PostureJac Blog

The Total Core-Prone.

The Total Core Prone Exercise improves core strength and reduces lordosis

This next exercise is called the Total Core-Prone because it trains the core muscles from the upper cervical spine down to the pelvic floor.  Proposed muscle activation includes the following: the deep neck flexors, lower cervical multifidus, lower trapezius, transversus abdominis, lumbar mutifidus, oblique abdominals, rectus abdominis, pubococcygeus, gluteus maximus, etc.  It is an advanced exercise that requires physiologic mobility of the spine and pelvis before it should be attempted; at no time should painful symptoms be experienced by the patient.

a. The prone-lying patient sets the lumbopelvic region in a neutral physiologic position followed by activation of the pubococcygeus (eg. “stop urine flow”) and transversus abdominis (eg, indrawing of the navel to the spine on exhalation without performing a posterior pelvic tilt).

b. The PostureJac handles are then engaged in a downward direction while the patient retracts the head-neck region (ie, upper cervical flexion with lower cervical extension).  This will flatten the cervicothoracic junction by extending it slightly.

The patient’s upper limbs should be slightly externally rotated for optimal recruitment of the lower trapezius and posterior rotator cuff muscles (Fifure 25-).

c. The trunk should then be extended slightly, but not in the lumbar spine.  Preventing an arching of the lower back will recruit the global abdominal muscles and gluteus maximus.  The Stabilizer^TM (Chattanooga Group, Hixson, TN) can be used to further isolate the core muscles of the lumbopelvic region.

d. The Total Core-Prone can be repeated 5 – 10 times, held for 5 – 10 seconds, and repeated 2 –3 times per day.  The patient must be reminded to breathe normally throughout.

The HeadFlex.

It is becoming well established in the scientific literature that individuals with chronic primary headaches, to a large degree, suffer from weakness and poor endurance of the deep neck flexors (ie, rectus capitis anterior, rectus capitis lateralis, longus capitis, and longus colli), which is also correlated to forward head posture^34,35,36. By stabilizing the scapulothoracic region and lower cervical spine, the PostureJac can be used to dramatically improve function of the deep neck flexors (ie, strength and endurance). In addition, the reconditioning of this deep and local core system enables the superficial neck flexors (eg. sternocleidomastoid and scalene) to relax, which contributes to posture correction of the head-neck region.  Prior to commencing the HeadFlex exercise, the therapist should first address flexion limitation in the upper cervical spine (eg. inhibitive occipital distraction technique and occipital extensor stretching).  Otherwise, the deep neck flexors will be unable to achieve their full strength and endurance potential^37,38,39.

a. The supine-lying patient begins by engaging both handles down towards the feet.

b. When moderate pressure is felt under the shoulder straps, the patient performs a chin-tuck and raises the back of the head less than an inch off the surface (Figure 25-).  It is important that the motion be confined to the upper neck as much as possible.  This ensures that the superficial neck flexors are kept from substituting for the deep neck flexors.

c. The goal is for the patient to maintain this position for at least 10 seconds without shaking, raising, or lowering the head. As strength and endurance show signs of improving, the amount of downward pressure applied to the PostureJac handles can be lessened. The HeadFlex can be performed up to 3 times per day.

d. An advanced form of the HeadFlex exercise consists of performing it with the head-neck off the end of the treatment table (Figure 25-). This should only be attempted under professional supervision.

e. If at any time the patient experiences pain, dizziness, numbness, etc., the exercise should be stopped

The JacRetract.

This 2-stage exercise works very well with McKenzie’s neck retraction exercises³³.  The key to successful head-neck retraction is trunk stability.  Without it, the movement is only partially effective in restoring extension to the lower cervical spine.

Stage 1.

a. In the sitting or standing position, the patient engages the handles in a downward direction until there is moderate pressure against the shoulders.

b. In the chin-tucked position (chin to hyoid, eyes looking straight ahead, head rotation around ear axis), the patient retracts the head-neck backward  for 3 seconds.

c. Repeat this movement 10 times.

d. If at any time the patient experiences pain, dizziness, numbness, etc., the exercise should be stopped.

Stage 2.

a. At the end of Stage 1, the patient is instructed to turn slowly to the right  then slowly to the left, 10 times, maintaining the head-neck retraction throughout.

b. If at any time the patient experiences pain, dizziness, numbness, etc., the exercise should be stopped.

Under therapist supervision, some select patients may respond well to rotation from a position of head-neck retraction/extension .  This maneuver potentially closes the facet joints from C2 down to T4 and if done correctly can be helpful in both McKenzie’s dysfunction and derangement syndromes (see chapter 2). However, it should be done carefully as facet impingement can occur if done too quickly or too far into the range.

The Total Core-Standing.

This exercise activates the entire core system from the bottom up. It’s a wonderful way to “awaken” the postural support muscles of the entire body.

a. The patient stands with relaxed knees, finds his/her neutral lumbopelvic position, and then activates the core muscles of the lower torso (pubococcygeus, transversus abdominis, etc.)

b. The posterior fibers of the gluteus medius and gluteus maximus muscles are then contracted by slightly externally rotating the hips in the standing, weight bearing position.

c. The patient then engages the PostureJac handles towards the floor, adding slight external rotation of the shoulders (ie, lower trapezius and posterior rotator cuff activation).

d. From here the patient performs a chin-tuck/neck retraction movement to recruit the deep neck flexors and lower cervical multifidus .

e. From this position of total core activation, the patient performs partial squats 5 – 10 times . This not only dissociates the hips from a stable trunk, but also works the quads concentrically and eccentrically.

f. The Total Core-Standing should be done several times per day and used as a complete postural retraining tool.

5. The Head Turner.

Someone has said that, “Neutral is that position from which all movements are most free.” What a concept! The Head Turner consists of head-neck rotation performed from the neutral or orthostatic head-neck position.  Consequently, it allows for rotation that is more mobile than it otherwise would be.  In fact, the motion is typically felt to occur into the upper thoracic spine, which is quite beneficial.

a. The sitting or standing patient neutralizes his/her posture by lightly pressing down on the PostureJac handles and adjusting head-neck position to a more vertical alignment.

b. The patient then turns slowly to the right (Figure 25-) and back to the midline.

c. This movement is then repeated to the left side and back.

d. The patient turns at least 3 times to either side several times per day.

e. If at any time the patient experiences pain, dizziness, numbness, etc., the exercise should be stopped.

4. The TurtleNeck.

Similar to the Rocket and Piston, the name TurtleNeck paints a picture of spinal lengthening.  In this case, of a turtle’s head-neck emerging from its shell.  With that in mind, the procedure is quite simple.

a. The sitting or standing patient, or non-patient for that matter, pushes down on the “shell” as the head-neck region works its way in an upward direction (Figure 25-).

b. The TurtleNeck allows for stretching free-style.  The patient is instructed to feel for restrictions in the head-neck and shoulder muscles and use the PostureJac to elongate the head, neck, and spine.

c. This free-style stretching should be performed gently and for under a minute at first and then progressed in intensity and duration over the ensuing weeks.

d. The TurtleNeck exercise reinforces this concept of “shoulders down, spine up.”

e. If at any time the patient experiences pain, dizziness, numbness, etc., the exercise should be stopped.

Some people become frustrated when they don’t immediately experience spinal lengthening (aka the “spinal lift”) when using the PostureJac (eg. the Rocket exercise).  My sense is that, in many individuals, spinal lengthening has not been experienced for some time, perhaps never!  In order for the “spinal corkscrew” mechanism to work at least three things are required:
1. Range of motion.
2. Muscle strength.
3. Coordination.

In a sort of “priming the pump” maneuver, the Piston exercise is a good way of preparing for the Rocket.  By raising the shoulders first, the spine is more easily “jacked up” on the pushing down phase. Over time, the kinaesthetic awareness of this upward force of the spine will improve (like learning to ride a bike) and you’ll begin to experience the “lift” that we have been talking about on the website.

So, don’t get discouraged.  Stay with it and you’ll be taller and straighter in no time!

The Piston.

a. In the standing or sitting position, the patient performs a similar motion to the Rocket, but with an alternating up and down motion, resembling a piston in an engine’s cylinder .

b. A helpful analogy is the “3 elevator” illustration.  The patient imagines one “elevator” running up and down through the left shoulder, a second “elevator” running up and down through the right shoulder, and a third “elevator” running up and down through the center of the body (ie, the central column of the thorax).

c. Consequently, the “piston” motion involves the two shoulder “elevators” going down as the central “elevator” goes up; then the reverse occurs.  The upward motion of the middle “elevator” is similar to the upward lift of body posture that occurs with the Rocket and provides kinesthetic awareness of good posture, whereas the downward motion of the middle “elevator” enables the patient to experience poor posture as a means of contrast.

d. To exaggerate the piston experience, the patient is advised to squat down and slouch as the shoulders rise up ; proceed to toe standing as the shoulders are pressed down and the spine is lengthened . As with The Rocket, the patient must have the requisite balance before attempting the toe standing maneuver.

e. The Piston is performed up to 10 times, several times per day.  The downward force on the PostureJac handles can be increased as upward mobility of the torso improves.

f. To strengthen the corksrew mechanism, two loops of Thera-Band^â tubing (The Hygenic Corporation, Akron, OH) are used.  By draping the tubing on either side of the neck and holding it down with the opposite foot, resistance to the upward rise of the central column of the thorax is provided (Figure 25 – ).  The amount of resistance can be varied depending on the color of tubing used.  The patient must have the requisite mobility of the central column (ie, spine and sternum) before strengthening is commenced (this is a potent form of posture therapy and should be done under therapist supervision).

g. If at any time the patient experiences pain, dizziness, numbness, etc., the exercise should be stopped.

2. The Rocket.

The Rocket - Stage 1

a. In the standing or seated position (ideally in a chair without armrests so as to avoid interference), the patient pretends to be a rocket that is “blasting off.” As the PostureJac handles are pushed down with moderate pressure, the patient’s torso is propelled upward against gravity like a rocket until “lift-off” is experienced .  In fact, the rocket engine is an excellent example of Newton’s 3^rd Law of motion, which is crucial in grasping the mechanism by which the PostureJac improves body posture (ie, action and reaction).  If the rocket illustration fails to communicate a sense of upward rise of one’s body posture, perhaps the image of a fountain, rising from the base of the spine and working its way through the vertebral column to the top of the head, is preferred.

b. Initially, the joints of the thorax may not allow the unhindered upward rise of the central column of the thorax (ie, spine and sternum).  However, with time and practice this upward rise will free up and become second nature.

c. To enhance this feeling of “lift-off” the patient can rise up on his/her toes, as the spine is lengthening,

The Rocket - Stage 2

provided that the requisite balance is present .

d. As a stretching exercise, the Rocket is performed 3 times, held for up to 30 seconds, and repeated up to 6 times per day.  As a strengthening exercise, it is performed 10 times, held for 5 – 10 seconds, and performed 3 times per day.

e. If at any time the patient experiences pain, dizziness, numbness, etc., the exercise should be stopped.

Check out this video.     I think it is one of the best I’ve seen to demonstrate the importance of vertica axis to maintain mechanical efficiency and minimize muscle energy required to stay upright.     It shows the consequences of poor posture on our frame and body organs and how excessive energy is required to sustain an inefficient structure.        As we lose energy in the aging process, the collapse accelerates and causes chronic pain and disability.

The PostureJac aids the body in finding that plumb line to maintain that ideal vertical alignment.   It promotes the spinal lift that is demonstrated when people carry heavy loads on their head.     See the Spinal Lift page  for more details.