2 Neck Pain treatment Flashcards
What are the 4 subgroups of neck pain classification?
- Neck pain with mobility
- Neck pain with headache
- Neckpain without movement coordination impairments
- Neck pain with radiating pain
What are the symptoms of neck pain with mobility deficits?
- Central and/or unilateral neck pain
- Limitation in neck motion that consistently reproduces symptoms
- Associated (referred) shoulder girdle or upper extremity pain may be present
What exam findings would you find with Neck Pain Mobility deficits?
- Limited Cervical ROM
- Pain reproduced at end range (AROM/PROM)
- Restricted segmental mobility
- Intersegmental restriction
- Referred pain reproduced in provication of musculature
- Deficits in cervicoscapulothoric strength and motor control with subacute/chronic pain
What are the symptoms of neck pain with movement coordination impairments?
- Linked to whiplash/trauma
- Associated/reffered shoulder girdle/UE pain
- Associated non specfici concussion signs/symptoms
- Nausea/Dizziness
- Headache, concentration or memory difficulty, sensitive to stimuli
What are exam findings for Neck pain with movement and coordiation impairments?
- Positive cranial cervical flexion test
- Positive neck flecor muscle edurance test
- positive pressure algometry
- Stregth/endurance deficitis
- neck pain at MID RANGE and worse at endrange
- Point tenderness (trigger point)
- sensiomotor impairments (altered activation, proprioception, balance)
- Pain reproduced by provication of cervical segments inolved
What are symptoms of neck pain with headache?
- Noncontinuous, unilateral neck pain and associated headache
- headache is aggravated by neck movements or sustained position
What are the exam findings for neck pain with headache?
- Positive cervical flexion rotation test
- Headache reproduced with involved cervical segment provocation
- Limited cervical ROM
- Restricted upper cervical segmental mobility
- Strength, edurance, coordination deficits of the neck muscles
What are symptoms of neck pain with radicular pain?
- Narrow band of lancinating/radiating pain in extremity
- UE dermatomal paresthesia/numbness, myotomal weakness
What are exam findings in neck pain with radiating pain?
- Radiating pain reproduced or relieved with rediculopathy testing: postive clisters, upper limg nerve mobility, spurlings test, distraction, ROM
- UE sensory strength, reflex, sensory deficits
Describe the Acute phase of neck pain
- Highly irritable
- pain experienced at rest or with initial to mid range spinal movements (before tissue resistance)
What is the sub-acute phase of neck pain?
- Moderate irritability
- Pain experienced with mid-range motions that worse with end-range spinal movements: with tissue resistance
What is the chronic phase of neck pain?
- Low degree of irritability
- Pain that worsens with sustained end range spinal movements or positions (overpressure into tissue resistance)
What are the intervention strategies with neck pain with mobility deficits?
- Thoracic manips
- Cervical mobs/manips
- ROM/Stretching/Strengthening
What are the intervention strategies for pain with movement coordination impairments?
- Education/Advice
- Minimize collar use
- AROM/Strength exercises
- Proprioception exercise
- Cervical mobilization
- ICE HEAT TENS
What are intervention strategies for neck pain with headache?
- C1-2 Self SNAG
- CT mob/manipulation
- ROM/stretching/Strengthening
What are intervention strategies for neck pain with radiating pain?
- Intermittent traction
- Centralizing exercises
- Strength exercises
- CT Mob/manipulation
What are risk factors for neck pain?
- Female and prior history of neck pain
- Age > 40
- High job demands
- HIstory of smoking
- Low social or work support
- prior history of LBP
Describe high pain catastrophizing in neck pain
Pain catastrophinzing scale >20 cut off for prognosis
Describe acute post traumatic stress symptoms
- impact of events scale > 33
- not uncommon wth acute injuries
- predicts symptom chronicity not for PTSD
What are common AGGS for C Spine?
- Looking up
- Over shoulder/back up car
- Prolonged sit/ read/ computer
- Outstretched arm use
- Lifting
- Cough/Sneeze
- Use Pillow/ no pillow
what are common AGGS for T Spine?
- Rotate trunk
- Deep inhale/exhale
- cough/Sneeze
- Lifting
- Neck or UE movements
- Non movement (food related)
Describe common easing factors
- laying down
- pillows/no pillows (sign of instability)
- Sit with head/arm supported (decreases nerve root compression)
- Bracing
- Raise arm overhead (arm abduction sign)
- C4C5 radiculopathy ease
- Bakody’s sign
What is the NDI?
- Modified from ODI
- Most Commonly used
- 10 questions, scored 0-5 (higher = worse)
MCID = anything less than umber not different
great short term goal
What is the PSFS?
Patient specific functional scale
- 3 patient selected activites
- score: avg individual item scores
MCID: 2 in poits with Cervical radiculopathy
What is the FABQ?
- Feat avoidance Beliefs Questionnaire
- Pts with neck pain had weaker associations between fear avoidance beliefs, pain, and disability tha pts with low back pain
- Differenes in gender, symptom onset, payer source
- MCID = unknown
What is the NPRS MCID?
1.5 small but meaningful
What is the GROC?
Global Rating of change scale
- asses overall response to care
- score from -7 to +7
- 1 - 3 small change
- 4-5 mod
- 5-7 Large
+ve = better
need to if change is important to patient
