Cervical Stabilization and Mobilization

Would you believe me if I told you that by doing three simple exercises for less than five minutes a day you would have a healthier body with a more alert mind, fewer headaches, and greater flexibility? Well, it’s true. Not only have I seen these exercises (what we physical therapists call “cervical stabilization and mobilization”) help resolve my patients’ neck issues, but they also helped me tremendously in my recovery from being rear-ended by a distracted college student who was chatting away on her cell phone and failed to notice that the traffic light had changed.

These exercises are designed to align, mobilize, and stabilize the first three cervical vertebrae (C1, C2, and C3). The exercises improve the alignment of the joint surfaces and help to balance the relationships between the muscles that control the movement and stability of these three key vertebrae.

Before we go any further, I should explain a little bit about what each of these vertebrae do and how they not only control how your head moves, but to a significant extent, how the rest of your spine (and therefore your entire body) does too.

C1 (Atlas)
Named for the Titan of Greek mythology whose punishment for warring against the gods was to support the weight of the heavens (which is often depicted as a globe) for eternity. The globe of the head rests literally right on top this first cervical vertebra (C1), allowing the fine movements of the head on top of the neck. The nerve roots (sensory nerves) emerging from C1 innervate the skin around and above the ear. If C1 is misaligned, you will probably notice pain at the base of your skull and underneath the jaw and the inability to move your head normally. In addition to pain at the base of your skull, the symptoms of a C1 misalignment can include wicked headaches, migraines, felling “fuzzy headed,” dizziness, TMJ pain, even vertigo.

C2 (Axis)
The English word “axis” comes from the Latin word of the same spelling, meaning axel or pivot. The most distinctive feature of the Axis (C2) is its “odontoid process” (a tooth-like protrusion often called the “dens”) that forms a pivot upon which the Atlas (C1) rotates. In general, C2 directs cervical mobility. The nerve roots (sensory nerves) emerging from C2 innervate the skin of the back of the skull. If the Axis is misaligned, my patients frequently report pain at the base of the skull that extends up the back of the head as well as referred pain behind the eyes and in the temples. As with C1 misalignment, C2 misalignment makes it difficult to turn your head left or right.

C1 & C2 Innervation Issues
The upper cervical spine works as a functional unit. So it is difficult, even for experienced therapists and doctors, to discern whether C1 and C2 are out of alignment because the symptoms are so similar. For example, when C1 is out of alignment, it is likely to cause C2 nerve impingement symptoms (pain that start at the base of the skull and extend over the top of the head and lodges behind the eyes and/or in the temples). I see a lot more C1 misalignment. That’s not to say that C2 misalignment symptoms are uncommon, but C1 issues are more prevalent.

C3 (no cool Greek or Latin name)
The third cervical vertebra (third one down from the base of the skull) is similar in structure to the next three vertebrae: C4, C5, and C6. C3 is on the same plane with the mandible (lower jaw) and the hyoid bone (a floating bone that sits above the Adam’s Apple). If you moved your finger back along your jaw line, you would be at the C3 level. The motor nerve root (which controls muscle movement) emerging from C3 innervates the muscles of the face and neck. If this vertebra is misaligned, you may notice facial pain, tingling, or muscle spasms. C3, C4, and C5 also innervate the diaphragm, which is why people who have traumatic upper spinal cord injuries often have trouble breathing.

The relationship between these first three vertebrae is interrelated, requiring the coordinated movement of dozens of muscles, tendons, and ligaments—all of which are about the size and thickness of your little finger. If any of these vertebrae are misaligned or have their normal movement restricted, it often sets off a chain reaction of pain and discomfort that can be difficult to clear.

If left uncorrected, this sort of problem can set up a positive feedback loop that basically shuts down the normal movement and mobility that are critical to daily life such as, nodding your head “yes,” shaking your head “no,” turning your head to parallel park your car, or looking left and right before you cross the street.

Fortunately, the exercises listed below harness the intrinsic intelligence of your central nervous system, which allows you to move your head in all directions.

Once a cervical joint is stabilized and mobilized, these exercises allow the neck to stay in spinal neutral, which is the optimal state of being—your ideal blueprint.

A Word Before You Start
Before you begin the exercises listed below, it’s important that you understand one simple, yet subtle, concept. All three exercises involve an isometric contraction between the palm of your hand and the side of your head. You will receive the most benefit if you focus on resisting the force of your hand against the side of your head—instead of pushing your head into the palm of your hand. Although this difference might sound trivial, it’s not. Cervical stabilization and mobilization occur when your neck actively resists your hand pressing against the side of your head.

Although it might feel like you are doing more “work” when you press your head into your hand, that type isometric contraction recruits many of the muscles, tendons, ligaments, and bones of your neck and chest, which prevent these exercises from working their magic on the alignment of the first three cervical vertebrae.

So relax and allow your head the resist the pressure of your hands.

Exercise 1: Balancing Atlas with Rotation 

 

Position: Lie on your back with your head in a neutral position (chin in, nose pointing straight up at the ceiling). Do not put a pillow under your head unless you cannot rest your head comfortably without one. Place the heels of each hand on your temples in the natural indentation just above your cheekbones.

Exercise: With your chin tucked in as far as you can, use the muscles at the base of your skull to resist your head being turned to the left by your right hand. Focus on the muscles at the base of your skull, and avoid using the muscles of your entire neck. Recruiting these other neck muscles defeats the mobilization and stabilization of your Atlas (C1). Admittedly, this is a fine line that might take you a few times of figure out.

Resist the force of your hand while keeping your head straight with your nose pointing straight at the ceiling. The force of your hand is stronger than your upper cervical muscles, so gradually increase the force of your hand until it is equal what the muscles at the base of your skull can resist. Applying this type of balanced force helps prevent your head from moving out of the mid-line of your body.

You are attempting to keep your head in a neutral position as you push against it with your right hand. Hold for four seconds, and then switch hands and repeat the exercise using your left hand. Repeat this exercise four times on both sides (4 counts x 4 sets).

Tip: Look in the direction of the hand that is attempting to rotate your head. If you are resisting the force of your right hand, look to your right. Using your eyes brings in a visual component to this isometric exercise, which stimulates your brain and incorporates an element of balance.

Exercise 2: Balancing Atlas-Axis with Side Bend

Position: Lie on your back with your head in a neutral position (chin in, nose pointing straight up at the ceiling). Do not put a pillow under your head unless you cannot rest your head comfortably without one. Place the heels of your hands on the tops of your ears or just slightly above your ears.

Exercise: With your chin tucked in as far as you can, press your right palm against the right side of your head as if it were attempt to block your right ear from moving to where your chin is now. Again, it’s your hand that is pressing against your head, not the other way around. The force of your hand should be equal to what the muscles at the base of your skull can oppose. This equal resistance prevents your head from moving out of the mid-line of your body. Repeat on the left side, using your left hand to keep your neck completely still. Repeat this exercise four times on both sides (4 counts x 4 sets).

Tip: The trick here is to use the pressure of your hand to prevent your neck from side bending at/near the base of your skull. The movement your hand is trying to prevent is a small bird-like tilting of your head at top of the neck. If you recruit all the muscles of the neck, you take away this exercise’s ability to mobilize the Atlas-Axis joint.

Exercise 3: Correcting C2’s Functional Relationship

Position: As with the Atlas-Axis Mobilization exercise you just completed, lie on your back with your head in a neutral position (chin in, nose pointing straight up at the ceiling). Do not put a pillow under your head unless you cannot rest your head comfortably without one. Start with the heels of your hands on the tops of your ears or just slightly above them.

Exercise: With your chin tucked in as far as you can, press your right palm against the right side of your head as if it were attempt to block your right ear from moving to where your chin is now. Your right hand prevents your head from moving. Again, it’s your hand that is pressing against your head, not the other way around. The force of your hand should be equal to what the muscles at the base of your skull can oppose. Turn your eyes to the right as well.

This time, instead of switching to your left hand after you have completed four counts, side bend your head slightly to the right so your ear moves slightly in the direction of your chin —as if you were taking up the slack that the previous set of this exercise created. All the side-bending movement should occur right at the base of your skull—not throughout your entire neck. Admittedly, this kind of selective motion is a little tricky at first, and it takes a few sessions to feel the difference between using your whole neck and using just the muscles at the base of the skull. When done correctly; however, this exercise produces powerful results.

Repeat this exercise four times, doing each set for four full counts, and then side bending your head slightly further towards your chin. Do this a total of four times, and then repeat on the other side.

Tip: As with the previous exercise, the trick here is to resist side bending your head from the base of your skull, while keeping the rest of your neck as steady as possible. Again, The movement you are trying to prevent is a small bird-like tilting of your head at top of the neck.

Congratulations! You’ve just completed the entire cervical stabilization and mobilization workout. The most startling benefit of doing these three exercises is the flexibility, mobility, and stability they create and maintain throughout your body, including your lower back.

Please let me know if you have any questions or concerns.

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Tagged as: atlas, axis, c1, c2, c3, cervical spine, cervical stabilization and mobilization, cervical vertebre