It’s really not fair! You have to wrestle with all the pain and muscle imbalances that go with having spasmodic Torticollis and it doesn’t get you off the hook! You still need to exercise regularly; in fact, you may need to exercise more. There are specific things that you need to address that the average person doesn’t. Let’s explore why we all need to exercise.

Physiological Changes over Time

As you start to move into your thirties, your body is already starting to age. By the time you hit forty you lose 10% of your aerobic capacity. You begin to have decreased muscle mass, local muscular endurance and strength. That extra 100
calories per day adds up to 1 pound/ year on the scales. The ability of your tissues to heal starts to diminish.

This decline continues: between 50 and 70 years of age there is a 30% reduction in strength, 10% loss of aerobic capacity per decade and most of us get stiffer. Another statistic to be aware of: 40% of women 55-64, 45% of women 65-74 and 65% of women 75-84 are unable to lift 10 pounds. That means they are unable to lift a bag of groceries; a total loss of independence.

The Good News

Your body will respond to training as you get older just as it did when you were younger. We lose strength and the ability to move through big ranges because most of us just stop moving! The postural issues and muscle imbalances caused by ST make you more vulnerable to osteoarthritis and tendonitis and exercise can really help address these problems.

Considerations for ST Exercisers

What kind of exercise do you need? It’s important that you work on all the systems that keep your body working well. Your heart and circulation require aerobic exercise to stay healthy. That means walking, swimming, cycling, elliptical machines or exercise classes that keep your heart rate in its target zone. At least three times a week for 30-40 minutes. Your muscles need to stay strong. That means strengthening by weight training, doing exercises that use your body weight as resistance e.g. a ball class, Pilates, Yoga or taking a class
that uses a selection of these activities. The evidence for improving strength and decreasing neck pain is well documented (2, 3, 4, 5, and 6). Stretching will help to lengthen the muscles that ST shortens, but it will also keep your whole body moving well and allow you to bend and reach and get up and down from the floor. You can do this with specific stretching, or take a class. Yoga and Pilates can be really helpful. (Figure 1)

Figure 1: Relaxing and stretching on the ball.

Exercise hurts me!

We all know we should exercise but that doesn’t mean we like it! ST’rs have their own sets of issues, including pain, which can make it difficult to exercise
successfully. I would like to suggest some principles that might make it easier for you to get started and then continue to exercise.

1. Time of day: Think about your body. When are your ST Symptoms at their worst? What works best for your schedule? Most of the ST’rs I have worked with are at their best in the morning, before they have had to fight gravity for the day. If you can make this work for your schedule this is probably the best time of day to exercise.
2. “Neuro Tricks”: It’s important to understand that your neck is a major intersection for information going to your brain and vice versa.
   There are reflexes associated with your neck that will bring your head into a normal upright position to maintain vision straight ahead (optical righting reflex) and bring your body into a normal position
   in space and relation to the ground (Labyrinthine or righting reflexes). These reflexes tie into your neck muscles to change your head and neck positions. Body position will also affect your ST. Lying on your back (supine) promotes flexion for your whole body. Lying on your stomach (prone) facilitates extension. Remember these ideas, they
   can help you.

Why do my symptoms get worse with bouncing or resistive exercise?

Your brain will always try to maintain your head position to help you look straight ahead. The brain also wants you to see clearly when you move. When you bounce, the brain increases the tone in the neck muscles to help support your head against gravity. When you lift weights in an upright position as your shoulders fatigue, you will recruit the muscles in your neck to help you which may increase the tightness in your neck. How do you overcome this? I think smooth rhythmic activities are the way to go. We know that the neurological system responds well to smooth rhythmic exercise. They are "calming" to the nervous system and less likely to fire up muscular tone e.g. swimming, yoga, Tai C'hi, walking, Nia, and Pilates (especially equipment work). (Figure 2)

	Figure 2: Leg press on a pilates reformer. Modified neck position with a pillow.
	Figure 3: Flexion series on a pilates cadillac table while sitting on a ball.

Don’t be afraid to modify how you exercise. Just because everyone else is standing or sitting up to exercise doesn’t mean that you have to. (Figure 4)

Figure 4: Exercising on a ball. In this position the head and neck are supported while the shoulders, abdominals, gluteal and leg muscles are strengthened.

If we think about body reflexes and if your ST tends to make your neck flex forward or forwards and sideways, exercising on your back can make that pattern stronger. You may want to exercise on your front to make those extensors work harder and counteract the flexion. Alternately, if your ST pattern pulls you backwards or backwards and sideways, exercising on your front will make those muscles work harder. So exercising on your back may be a better place for head control. You can also use your eyes to help contract the neck muscles you want to use. Looking down will make the muscles in the front of your neck work; looking up the extensors and to the side, the lateral flexors. If your head pulls to the left try directing your gaze to the right. (Figure 5)

Figure 5: Gazing to the right helps keep Helen's head in a better position by recruiting her neck muscles on the right, counterbalancing the muscles on the left.

Holding your head up against gravity is very hard work especially if you don’t have good posture because of ST. Your head weighs 10% of your body weight. Your neck muscles can hold on to that without difficulty if everything lines up well but if your head is 4 inches further forward or backwards the load placed by your head on your neck is 4 times that, e.g. If you weigh 150lbs, your head weighs approx. 15 lbs and if your head is 4 inches forward the load is 60lbs to your neck and just think of the stress on your low back (how many of you have low back problems?). So it’s important to use the best posture you can when exercising. It’s also really nice to get out of gravity and not fight it! (Figure 6)

Figure 6: This is a downward dog pose from yoga, it works on strength for the shoulders, mobility for the backs of the legs and heels and allows your neck to just hang and relax.

What About Stretching?

It’s really important to stretch the muscles that get tight with your ST. Muscles that are held in a consistently short position will start to lose muscle fibers, and in a worst case scenario, fibrose. If this happens there is no muscle to stretch any more. It has just changed to fibrous tissue. Your head position is
fixed.

Figure 7: Assisted stretch to the left lateral neck muscles (on the side)

There are a few things to consider when you stretch:

• Stretching should “stretch” not hurt!
• Move carefully and smoothly in and out of stretched positions
• Stretching aggressively and or bouncing will increase your tightness, not loosen you up
• Think about what you want to stretch and why (Figure 8)
• Modify positions so that all of your body feels good when you stretch. (Figure 9)

	Figure 8: This is a great stretch for the back of the neck and the whole spine.
	Figure 9: This is a modified version of the same stretch. Charlene has low back problems and could not tolerate the original bending position.

I’m a strong believer in thinking outside the box for exercising. Try not to get in a battle with your ST. Remember, you are unique. If you are to exercise successfully with ST it will require creativity, persistence and confidence that you are the expert on your own body. Don’t be afraid to seek out help if you can’t figure out how to modify your exercise program. A physical therapist is often a good place to start!

Mikki Townshend PT, OCS
mikki@newmotionpt.com