3 Neck Pain Mobility WAD Flashcards
What are the common symptoms of neckpain with mobility deficits?
- Central and unilateral neck pain
- limitation in neck motion that reproduces symptoms
- Associated shoudler girdle and UE pain that may be present
What is are the expected exam findings for neck pain with mobility deficits?
- Limited cervical ROM
- Neck pain reproduced at end ranges of AROM/PROM
- Restricted C and T segmental mobility
- Neck and reffered pain reproduced with provication of involved C or Upper thoracic segments or cervical musculature
- Deficits in cervicoscapulothoracic strength and motor control presented with individuals with subacute or chronic neck pain
What the the physical impairment measures?
- Cervical AROM
- Cervical and thoracic segmental mobility
Check for symtom reproduction and when in range is pain produced?
What are the Acute interventions for neck pain with mobility impairments?
- Thoracic manipulation
- Cervical mobilization or manip
- Cervical ROM, stretching, isometric strengthening
- Advice to stay active + ROM/Isometric HEP exercise
- Supervised exercise
- Stay active (general fitness training)
What are the subacute interventions for mobility deficits?
- Cervical/Thoracic manip/mobilization
- Cervivoscapulothoric Endurance exercise
What are the interventions for chronic mobility deficits?
- Thoracic manipulation
- Cervical mobilization
- Combined Cervicoscapulothoric exercise plus mobiliation + maip
- Mixed exercise for coordination, proprioception, postural training, stretching, strengthening, endurance, cognitive affective elemments
- Stay active lifestyle
- Dry needle, low level laser, High power US, traction, TENS, E stim
T or False Thoracic thurst improves short term and long term outcomes regardless of CPR?
T
What is the clinical prediction rule for Cervical Thrust Manipulation?
- Symptoms < 38 days
- Postive expecation of manipulation will help
- Cervical rotation ROM side to side difference of 10 degrees or greater
- Pain with PA testing mid cervical range
What are common symptoms you find with Neck Pain with movement coordination impairments (WAD)?
- Mechanism of onset lined to trauma/whiplash
- Associated shoulder girld UE pain
- Associated non specific concussive s/s
- Dizziness and nausea
- Headache, concentration or memory difficulties, confusion, hypersensitivity to mechanical theral, acoutsic, odor or light
What findings would you expect for Neck pain with coordination impairments?
- Positive cranial cervical flexion test
- Positive neck flecor/muscle endurance test
- postive pressure algometry
- Strength/endurance deficits
- Neck pain mid range that worses with end range
- point tenderness may include myofascial trigger points
- Sensiomotor impairment may include altered muscle activation/proprioception/ postural or balance
- Neck and reffered pain reproduced involved cervical segments
What muscles are associated with movement coordination impairments?
- Anterior
- Longus colli, Longus capitus
- Posterior
- Cervical multifdi, semispinalis cervicis/capitus, splenius cervicus/capitus
Deep to SCM muscles
Control, stability (mid range), support of C curvature, unable to be replicated by more specific elements
Label 1 - 4
- Multifidus rotators
- Semispinalis Cervicis
- Semispinalis capitus
- Splennius Cerv/Cap
- Trapezius
What is fatty infiltrate and what muscles occur during whiplast?
- Sub occipital and deep multifidus muscles
- leads to muscle not being used to the best of its ability
Which muscles show hyperactivity and poor endurance after whiplash?
- Hyperactivity: SCM, scalenes, trapezius
- Poor endurance: Deep neck flexors
What is the Craniocervical Flexion Test?
- Start with pressure unit to 20mmHg
- pt gives chin tuck at 5 different pressures (22, 24, 26,28, 30)
- Hold for 10 seconds/30 second rest
- Testing ends when patient can hold pressure for 10 seconds
Looing for engagement of superficial muscles and hyperactivity
What is the Deep Neck Flexor Endurance Test?
- pt in supine and hooklying
- Tuck and lift your chin
- Maintained ISOMETRICALLY
- Head lifted 1in/2.5cm off table with chin retracted
- Testing ends Skin sepatates >1 sec or head falls to table
Norm: Males 39sec, Females, 29 seconds
No neck pain
What is a joint position error test?
- Test to determine neck proprioception
- Target on wall with lazer 3 ft away
- pt closes eyes and rotates to starting position on target
- should be in green
- Yellow = clininically significant poor proprioception of C spine
How do you train the DNF muscles?
ENDURANCE
- Low load at <20% MVC
- longer duration (hold 5-10 seconds)
- May progress to higher load based off functional demands (consider proprioception)
What are some muscle training ares to target?
- Axioscapular
- Restore functional deficits
- be respective of pain but not guided
What are you to educate the patient?
- Decrease cervical collar use
- Stay active/act as usual
- Perform mobilizing exercises
What is Whiplash?
- Rear end MVA injury
- Encompass any accerlation-decelelration injury to neck
- Non physiological movements producing S shaped Curve
What is the local and systemic clincal presentation for whiplash?
- Local: Localized pain and tenderness, limited cervical ROM, Headaches, Muscle weakness
- Systemic: Widespread pain, Sensory disturbance, Dizziness, fear/anxiety
What is the Quebec Trask Force Classification grade?
0 = no complaint/no physical signs
I = Neck pain, stiffness or tenderness only, no physical signs
II = neck complaint, MSK signs: decreased ROM, pointed tenderness (MOST will resolved 6-8 weeks)
III= Neck complaint + neuro signs
IV = Fracture or disloation
How does muscle loss of the deep neck affect performance?
- Loss of stability
- loss of ROM and pain for chonicity
- Leads to aptients relying on superficial muscles (SCM)
What are the prognostic indicators of whiplash?
- Patients who score higher lead to more progression of chonicity
- Age >45
- Women
What are predcitors of poor outcomes folling whiplash injury?
- Restricted neck movemnt <90 L and R combined
- Cold Hyperalgesia (low threshold for pain activation with sensory stimuli (cold, theral input and pressure) - altered pain processings
- Moderate levels of acute post traumatic stress (PTSD)
- High intial pain and disability
- Age >45
- Gender ?
What are psychological factors in WAD?
- Pain catastrophising
- fear of movement
- Lower pain self efficacy
- Distress
Post traumatic stress symptoms
HIGH PAIN AND DISABILITY IN ACUTE WAD
What are the Post Traumatic Stress signs?
- Exposure to event - life threatening
- Fear, helplessness or horror
- Symtoms in 3 domains
- Re-experience/intrustion (thoughts, dreams, recurring thoughts, anxiety in related situations)
- Avoidance (similar or connected)
- Physiolocal arousal (sleep disturbance, hypervigilance, startled, irritable)
- Duration > 1 month
- Signifncant distress or impairment in functioning
What is the management strategy for acute WAD?
- Assesment
- No psychological debriefing
- Assurance
- allow for natural recovery
- Refferal at 6 weeks
What are manangement strategy for Chronic WAD?
- Screening assesment
- IES
- Referral if moderate
- Integral or delay PT
