Continuation of the program at home, control appointment

The group participants should continue the program and self-help strategies for pain or dizziness learned over the 10 weeks in the group for at least 4-6 weeks at home with a frequency of 3-4 exercise units a 20 minute week. The learned exercises and neck-friendly work behaviour must be integrated into everyday life. For this purpose a fixed exercise date is recommended, e.g. in the morning before taking a shower or in the evening during the news.

The regular practice of a neck/back-friendly sport such as Nordic walking or back swimming can significantly support the healing success. Afterwards a control appointment should take place again to check the success – of the neck school – with the prescribing physician under consultation of the physiotherapeutic therapy report. This check-up appointment should include a discussion and an examination of the results achieved with regard to pain behaviour, mobility and resilience.

Depending on the results of the treatment, the further procedure will be discussed with the doctor or the physiotherapist.

If there is no pain (very often), the program can be continued in a “slimmed-down” form and maintained for the long term. In a study it was proven that the achieved freedom from pain only lasts permanently with continuous training.
In the event of improvement (less frequently), it may be possible to carry out physiotherapeutic individual therapy or other therapeutic measures in addition to continuing the program if functional complaints are still present.
However, the goal should be independence and autonomy in dealing with the pain.
If the state of pain remains unchanged (individual cases), the doctor should diagnose again and carry out a modified pain therapy. Perhaps a closer look at the psychosocial factors that maintain the pain event can also bring further therapeutic success.

important: high fun factor, partner exercises, coordination exercises The group participants learn about the different movement possibilities of the cervical spine and shoulder girdle and the coupling of breathing and movement. By directing attention to the muscles, you will be able to feel the difference between tense and relaxed muscles.

Above all, the perception of relaxation is an important prerequisite for the correct execution of the exercise program and the later transfer of what you have learned into everyday life. The perception training also includes learning the local stabilization exercises. It has been proven that strength training muscle building has the highest treatment effectiveness in terms of pain relief compared to a general fitness or gymnastics program.

In one study, 73% of the participants who had undergone special strength training for the neck, cervical and shoulder muscles for 3/week for more than a year achieved a significant reduction in pain. The aim of the strengthening program is to improve the stability of the cervical spine and to relieve the usually very tense shoulder muscles (shoulder lifter). In addition to training the deep, short cervical muscles, the focus is on strengthening the flexor, extensor and rotation muscles of the cervical spine, the shoulder blade stabilizers and the back extensor muscles.

To intensify the training stimulus, small devices such as Theraband, weight cuffs or small dumbbells can be used. Unfortunately, the use of special strength equipment for training the neck and shoulder muscles often proves to be a pain intensifier due to the excessive training stimulus in relation to the increased sensitivity of those affected. In addition, the participants cannot carry out this training measure independently at home.

Warm-up exercises
Body awareness training
Strengthening program

The selection, duration and number of repetitions of the exercises are based on the individual pain, strength and movement findings! The aim of the strength endurance training is a holding time of 7-10 sec. and 3 repetition series of 10 exercises each.

Important: During the exercises, ensure calm, even breathing! For exercises in a sitting position a mirror may be useful for self-monitoring. Caution: When exercising with dumbbells or weight cuffs, the weights should not be lifted with the arm stretched from bottom to top over 90° arm torso angle.

Starting position upright sitting on the stool Exercise version the chin is pulled back, the back of the head is pushed out, the cervical spine describes a small bending movementStarting position upright sitting on the stool Exercise version the head is moved while keeping the bending in the neck Important: the chin should not point towards the ceiling! Starting position upright sitting on the stool Exercise performance both shoulders are moved from the front top to the back, the shoulder blades are pulled towards the trouser pockets backwards, downwards and heldStarting position upright sitting on the stool Exercise performance the head is pressed sideways against the hand and held Exercise performance the head is turned right/left against the hand and heldBeginning position quadruped, knees and hands are at right angles under the shoulder girdle and pelvic girdle, the back is flat (pull navel towards the spine) Exercise The head is moved downwards in the direction of flexion, then upwards in the direction of extensionBeginning position prone position on the mat Forehead underlayed with a small towel, the navel pulled towards the spineExercise The fingertips are on the back of the head, the chin is pulled towards the navel, the head is lifted, the back of the head is pressed against the fingertips and heldInitial position prone position prone position on the mat: the legs are turned up, the arms lie to the side of the body, the head if possible flat on the matExercise The chin is pulled towards the breastbone, the back of the head is pulled approx. 1cm from the floor Variation View over the right/left chest, then lift the back of the head approx.

1cm from the floorStarting position: seat on the mat, legs are turned on Exercise position: both arms are extended forward, the chin is pulled towards the sternum, the upper body is slowly moved towards the supine position until the point where it is still possible to sit upright.The instructing physiotherapist must respond to the individual performance level of the group participants and take this into account by providing differentiated exercise information. The aim is that all group participants are able to carry out the exercises correctly and continue the exercise program at home without supervision. The intensity of the exercises and thus the training stimulus are increased in the course of the 10 exercise units in terms of execution, holding time, strength requirements, number of repetitions, etc.

During the 10 exercise units, an increase in performance in terms of coordination and muscle strength should be achieved by all course participants within their individual load range. Learning the correct posture is a very important part of the exercise program right from the start, especially for those who work at a seated workplace. Due to the hunchback that develops when there is a lack of muscle activity, the cervical spine must perform a forward compensatory movement (strengthening the natural forward curvature = lordosis), otherwise it is no longer possible to look straight ahead, e.g. towards the screen.

As a result, the skull slides slightly forward on the upper cervical vertebrae, which can lead to irritation in the head joints and increased pressure on the small vertebral joints. The slackening of the front neck flexor muscles causes muscle imbalances, tension in the neck and shoulder muscles, neck and headaches, and dizziness can result. Exercise example posture training: Starting position: sitting on a stool Exercise execution: lift the sternum, push the back of the head out towards the ceiling, pull the navel towards the spine, pull the shoulder blades backwards and downwards towards the trouser pockets.

It is essential to set up an ergonomic workstation to support an upright posture and to relieve the neck, preferably as a preventive measure. Mobilization exercises: The aim of mobilization exercises is to improve mobility in the cervical spine and to break up altered movement patterns. Example: Patients who are concerned about protection do not only turn their head when looking around, but the entire thoracic spine.

The fear of movement is reduced by the targeted exercises, and the extended range of motion can be perceived as a pleasant relief in everyday movements. Starting position: upright sitting on the stool Exercise: the head is turned to the side until the pain-free end position (looking over the shoulder), with the help of a long exhalation, the patient tries to move the head slightly in the direction of rotation over 3 breathing phases further in the direction of rotation until it is slightly above the pain threshold, then the head is slowly moved back to the middle position. Important: the shoulders and knees are aligned forward during the exercise The same exercise sequence can also be carried out in the bending or side-tilting movement of the cervical spine.

Starting position upright sitting in front of the mirror Exercise execution the head is tilted to the right/left side towards the ear and turned to the opposite hip. One hand grasps over the head and carefully supports the tilting movement, the other hand rests with the palm of the hand sideways to the floor. A pulling feeling develops on the shoulder side where the hand pushes towards the floor.

(muscle stretching)1. Total body relaxation: Autogenic training – physical relaxation via mental imagination – or the Jacobsen relaxation exercises, in which relaxation is perceived and learned by first tensing the various muscle groups of the whole body. 2. targeted relaxation of individual muscle groups: Exercise example for targeted relaxation of the shoulder lifter: Starting position: sitting upright on the stool Exercise performance: both shoulders are pulled into the tensed position towards the ears and held there until the shoulders hurt, then the shoulders are deliberately dropped with a deep exhalation.

A light dumbbell or an adequate weight can be used as a support. This exercise should be repeated until a feeling of relaxation and warmth is felt on the shoulders. The aim of the exercise is for the patient to perceive his tense shoulder position in everyday life – constantly lifting the shoulders – and to learn to correct it independently.There are various possibilities for self-help in the case of pain intensification, whether caused by the exercises or by stressful everyday activities: Examples Trigger point treatment: Transverse stretching: Starting position: sitting upright on the stool Exercise execution: one arm is turned outwards beside the body.

The other hand grasps the upper part of the large shoulder muscle over the relevant shoulder. With the exhalation the muscle is pulled forward and held for a few seconds. In this way, the muscle is stretched and relaxed at right angles to its path.

This exercise should be repeated several times. In the case of severe tension complaints on the shoulder, it is best to do it several times a day. Trigger point massage: Starting position: supine position, small pillow, if necessary knee roll Exercise execution: 2 tennis balls are placed under the right and left shoulder on the pain points of the large shoulder muscle.

The head is laid relaxed on a small pillow. By slowly rolling the head from one side to the other, the muscles are massaged by the tennis balls. Trigger point massage as partner exercise: Starting position: upright seat, the partner stands behind it: Exercise: The partner massages with two hedgehog balls with small, circular movements the pain points on the right and left side of the spine (from top to bottom) and on the shoulder muscles (from inside to outside).

In the beginning only little pressure should be applied, later on pressure can be increased. After massaging, feel the relaxation of the treated areas.

Trigger point handling see below
Heat
Treatment with the Ten device
Stretching exercises
Possible medication
Tape

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