Physiotherapy and exercises for cervical dystonia Information for patients This leaflet has advice on physiotherapy and exercises you can do to help control cervical dystonia. If you have any queries, please speak to your physiotherapist.

How can physiotherapy help me? The aims of physiotherapy for cervical dystonia are:    

help your spine and neck muscles stay flexible reduce your spasms, if you experience them reduce any pain and/or discomfort control the position of your head

You may find some activities are harder because they make your abnormal neck movement worse. You may also find that sometimes the twisting, or pulling, of your neck (torticollis) seems to go away. Things that can make your symptoms worse

Things you can do to ease your symptoms

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Stress and self-consciousness

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Sleeping

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Walking

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Lying down

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Tiredness

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Relaxation

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Carrying a bag on the shoulder that your head turns towards.

What can I do to manage cervical dystonia? TV/computer screens Do not set up your TV or computer differently to allow for your abnormal head position. Instead, sit with the screen directly in front of you and take lots of short breaks.

Relaxation A relaxation class or an activity such as Thai Chi may help improve your symptoms. A way of relaxing you can do by yourself is diaphragmatic breathing. It can help you to relax in stressful situations. Your diaphragm is the muscle that separates your stomach (abdomen) from your chest. When you use your diaphragm to breathe you have the most air going into and out of your lungs.

How to do diaphragmatic breathing? Learn this way of breathing to help you relax in stressful situations: • • • • •

Choose a quiet place with little or no interruptions and noise Wear loose clothing and sit or lie down comfortably Place one hand on your chest and the other on your stomach Breathe in slowly through your nose and watch your stomach rise Breathe out slowly through your mouth and watch your stomach gently fall back down • Keep breathing slowly and pause after breathing in and breathing out.

Exercise Exercise will not cure cervical dystonia but it can help you to control it. It works best if you are relaxed, so try to do it after diaphragmatic breathing. There are three different types of exercise for cervical dystonia: 1. 2. 3.

Range of movement, where you gradually move your head a little bit further each time. Midline awareness, where you try to keep your head in the target position for longer each time. Stretches.

Range of movement exercises These exercises aim to improve how far you can move your head in all directions. Only move your head as far as comfortable – you should not feel any pain. You may find it useful to do them in front of a mirror so you can see what you are doing and whether you are improving.

Neck flexion/extension

Left and right lateral flexion

Left and right rotation

Midline awareness exercises These help your body to relearn the ability to know when your head is straight. Look at a mirror and practise moving your head into what is known as the midline position, by lining up your chin with the v-shaped

cavity at the bottom of your neck. Start by doing this with your eyes open and gradually build up how long you can stay in this position. After a while, try doing these exercises with your eyes closed.

Chin tuck This can help you to reduce the pull of the muscles at the front of your neck. Sit up tall, on a well-supported chair and tuck your chin backwards and down into your neck.

Stretches Stretches can help you to increase or keep a range of neck movements. Your physiotherapist will tell you which stretches and in which direction to do them in. Your physiotherapist may give you other exercises that are aimed at you individual needs.

Core stability You may be advised to do some basic ‘core stability’ exercises. Your core muscles are deep muscles within your tummy. They connect your spine, pelvis and shoulders. People with cervical dystonia often have weak core muscles which may help make certain neck muscles overactive.

1.

Engaging your core muscles: Starting position: lie on your back with your knees bent, feet flat on the floor and hip-width apart, and your arms by your sides. Make sure your neck is relaxed. You may need one or two pillows under your head – your physiotherapist will advise you on the best position.

Action: Gently pull your tummy muscles in, and pull your pelvic floor muscles up and in, as if you are stopping yourself from passing urine and wind at the same time. Hold this position for 10-60 seconds as you breathe. 3.

One leg stretch:

Lie down in the starting position and engage your core muscles, as before. Slowly slide one heel forward to straighten your leg. Only move as far as a neutral spine allows. Do not let your pelvis twist. Slowly move your leg to the start position. 3.

Knee drop out:

Lie down in the starting position and engage your core muscles, as before. Slowly roll one leg outwards. Only move as far as a neutral spine allows. Do not let your pelvis twist.

Sharing your information We have teamed up with Guy's and St Thomas' Hospitals in a partnership known as King’s Health Partners Academic Health Sciences Centre. We are working together to give our patients the best possible care, so you might find we invite you for appointments at Guy's or St Thomas'. To make sure everyone you meet always has the most up-to-date information about your health, we may share information about you between the hospitals.

Care provided by students We provide clinical training where our students get practical experience by treating patients. Please tell your doctor or nurse if you do not want students to be involved in your care. Your treatment will not be affected by your decision.

PALS The Patient Advice and Liaison Service (PALS) is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. The PALS office is located

on the ground floor of the Hambleden Wing, near the main entrance on Bessemer Road - staff will be happy to direct you. Tel: Fax: Email:

020 3299 3601 020 3299 3626 [email protected]

If you would like the information in this leaflet in a different language or format, please contact PALS on 020 3299 1844.

www.kch.nhs.uk PL628 July 2014

Corporate Comms: 0828 Review date July 2017