Omar Ward

Prevent & Treat Final

Dr. Tuscan

May 4, 2020

I was working a college football game and the running back for the team was being

tackled from behind by a defender and while falling forward his neck was grabbed under his

helmet by another defender coming from in front of him and had his neck and back

hyperextended way past the normal range. The player was lying on his stomach after the

defenders got off of the top of him. The client was describing a burning pain in his lower cervical

area and he couldn’t move his neck. Also described the pain to be radiating from his shoulder all

the way down to his middle finger. When he said the pain was radiating down to his middle

finger I knew it was a herniated disc in his c-6-c7 vertebrae. I told the player that we were going

to schedule an MRI as fast as possible but in the meantime he was going to have to ice and heat

the area so the swelling is reduced and can take over the counter medication to contain the pain

also. Not to be bed ridden move around a little bit but all normal activities are cancelled until

notified.

The MRI was scheduled a week later and the results came back a herniated disc between

c6-c7. When experiencing a herniated disc it is the Intervertebral discs located between

vertebrae, Consist of a fibrous outer ring (annulus fibrosus), a core of a semifluid substance

(nucleus pulposus). A herniated disc is the breakdown of the annulus fibrosus, where a portion,

or all, of the nucleus pulposus protrudes.

Herniation between the c6-c7 vertebrae symptoms include Pain radiating from the neck

over the posterior central arm to the dorsal side of the index, middle & radial ½ of the ring
finger. Sensory loss would occur in the same areas and the triceps and wrist flexor muscles may

demonstrate weakness. The triceps reflex is also affected. Surgery will not be needed to treat him

thankfully but he will have to endure six weeks of therapy to fully return to the sport.

The plan listed under this section is the six week therapy program setup for the client to

follow so that they can return to their football activities. He will meet with a physical therapist

three times a week and the exercises can be done at home also .

Week 1-2

Weeks one and two will consist of a lot of stretching to relieve the pain and get more motion in

the area injured.

Pre Stretching:

● Heating pad on the injured area for 15 minutes to reduce swelling

● After heating electric stim with a TENS unit will be given to stimulate the muscles and

prevent oxidative damage of the myocardial tissues.

● Massage therapy will be done to the affected area with massage lotion on the affected

area palpating gently to break up any scary tissue and activate the muscles in the area

Stretches:

1. Lateral bend

● Sit up tall and relax your shoulders.

● Slowly tilt your head to one side as if you’re going to touch your ear to your shoulder.
● Hold this position for 30 seconds, then rest. Repeat 3 times

2. Scalene stretch

● Sit up tall and relax your shoulders.

 ● Grasp the chair you’re sitting in with your left hand and let your shoulder blade move
down.
● Slowly bend your right ear down toward your right shoulder and slightly backward.
● Hold this position for 30 seconds, rest, and repeat 3 times each side

3. Neck rotation

● Sit up tall and relax your shoulders.

● Gently turn your head to the side. Don’t over-rotate your head behind you and avoid
twisting your neck.
● Slowly turn your head to the other side.
● Hold each position for 30 seconds. Repeat 3 times

Weeks 3-5

Weeks 3-5 will be the strengthening phase where the athlete will do exercises to start utilizing
the muscles in the injured area. By the end of week 5 the athlete should be able to start walking
through practice reps with no contact at about 75%. The pre strength exercises will be the same
routine to keep the body going.

Pre Strength Exercises :

● Heating pad on the injured area for 15 minutes to reduce swelling

● After heating electric stim with a TENS unit will be given to stimulate the muscles and

prevent oxidative damage of the myocardial tissues.

● Massage therapy will be done to the affected area with massage lotion on the affected

area palpating gently to break up any scary tissue and activate the muscles in the area

Strength Exercises:

1. Neck extension
 ● Lie on your back on a table or bed with the bottom of your neck in line with the edge.
● Slowly and gently lower your head backward and let it hang. If this makes your pain
worse, or sends pain down your arm, don’t continue.
● Hold this position for 1 minute, rest 1 minute, and repeat 5 to 15 times.

2. Neck extension with head lift

● Lie on your stomach on a table or bed with your arms by your side and head hanging off
the structure.
● Slowly and gently raise your head up, extending your neck against gravity.
● Hold this position for 5 to 10 seconds. Repeat 15 to 20 times.

3. Neck retraction (chin tuck)

● Lie on your back with your head on the bed and hands by your side.
● Tuck your chin in toward your chest, making a double chin.
● Hold this position for 5 to 10 seconds. Repeat 15 to 20 times.

4. Shoulder retraction

● Sit or stand against a wall with your arms by your side.

● Bend your elbows to 90 degrees.
● Bring your shoulders down and back and push the back of your arms toward the wall,
squeezing your shoulder blades together.

5. Isometric hold

● Sit up tall and relax your shoulders. Put your hand on your forehead.
● Press your head into your hand without moving your head.
● Hold this position for 5 to 15 seconds. Repeat 15 times.

Week 6
This will be the testing stage and to determine if the athlete is ready to fully engage in full
contact and go back to participate in all football activities. Before testing the same pre work and
strengthening week will be done and afterwards the testing will be done.

Pre Strength Exercises :

● Heating pad on the injured area for 15 minutes to reduce swelling

● After heating electric stim with a TENS unit will be given to stimulate the muscles and

prevent oxidative damage of the myocardial tissues.

Strength Exercises:

1. Neck extension

● Lie on your back on a table or bed with the bottom of your neck in line with the edge.
● Slowly and gently lower your head backward and let it hang. If this makes your pain
worse, or sends pain down your arm, don’t continue.
● Hold this position for 1 minute, rest 1 minute, and repeat 5 to 15 times.

2. Neck extension with head lift

● Lie on your stomach on a table or bed with your arms by your side and head hanging off
the structure.
● Slowly and gently raise your head up, extending your neck against gravity.
● Hold this position for 5 to 10 seconds. Repeat 15 to 20 times.

3. Neck retraction (chin tuck)

● Lie on your back with your head on the bed and hands by your side.
● Tuck your chin in toward your chest, making a double chin.
● Hold this position for 5 to 10 seconds. Repeat 15 to 20 times.

4. Shoulder retraction
 ● Sit or stand against a wall with your arms by your side.
● Bend your elbows to 90 degrees.
● Bring your shoulders down and back and push the back of your arms toward the wall,
squeezing your shoulder blades together.

5. Isometric hold

● Sit up tall and relax your shoulders. Put your hand on your forehead.
● Press your head into your hand without moving your head.
● Hold this position for 5 to 15 seconds. Repeat 15 times.

Testing

Spurling's test can help diagnose acute radiculopathy. This test is performed by
maximally extending the neck and rotating towards the involved side while compressing the
head to load the cervical spine axially.

Return to Activity:

Week 6 is when the athlete can return back to activity and if the athlete is pain free, completely
neurologically intact (no persistent numbness or weakness), has full strength and range of motion
they are in the clear to participate in all activities.
Bibliography

https://www.youtube.com/watch?v=9gjdmww3vgM

https://mayfieldclinic.com/pe-hcdisc.htm

https://www.healthline.com/health/fitness-exercise/herniated-disk-exercises

https://www.spine-health.com/conditions/spine-anatomy/c6-c7-treatment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146184/

https://www.ncbi.nlm.nih.gov/books/NBK546618/

http://www.scottsdalesportsmedicine.com/content/herniated-discs-my-spine-when-can-i-return-

my-sport

https://www.pinterest.com/pin/461196818085812384/

https://www.slideshare.net/tobyscottdc/cervical-spine-stretching-1648236

scalene neck stretch with chair

https://redefiningstrength.com/essential-exercise-scapular-wall-holds/

https://health.cornell.edu/sites/health/files/pdf-library/acute-neck-pain.pdf

https://myrehabconnection.com/cervical-extensor-exercise-progressions/

https://www.gymvisual.com/illustrations/3925-lying-neck-extension-stretch.html

https://www.afrugalchick.com/woot-sunbeam-renue-heat-therapy-neck-shoulder-wrap-heating-

pad-21-99-33-everywhere-else/

https://pantherpt.com/physical-therapy-treatments/electrical-stimulation/

https://www.spine-health.com/conditions/neck-pain/massage-therapy-chronic-stiff-neck