Question:

Bridgett Wallace, PT, DPT: “This is a great question for you. Particularly, not just as you specialize as a therapist in the cervical spine or the spine, but even prior to being a physical therapist in your work as an athletic trainer. There’s been a few studies that show that increasing neck strength decreases the concussion risk by four-fold. And so I get a lot of questions of, well, these athletes, they have big, strong neck muscles. What they don’t have is the intrinsic. So could you elaborate, kind of your experience from athletic trainer, physical therapist, about the misconception about someone being strong in their neck, and having weak intrinsic cervical muscles?”

Answer:

Angela Rich, PT, OCS, ScD, ATC: “Absolutely. And it goes well, even from that point, we were talking about weak intrinsics, even just ligament instability. Just because someone has a big thick neck or a huge shoulders, does not mean that they have a stable shoulder, right? They can be grossly unstable in their shoulder. So you have to be able… You have to go in and assess all the things separately. That’s why we look separately at deep neck flexors and deep neck extensors. And then we do an endurance test and… Or a test, that involves weight.

And so, appearances is anything. I used to kid around with my athletes, especially my track and field people, that their muscles used were full of air. And because when I’d actually look at their musculature, they were so weak. But they were just these huge muscles that in a lot of times, musculature that is in dysfunction, right, you don’t have good neuromuscular control. It doesn’t necessarily mean it’s weak. It may mean that it’s just… I hate to use the word, but may mean it’s not turned on or it doesn’t exactly know what to do. And once you work with a muscle, it’s like, “All right, I got into here. I know what to do now”, and you can just do it sometimes. Especially when we’re talking to athletes. Okay? They have to understand that when there has been injury, that is a protective mechanism that we’ve seen in a lot with a… The musculature goes into dysfunction.

So when we know we raise our arm up, we should have a feed forward right over our musculature to stabilize our spine. That may go away totally. And you have to assess that to make sure that the musculature is doing what it actually needs to do. And sometime, it’s just prompting it to get it to come back and to fire properly.”

Bridgett Wallace, PT, DPT: “Yeah. And I think that’s one of the… Through the years being able to work together and all of us vestibular therapists participating in this. When people have movement related dizziness, it’s a big indicator it’s their inner ear. And so what… They rarely meet people that want to be dizzy. So what they do is they stop moving their head… Their muscles, they’re over overactive activation of the muscles, in an order, not to be dizzy. So we battle between, okay, I’m going to work on the neck. But then when I do it, it increases their dizziness. So now it comes back to that challenge of, we know we need to work parallel, but when do we decide to choose this? And when do we choose that? Do you have any kind of words of wisdom when you’re treating that kind of combined of movement related dizziness and the cervical spine?”

Angela Rich, PT, OCS, ScD, ATC: “If you’re talk… Well, what the word that just stuck out in my head when you… And I got lost on what you said, was the fact of over protected. And what we know is that muscles change in what their function are. Right? So we know that the long lever muscles actually start to function and try to function as a segmental stabilizer. And that’s where a lot of this comes into play. And so basically it’s getting that retrain the person as far as precision and getting the muscles to precisely control the segments may turn it on there and get in hand the other muscles, the sternocleidomastoid, some of the [inaudible 00:04:02], levator scapulae, to decrease their function as being the stabilizer of the neck. They’re a prime mover. It’s basically just to learn, to know how to separate that and how to assess that.”

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RESOURCES & LINKS:

• This Q&A is an excerpt from the Vestibular Health Summit Sessions
• The Vestibular Health Summit Sessions are included with 360NeuroGO Enterprise

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FACULTY:

Angela Rich, PT, OCS, ScD, ATC

Angela Rich was a private practice owner for 16 years, specializing in orthopaedics and sports medicine. In 2015, she turned her focus to teaching as an Assistant Professor in Texas State University’s Doctor of Physical Therapy Program with responsibilities in Orthopaedics and Therapeutic Interventions. In 2017, Dr. Rich was recognized with the Faculty Excellence Award in Teaching for the Department of Physical Therapy and the College of Health Professions. Her research agenda focuses on the identification of movement system dysfunction and impairment-based intervention.

Bridgett Wallace, PT, DPT

Bridgett Wallace, PT, DPT, has a doctorate of physical therapy and holds competency-based certifications in vestibular rehabilitation and concussion management. Dr. Wallace has been treating patients with dizziness and balance disorders for more than 20 years and is the founder and President of 360 Balance & Dizziness – a specialty clinic for the evaluation and treatment of dizziness and balance disorders that includes both audiology and therapy services. She is also the co-founder and Director of Clinical Education for 360 Neuro Health Institute, which provides online, mobile, and live educational offerings for healthcare providers.