Thread by @Retlouping

Todays episode of “Old man shouting at the clouds”
Today I will cover some of the myths, controversies and falsify McKenzies opinion about the need to retract before extending the cervical spine to ensure end range cervical extension. Strap in (pictures added at the end)

As discussed in my previous tweetorials the head and neck work as a unit driven by the eyes and ears, the joints above C2 are the head joints and those below are the neck joints. Thus the head can also move independently of the neck joints to produce paradoxical motion.

These paradoxical motions allow the eyes to focus on an object whilst the gross motion of the neck is in the opposite direction.
Cervical retraction or head on neck retraction is McKenzie exercise, but he didn’t invent the motion, retraction is a functional motion.

Look at the soccer (football) player throwing a ball at the end of the thread. Mckenzie utilized the motion as a therepeutic less loaded form of neck extension. This may seem a foreign concept to some, but let me propose the loading and motion.
There are four functional sagittal

Motions of th head and neck, flexion literally looking wonderful and taking your chin down to chest, extension, rolling your head back and looking behind, protrusion, sitting slouch ed with head forward and retraction, drawing head back and chin drawn in towards neck.

The first three are common movement , retraction is less common, but occurs when we are startled or when we play sport and throw with two arms from and overhead position.
Functional flexion (looking down) is when the head and neck move together in to flexion.

Extension is when the head and neck move together, t is important to think that this is a long lever and gravity acts on the weight of the head, this causes quite high loads on the paosteriro articular surfaces of the neck. Protrusion and Retraction are when the head moves ....

In the opposite direction to the neck. Protrusion is flexion of the neck and extension of the head joints (predominantly OA joint extension), Retraction is the opposite neck extension with head flexion (again predominantly OA joint flexion) Studies by Penning et al showed...

That in protrusion and retraction this is the greatest motion of the OA joint and thus may explain the common production of headaches in protrusion and therpeutic effect of Retraction for some headaches.

Retraction also has important loading differences than head and neck extension motion, which was highland long lever. Retraction keeps gravity axially and the weight of the head moves anteriorly as the OA joint flexes. This may be why retraction is a more comfortable

When yo have neck pain , as there is less load on the posterior neck joints.
Mckenzie suggests that you need to perform retraction before extension to ensure you reach end range of cervical extension in sitting. This is not true. I have posted “Rabbit Ears extension” below

By utilizing a pillow case to take the weight of the head and focusing your eyes on the “rabbit ears” raising your arms and extending your head and neck will achieve end range withotu retracting first. The reason for this s that the thoracic spine is moving as the arms raise.

I propose three useful loading strategies to achieve cervical extension in sitting. First you must be in a straight back chair supported to the level of the Lower scapula angle around T8.

Rabbit ears is the least load as the head weight is taken by the pillow case, retraction is the next least load, as the head weight is carried axially and th head flexes as the neck extends, finally retraction extension is most load.

It is important to understand the paradoxical movements between head joints and neck joints, it will allow you to understand the different functions of the head and neck. I will post pictures below to illustrate the text. Understanding these principles are useful for headache

And neck pain treatment, most will allow patient self treatment strategies to be implemented.

Thanks for reading

@threadreaderapp unroll please