(6) Cervical Spine Treatment Flashcards
What are treatment approaches for pain?
- exercise rehab
- advice & education
- manual therapy (joint & soft tissue)
- meds?
- electrotherapy?
What are the treatment approaches for joint dysfunction?
- exercise rehab
- manual therapy
- advice & education
What are the treatment approaches for muscle dysfunction?
- exercise rehab
- manual therapy
- advice & education
What are the treatment approaches for neural dysfunction?
- exercise rehab
- manual therapy
- advice & education
What are the treatment approaches for cognitive affective behavioural dysfunction?
- ‘Counselling’, education
- Exercise rehabilitation
What are the main areas of rehab?
- pain
- muscle
- joint
- nerve
- lifestyle
- cognitive-affective-behavioural
When would you use manual therapy on the cervical spine?
- Pain (maitland mobs I-II)
- Joint dysfunction (maitland mobs III-IV)
- Muscle dysfunction (Therapeutic massage & trigger points)
- Neural dysfunction (mobs)
What are some contraindications for performing manual therapy on the cervical spine?
- fracture
- active cancer
- recent relevant trauma
- UMNL
- Worsening neuro condition
- ligamentous rupture
- instability
What are some precautions for manual therapy on cervical spine?
- inflammatory disease
- RA
- Hx cancer
- OP
- infection
- long term steroid use
- blood clots
What are Sustained Natural Apophyseal Glides (SNAGs)
Therapist applies the appropriate
accessory facet joint glide while the patient performs the symptomatic movement
What is a neural mobilisation test for the cervical spine?
- adverse neural dynamics
- brachial plexus tension test
What are the principles of neural dynamics for the cervical spine?
- start movements away from site of presumed pathology
- through range v end range techniques
- add/subtract load as required
What are the outcomes of manual therapy?
- biomechanical effects supporting increased mobility
- decreased activation of regions responsible for pain
- decreased spinal activity via dorsal root ganglion
- increased production dopamine
What does the evidence say about manipulation & mobilisation?
- low moderate evidence
- reduce pain and improve function in chronic non specific neck pain
- multimodal approach has best impact
What should you consider when carrying out exercise rehab?
- SIN
- Comorbidities
- Contraindications
- Warnings
- Group or individual
What exercise rehab should be used for joint dysfunction (hypomobility)?
- Mobilising (increase ROM)
- Flex, ext, rotation, lat flex
- Active / assisted
What are some strengthening / activating exercises for the cervical spine?
- isometric resisted
- Flexion
- extension
- lat flexion
- rotation
What are some muscle endurance exercises for the cervical spine?
- contract at 50-70% 1RM for high reps
- motivation
- goal-orientated
- general rule 2-3 times a week
What should be focused on for muscle instability in the cervical spine?
- deep neck flexors
- long cervical extensors
- co-contraction (multiple groups)
What does the evidence say about exercise rehabilitation for cervical spine injuries?
- there is a role for strengthening exercises in the treatment of chronic neck pain, cervicogenic headache and cervical radiculopathy if these exercises are focused on the neck, shoulder and shoulder blade region
- Minimal effect on neck pain and function when only stretching or endurance are used
What should you consider when ‘counselling’ or advising?
- Health literacy
- Personalised
- Invite questions
- Positive but honest
What are the key areas of advising or ‘counselling’?
- Guidance based (+ve, remain active etc)
- Pain management
- Recording
- Dysfunction (explain the why, compliance)
What is ergonomics and why is it important?
- relationship of the worker and the job
- focuses on design of work areas or work tasks to improve job performance
What lifestyle dysfunction should be addressed as part of advice & education?
- Inactivity
- ergonomics
- weight
- smoking
- ‘make every contact count’
What is the MOA of advice & education?
- alter experience/perception
- self-efficacy -> behaviour change
- psychological
- pain modulation
What does the evidence say for advice and education for the cervical spine?
- structured patient education was equal or less effective than other conservative treatments including massage, supervised exercise, and physiotherapy
- may provide more benefits when combined with physio
What are some outcome measures for cervical spine injuries?
- ROM
- Endurance test
- Pain scale
- Function/disability index
- Psychological attributes (anxiety & depression)
