to the big sternocleidomastoid. And these other muscles that pull me in plus, I'm constantly feeding myself into that forward head position. Extension, so my, it's my vertebrae, as they move forward, that's an extended position, the joint angle is changing into extension. And when I bring it back, they are the joint angle is shortening, so be flexion. So think about your elbow, when I curl my elbow, the joint space here is getting smaller, that's elbow flexion. When I do tricep extension, the angle would be getting bigger. That's extension. So same thing, we're just looking at the neck. So you can flex your neck this way. But we're talking about flexion and extension. So it's just anatomical terms. But it's really the percentage of motion of the joint, is it increasing or decreasing. And that's where it comes from.
 
Wendy Batts:
The key thing does is to understand good positioning, bad positioning forward heads, not good, neutral is good. If you don't remember the flexion extension, that part kind of takes care of itself. But you definitely want to know that the sternocleidomastoid is overactive. And then as the term I always use accidental exercise, every time I'm doing anything with my chin in the right position, the sternocleidomastoid has to, you know, I look at dimmer switches, it's never gonna be off. But the dimmer switch on the sternocleidomastoid comes down, which means the dimmer switch on the deep cervical flexor coil and capitas gets turned up. So I'm, even if I'm walking through the airport, which I do a ton with my backpack on, and I will check myself, if I can walk through that awesome Atlanta airport from Terminal eight. And I'm in good position that whole time, I'm accidentally strengthening the right muscles and keeping those other muscles turned down. So whether you're doing a bridge, whether you're doing a bicep curl, whether you're doing a tricep, fill in the blank, if you keep that head in the right position, you are simultaneously strengthening the right muscles and getting the muscles that are tend to be overactive to just kind of come down a little bit. So did I kind of that was perfect.
 
Marty Miller:
Okay, and another another to your point, when we're talking about exercises and the triceps. One very common compensation that I see is when somebody is using the cable, and you've got the rope, and they actually hunched their shoulders forward, and they look down and they do the triceps. And they keep their triceps like basically or their hands basically in front of their quads or maybe even to their side, you're really not getting full benefit of that too. Because think about what's happening at the shoulder, but also the stress that you're putting in your neck. So just stand up right, look straight ahead and then do your tricep extensions, and you're going to fill your triceps more, but you're also going to take the stress away from your shoulder plus that sternocleidomastoid. Hence, its name attaches to your clavicle. And if you can't get the right rotation, then you're actually causing your shoulder joint to be in a very bad or awkward position, which could lead to impingement. And you're decreasing the activation to your tricep, but you're trying to work. So it's funny you bring that up because I was going to do something I did a video about the bicep curls, I was going to do one on the tricep because, you know we all do triceps because it looks good, right? But I've yet to see somebody get injured because their triceps or biceps overactive or underactive, you know, there's certain muscles in your core and your lower extremity and the muscles in your neck that you have to truly train to prevent just some of these injuries we're talking about, you know, because if you're doing all your pushing and pulling, you're probably going to get enough arm work, but I'm not anti doing the accessory muscles like buys and tries. But when I do my triceps, I do them as a, I guess I'll use a term a counter posture, exercise or poor posture or I do it as a postural alignment exercise because as when he's saying if I do the rope, gravity in the machine wants to pull me here. So if I can do a tricep exercise, and keep my scapula in the right position, we're attracted rotated the right position and chin and neck in the right position why I do triceps? Great than I'm getting my triceps going on, but I'm doing it for everything else. I'm doing it for my postural muscles, you know, and yes, I want to do the triceps. But it's, that's not really the primary focus, if that makes sense. So maybe I'll throw a video out there this weekend on kind of showing that because, Wendy, as you said, everyone's caught up on where the weight stack is in there here. And all I see is the compression, I want to see somebody handle the weight appropriately and just be here. And then well as that as that weights pulling them up there, they're activating the right muscles to counter that.

Wendy Batts:
And I think it's important to note that shoulder elevation is also a huge cervical issue. When you have that you've got to think you've got your upper traps are going to be overactive, you got your sternocleidomastoid, you've got your levator, those muscles are going to go as soon as you go up, those muscles are getting shortened. And then if you've got internal rotation, so your shoulders are going there, think about the stress that you're putting on your neck. So all of these compensations we're talking about can truly affect the cervical spine in a very negative way, if you don't have ideal alignment. So to Marty's point, no matter your exercise, it doesn't matter how much you lift. If you can't lift it right, then you're not doing it right. And so do you really look cool, at the end of the day, maybe it depends on what is it you're trying to accomplish. But for me, if I'm in the in the gym, I want to activate the right muscle at the right time in the right plane of motion. So staying within the proper alignment, really focusing on your tempo focusing on your alignment, that's what you're looking for. Because as soon as a compensation occurs, you can't do it correctly. And you're actually going to increase the chances of injury or you know, cause something long term that can lead you to look like this guy on the right hand side. And then you're really in a lot of pain that could have easily been avoided. So we go to the next takeaway talking about breathing, it can also affect our breathing. So sustained forward head posture can negatively influence the respiratory system, because you're normal, when you're breathing in, this is going to be initiated by the contraction of the primary respiratory muscles such as the diaphragm and your external intercostals. So Marty, when we're talking about this slide, how can my breathing affect my cervical spine?

Marty Miller:
Well, you know, what comes first the chicken or the egg, right? So the key thing is, I like to breathe, I'm sure you do too. And I like in and out every day, effectively and efficiently. So the diaphragm, a lot of people, you know, they don't really realize it is a muscle, and I'm going to start with what I see like in a plank or another exercise, then we'll kind of reverse engineer it. So when we do a plank, when you and I've talked, we're not big fans of like, you know, three minute planks, etc. If you're not breathing properly during that, that means your diaphragm, or if you can't breathe at all, and you're holding your breath, that is kind of an indication that the diaphragm might be firing to stabilize a weak core. So right there. One, it's a sign of an unstable core. Number two, how are you going to breathe efficiently if the diaphragm is doing something that it's not 100% focused on doing. But when you look at your diaphragm, and this true, you know, really good breathing is I, we did this on another master director Roundtable. Last year, we made sure we talked about they're like the billows, where you know, to help kind of feed the fire. So if you look at those old school things, it's like you pull the handles apart, the bag, or the bills would open up, that's where the air comes in. And when you squeeze them together, the air goes out. So when you look at how you'd want to do diaphragmatic breathing, is as I'm going to take my breath in, I'm exaggerating, so you're seeing a little more motion here is my belly button should be coming out slightly, it's not massive, but just like you're opening up the ability to bring in that oxygen. And as I breathe, I would be squeezing in the air comes out. Now when I have a Ford head position, there's a lot of different things that can change with the anatomy. If I have a forehead position, last time I checked, the cervical spine is part of my entire spine or my core. So if my head is forward, that means now my spine is not a neutral, which means it's an unstable core, which means other muscles might have to contract. So a lot of times I think people focus on the thoracic and lumbar as the core that needs to be neutral and stable. So as soon as I push my head forward, I've changed the entire length tension relationship of all the muscles that would be stabilizing my core. If my diaphragm has to then jump in to stabilize the core of that I can't breathe as efficiently. So it's a lot of things that could be going on in there. But that's kind of like what I would say is a very easy way to look at it that everything's connected and that we want the diaphragm to be left alone to breathe and we want the cervical spine thoracic and lumbar spine in neutral. Let the proper link tension relief happened. And then hopefully, we can learn how to breathe properly.
 
Wendy Batts:
Yes, and think about and another important point to that, because as you were talking about the the bill, which again, when when we did that this below thing? Well, I didn't know what you're talking about. And we're not that different in age. So I have already showed me a picture when he showed me I understood. So if you don't know what we're talking about, welcome to my world, and sometimes having to deal with this smart man every year on as my co host, however, think about the scalenes, too, and the insertion point, because obviously, when you're inhaling and exhaling, you think about what's happening at the rib cage. And one thing that I think when you're not breathing correctly, one muscle that gets affected that literally can lock your neck down as well as your scalenes, because it inserts on the first and second rib. And so there's a lot of things when you're not in proper alignment that can cause your diaphragm not to be able to expand and contract like it's supposed to, because of what's happening at the neck as well. So it really, like you said chicken or egg, everything can can wreak havoc in a very bad bad way. If you don't have really good alignment. And I think we take a lot of these muscles for granted. Because we don't see them. We don't think about them. Now granted your sternocleidomastoid most people see most people have big ones because they're overactive, or ever used underpaid. Our heads heavy.

Marty Miller:
And there you have it, you want to get the zoo. Moving on.

Wendy Batts:
All right, Show me the money yet though. But that's okay. Want me to do that? Well, you know what, he was an Arizona State Sun Devils. So I gotta gotta give that to them. Not Jerry Maguire. But, but yes. So when we're looking at the key takeaways we want to talk, you know, we wanted you guys to really understand some of the basic anatomy. And we call it basic anatomy, but anatomy is anatomy, you really want to look at it, you want to look at the origin and insertion and the and the role that it can play on whatever body part we're talking about. Because every muscle can't if it's not working correctly, it's going to have to have other muscles help it do its job taking away for from what what it should be doing. So it's going to affect your kinetic chain. So always remember that you want to have proper LinkedIn relationships. So the joints are in ideal alignment, and then you're moving better, you're feeling better, you're performing better, and you're decreasing the chances of injury. So breathing patterns as Marty said, super important, it can be compromised with forward head posture. So we want to think about that. Think about what I talked about with the scaling specifically, you want to assess for the improper movement patterns, look for elevation look for internal rotation, look for forward head, look for lateral rotation, and make sure that if you see something even if it's minimal, you want to note it because we have that beautiful solutions table that can walk you through what you can do to help that compensation slowly start to to lessen and lessen until where it's no longer a compensation any longer it will take time but you can do it.

Marty Miller:
Awesome. And then of course we're not going to leave you hanging next week we're going to talk about program design. Yes, we want to help you have a better head and Oh yeah, again all about myself all about self care right here.
 
Wendy Batts:
So if you guys want to get a hold of me, you can find me on Instagram at Wendy dot batts 13 or you can email me as always at Wendy dot batts at nasn.org.
 
Marty Miller:
And then my information is right there Marty dot Miller at NASM dot org and then Instagram Dr. Marty Miller seven two. So Wendy, awesome information. I knew this would be fun as always. So thank you everyone for attending and we absolutely look forward to seeing you for part two next week.
 
 

 

 

The Author

National Academy of Sports Medicine

National Academy of Sports Medicine

Since 1987 the National Academy of Sports Medicine (NASM) has been the global leader in delivering evidence-based certifications and advanced specializations to health and fitness professionals. Our products and services are scientifically and clinically proven. They are revered and utilized by leading brands and programs around the world and have launched thousands of successful careers.