Burner – Stinger Rehab Program
When an athlete suffers a burner or stinger, it is usually due to the nerve being traumatized in some way. If there is disk involvement in the cervical spine, then this program will not be beneficial and could even be detrimental to the athlete. Make sure that the integrity of the cervical spine is good via communication with the athletic trainer and/or a physician.
The exercises are simple to implement, but it is crucial to err on the side of caution. When this program was first implemented back in the mid- 80’s for college level football athletes, the information we were given from the medical staff was that the damaged nerve only recovers at 2-5 mm per week. In severe cases there was tingling, numbness and weakness to the hand, meaning the athlete could be out several months. The second caution the medical staff advised us to be cognizant of was that the nerve would tire rather quickly. So many exercises were done to the limit of the damaged side with dumbbells that were unequal in weight so that the nerve was allowed to progress in recovery and regeneration. Neural tiredness is characterized by a heavy, tired, dull, dead and/or weak feeling. When this happens it can actually slow or even harm the recovery process of the nerve.
The exercises are as follows:
Manual Neck –
This drill is done four ways emphasizing both the concentric and eccentric resistance range of motion. The anterior version wraps the towel over the forehead and on the chin for grip and for sanitary purposes. The athlete will lie on their back and concentrically go from almost full extension to almost full flexion with resistance. Then the partner will provide the force to eccentrically push the head back to almost full extension. Do not get to full extension as this may trigger the nerve and cause the burner/stinger symptoms again.
The prone version requires the athlete to roll over onto their stomach. The towel is placed upon their posterior skull and the athlete will go from almost full flexion with resistance to almost full extension. The partner will again provide resistance for the eccentric portion of the range of motion. Again, the purpose behind going from almost full extension to almost full flexion is that no additional stinger event will be caused by the exercise program, as this would set the recovery process back.
Lateral is accomplished by having the athlete sit upright at the end of a bench and grab the front of the bench so there is no lateral flexion of the upper body. The towel goes over the head and the resistor places one hand on the outside of the head and the other will support the outside of the opposite shoulder. The athlete will attempt to go from ear on the shoulder to ear on the shoulder with concentric and eccentric resistance just as in the anterior and posterior versions of the exercise.
Shrug Series –
There are four versions of shrugs that are incorporated into the burner/stinger program. The first is the overhead shrug. This is not a strength exercise as much as a motor learning exercise. In contact sports the upper shoulder complex must brace and support the neck upon contact. This is accomplished by elevation or “bowing the neck” and many athletes are unable to do this movement with the arms in an overhead, extended position. Holding a bar overhead in a fully extended, locked out snatch grip, have the athlete attempt to press the bar using shoulder elevation. As the athlete does this, the spotter should place each of his index fingers on either side of the neck under the ears. The athlete should attempt to pinch the spotter’s fingers between the traps and neck muscles. The load is a bar only. Full ROM is important, especially at the top end or fully contracted part of the movement.
The second shrug to learn is the hang shrug. This shrug is done from the hang clean position with dumbbells in order to force the athlete to shrug up and back to increase the strength of the upper and mid trap in order to support the elevation/bowing action. This is also a motor learning drill that once learned, can be moderately loaded. Full ROM is important, especially at the top end or fully contracted part of the movement.
The next version is the bent over shrug. Just as the name implies, the athlete is bent over so that the back is parallel to the ground and the dumbbells are hanging from the shoulders in the hands. Varying of the grips by rotating the dumbbells will challenge the motor learning part of the exercise. Emphasis should be put on contracting the traps/shoulder blades down and back for full contraction. This drill can be moderately loaded. Full ROM is important, especially at the top end or fully contracted part of the movement. The dumbbells will go from the hang position in front of the thigh to the outer hip, almost to the back pocket.
The final version is the upright row, again with dumbbells in order to allow each side to be appropriately challenged without over stimulus of the nervous system. This version can be loaded the most in relation to the other drills. The spotter technique of placing the fingers on the traps is again recommended here so that full ROM contraction of the traps is accomplished.
Recommended Training Program –
The sets and reps are determined by the ability of the athlete and the traumatized nerve(s) to withstand the level of stimulus with out being over trained. Manual neck sets and reps are 1 set of 8-10 reps. As the athlete progresses, this becomes a max effort drill in which the athlete can only do 10 reps each direction. For each of the shrugs, begin with 1 set of 8-10 reps. As the athlete becomes accustomed to the training prescription, the volume can be progressed up to 3 sets of 8-10 reps. Remember that quality is much more important than quantity as the rehabilitation program progresses.
In injury prevention programs, emphasize ROM, optimal patterning and quality movements. The loads can be moderately heavy as long as full ROM is performed. Prescriptions can be 3 x 8-10 down to 4 x 5-6 or even 10-8-6-4.
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