What is done in manual therapy? | Physiotherapy after a whiplash injury

What is done in manual therapy?

The goals of manual therapy after whiplash injury are to restore the mobility of each mobile segment of the cervical spine and the position of the joint parts in relation to each other. This can reduce pain and restore the overall mobility of the cervical spine. Manual therapy may only be performed after the exclusion of a bony injury or after completely healed injuries.

In manual therapy of the cervical spine, too, the patient usually lies on his back and the therapist stands or sits behind him. The therapist can achieve relief and pain reduction by light traction on the cervical spine. In addition, he can bring the vertebral joints back into a physiological position by applying slight opposing pressures.

Which muscles are strengthened/how is this achieved?

After a whiplash injury, it is important to strengthen especially the deep neck muscles and the shoulder-neck muscles to stabilize the cervical spine and to avoid renewed trauma caused by jerky movements. Thus, the short neck muscles, the so-called back extensor muscles, which run directly next to the spine, and the segmental muscles, which run from vertebral body to vertebral body, should be strengthened. In most cases, the neck muscles have been overstretched or damaged by the whiplash injury, so that they are reactively tense or increasingly weakened by the relieving posture.

The physiotherapist shows gentle movement and strengthening exercises during therapy, which should also be carried out as a homework program between therapy sessions and afterwards. For example, your own hand can serve as a resistance by placing it on your forehead and pushing your head forward. Then the exercise is repeated with the hand on the back of the head, the head is pushed backwards into the hand.

1. )The following exercise is suitable for training the fine tuning of the movements: The patient sits on a chair in front of a white wall. A headband with a laser pointer is attached to his head.

Now he can be asked to perform various activities, such as writing letters on the wall, following a line/maze or a second laser pointer point, which is moved by the therapist. Posture training in general is also important. The posture always starts with the feet, not just the cervical spine.

From below, stability is built up so that the head can finally sit firmly on the trunk. When strengthening the musculature, it is primarily the holding muscles that should be influenced in order to withstand the stresses and strains of everyday life. Static exercises are particularly suitable for this.

Initially, this can be trained from the supine position : 2). The feet are set up about hip-wide apart, the arms are stretched out to the right and left of the body, the palms of the hands are turned towards the ceiling to continue an external rotation of the shoulders, which supports an opening of the chest and thus an upright posture. The back of the head lies with a long neck on a flat pillow.

Now the patient is asked to build up tension in the body, pressing the heels, lumbar spine and back of the hands firmly into the pad. From this starting position the head is pushed out for a long time, the spine is lollygagged and stretched. In order to create extra space and length in the cervical spine, the chin is tilted down slightly towards the décolleté and the chin is pushed backwards, like a double chin.

Often this position alone creates relaxation for the neck and head. In order to strengthen the muscles, the back of the head is pressed firmly into the base while maintaining the long neck. To support and test the tension, the therapist can now try to pull the pillow away from under the head.

The patient tries to prevent this by the tension and pressure of the head on the pad. As an increase for the musculature, the head is lifted slightly from the pad with stretched neck and held in place. The next step is to try to stretch the neck from a sitting position in the same way.

Finally, this exercise can be performed in any everyday situation. 3.) For a further stability exercise the patient is again in an upright sitting position.

Torso, neck and head are stretched and stable. Now the therapist gives resistance with his hands at different places on the head and shoulders, which the patient should not allow to be brought out of his position.

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