The downward dog is a commonly performed exercise in Yoga and has become a popular "stretch". Although this exercise has huge upside if performed correctly it is unfortunately common to see people perform this exercise in positions and with techniques that compromise the optimum balance of stability and mobility (which is really important for healthy joints). For this reason, many people are not receiving the benefit of performing this exercise and in some cases people are getting hurt. A few colleagues and I have seen more than a handful of patients present with low back and/or shoulder pain after performing an ill-executed downward dog. 

This video was taken at my clinic in Victoria and highlights some of the common errors in performing the downward dog and provides some pointers on how to perform it safely. This video should not replace effective one-on-one instruction.

p.s. I aplogize for the video quality... my HD videocamera broke and all I had was my phone... the quality is definitely good enough to get the point though, so please watch, comment, share.

Cervical radiculopathy (CR) is reported to affect about 3.5 persons per 1000. The condition mostly affects those who are in their 50s and 60s and it does not seem to be gender specific. CR is not typically the result of trauma, rather it is most commonly caused by a cervical disc herniation or a combination of discogenic and spondylotic changes that have become aggravated. 

Common symptoms of CR include neck and radicular pain as well as paresthesia. Scapular pain is also common and was present in 51.6% of cases in one study (1). 

Physical examination findings typically include painful cervical spine range of motion (ROM) and decreased deep tendon reflexes. Other findings include muscle weakness in 15% of cases, decreased sensation in 1/3 of cases, and rarely muscle atrophy, which is present in less than 2% of cases. 

The C7 nerve root is the most commonly involved level, which was present in 39.3%-46.3% of patients in one study; followed by C6 in 17.6%-42.6% of cases (2). 

An extensive review of the literature found insufficient evidence to draw firm conclusions about which treatments are appropriate for CR, nor could they identify therapies that are contraindicated (3). Another review reported that the evidence for manipulative therapy in CR is minimal, low in quality and has a high risk of bias (4). Nonetheless, 93% of chiropractors reported that they would use spinal manipulative therapy (SMT) in a patient with suspected or confirmed cervical disc herniation (4). Other manual medicine professionals employ this treatment as well. 

If you have ever had pain or an injury you are familiar with the sensation of stiffness, tightness, spasm, or “locking” of the joint(s) and muscles surrounding the area of pain. This is an automatic and neurological response to pain, inflammation, and injury, that serves the purpose of limiting movement around an injured joint. We call this response neuromuscular facilitation. Neuromuscular facilitation results in a state that we refer to as hypertonicity (i.e. increased muscle tone), with the result being increased stiffness and limited mobility. If you have ever had pain, you likely know what this feels like.