(3) Cervical Spine Interventions Flashcards
What are the two main objectives to Cervical Spine interventions?
Reverse dysfunctions
Prevent recurrence / transition to chronic symptoms
Acute Phase Goals
Educate / encourage pt to perform ADLs as tolerated (return to activity 2-4 days post-injury)
Absence from abuse > absolute rest (unless severe pain reported with all head and neck movements)
Head in neutral when sleeping in SL or supine
Increase pain-free ROM
Regain soft tissue extensibility / NM control
Initiate cervical stabilization program at earliest opportunity
Allow progression to sub-acute phase
In the Acute Phase related to a c-spine injury, should the PT promote absolute rest?
If possible, no! (unless symptoms are severe)
Get moving ASAP
Improving movement in what area of the body during the Acute Phase can decrease stress placed on the C-Spine?
T-Spine - area is often more stiff than C-Spine itself
What form of cardio is recommended during the Acute Phase?
Walking - less stress on tissues
Have pt return to swimming / running as able
What type of strengthening / re-education is recommended during the Acute Phase?
Global strengthening and postural re-ed
Scapular control
Core / LE strength and endurance
Cervical Collars
vs. Active Interventions / Indication / Functions
Active interventions preferred due to increased recovery outcomes
Collars CAN be used to support head and neck if pt has severe capsular restriction
Functions:
Maintain erect c-spine
Remind pt neck is injured
Allows pt to rest chin during activity (offsetting weight of head)
Allows pt to perform cervical rotation while weight of head is offset
Sub-Acute Phase Goals
Achieve significant decrease or complete resolution of pt’s pain
Restoration of full and pain-free vertebral ROM
Postural stabilization re-training of entire spine (CT stabilization and strengthening in gravity-eliminated and against gravity situations for neck and UQ)
Full integration of entire upper and lower kinetic chains
Ergonomic changes to workplace to decrease stress (computer at eye level in desk job scenario)
Overall strength and CV fitness training
Research suggests that the ___ phase is CRITICAL in preventing chronicity and disability.
Sub-Acute
Sub-Acute Phase Interventions
Mobility and strengthening exercises to maintain ROM
Aerobic exercise for symptom modulation and increased activity tolerance
Functional training to ensure pt maximizes gains made in PT (what activities does the pt need to return to?)
Chronic Phase Approach
Maximize function
Pay attention to yellow flags
Use multi-modal approach (CBT / aerobic exercise / meds)
Neck Pain Classification Categories (Buckets)
Neck Pain w/ Mobility Deficits
Neck Pain w/ Movement Coordination Impairments (WAD)
Neck Pain w/ HAs
Neck Pain w/ Radiating Pain
Neck Pain w/ Mobility Deficits
Common Signs and Symptoms
Central / unilateral neck pain
Limitation in neck ROM that consistently reproduces symptoms
Referred shoulder girdle / UE pain may be present (facet dysfunction)
Neck Pain w/ Mobility Deficits
Expected Exam Findings
Limited cervical ROM
Neck pain reproduced at end ranges (AROM and PROM)
Restricted segmental cervical and thoracic mobility
Neck and referred pain (reproduced with provocation of involved c-spine or t-spine segments)
Deficits in cervico-scapulo-thoracic strength and motor control (sub-acute and chronic cases)
Central vs. Unilateral Neck Pain (Neck Pain w/ Mobility Deficits Bucket)
Facet Joint referrals tend to be unilateral (younger people)
Central neck pain associated with pain at end range of ALL ROM (older people)
Neck Pain w/ Mobility Deficits
Acute Phase Interventions
Thoracic manipulation
Neck ROM
ST / UE strengthening
Cervical manipulation / mobilization
Neck Pain w/ Mobility Deficits
Sub-Acute Phase Interventions
Neck / shoulder girdle endurance exercises
Thoracic / cervical manipulation
Cervical mobilization
Neck Pain w/ Mobility Deficits
Chronic Phase Interventions
Thoracic manipulation
Cervical manipulation / mobilization
Cervical / ST region exercise (neuromuscular / stretching / strengthening)
Patient education
Neck Pain w/ Movement Coordination Impairments (WAD)
Common Signs and Symptoms
MOI linked to trauma or whiplash OR general hypermobility (gradual onset, no clear MOI)
Referred shoulder girdle or UE pain
Non-specific concussive S&S
Dizziness / nausea
HA, concentration or memory deficits
Confusion
Hypersensitivity to stimuli
Heightened affective distress
In the case of hypermobility, what can patients sometimes experience (related to pain) at end-range?
They may feel relief!
Neck Pain w/ Movement Coordination Impairments (WAD)
Expected Exam Findings
(+) Cranial Cervical Flexion Test / Neck Flexor Muscle Endurance Test / Pressure Algometry
Strength / endurance deficits in neck muscles
Neck pain at mid-range that worsens with end-range positions
Point tenderness (trigger points)
Altered muscle activation patterns / proprioceptive deficits / postural balance or control
Neck pain and referred pain reproduced by provocation of involved segments
