SHOULD I retract my head?
The head retraction is an essential part of neck therapy. It is a normal, physiological movement, that is prescribed around the world, by physicians, physiotherapists, osteopaths, chiropractors and more, due to its ability to help.
There are many variations of it. I tell my patients, do not do an exercise unless your therapist tells you WHY. And how often, and with what technique. And again, WHY! Same goes if a health professional advises you NOT to do an exercise, or sleep on your stomach, or look up and back with your neck…. There are no, across the board, unsafe movements or positions, but some CAN be harmful depending on your condition. Reasons should be given so that you the client can be empowered with the understanding, and be able to ultimately trouble shoot movements / exercises on your own, and more independently manage your symptoms. So do not perform repeated head retractions unless it has been prescribed to you, as a remedial exercise.
Let's assume you have been prescribed this movement to do on a regular basis. I have noticed 2 common techniques taught. One, with the head in a neutral position, and another, with a flexion direction added in. They have different indications.
VARIATIONS of The Head Retraction
The neutral position head retraction tends to displace discal material anteriorly, thereby helping most discogenic issues that require this direction of displacement. Also, for the same reason, it is helpful for headache patients who have sensitization of the brainstem from asymmetrical pressure distribution on the disc, which tends to be posteriorly displaced, from a forward head posture.
The flexion added head retraction (which I do not tend to prescribe) tends to be done to "stretch out" sub occipital muscles. It can also be used to re-model an adherent nerve root (which typically develops after a long-standing herniation). However, caution should be taken as this flexion force also does displace disc material posteriorly, which, as explained above, may be not advisable in certain conditions.
I am a liberal physio, I like to push what a patient can do, in the name of expediting recovery. But there are, as we say in the business, ‘directional preferences’ when it comes to disc issues, and certain directions like repeated flexion of the spine CAN sometimes be deleterious in the recovery. I see more often than not, the client is doing something that is preventing their healing, and sometimes the focus is on doing the right treatment, but not enough digging is done to ultimately determine and advise the client on what NOT to do. Finally, when someone is recovering from a disc issue, flexion LATER is often required to fully heal, but there is a time and place for it.
COMMON ISSUES with correct performance of The Head Retraction:
- Adding flexion or extension to the movement. Some clients are unknowingly doing this!
Strategies to Fix:
- set your gaze forward, if your gaze goes up or down, so will your chin.
- Imagine wearing a baseball cap, the brim should not move down as you retract.
- Imagine a drawer closing, it moves straight back, not up or down.
- Imagine smelly cheese- and move your head back away from it.
- Use your hand on the chin to guide you, I know, it can be a weird movement to learn - this can make it easier!
- Breathe during, generally a good tip with most exercises. 😊
- Don’t try it in the car when driving, as the headrest will often stop the head movement back and then you end up flexing downwards.
- Look in the mirror, ensure that you are indeed retracting the head and not just tipping back from your mid back.
I have taught this movement to students, clients of all ages, from 5 years to 90 years of age, to physicians, neurologists, dentists, and to a room full of PT’s. It does take a few minutes of practice, but is worth the efforts. 😊
POSITION, FORCE and TIME Enhancements of The Head Retraction
- Can be done in sitting, standing, supine over the edge of a table or bed or resting propped up on your forearms.
- Can be done with self overpressure on the chin, mobilization from a therapist, and with a strap around the neck, to provide more effective segmental motion.
- Can be held for 0.5 seconds to 3 minutes, depending on the issue and response to movement.
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