C-spine Flashcards
Approximately 70% of patients with chronic neck pain exhibit decline in muscular strength and endurance of the
SCOM and deep cervical flexor
Continuous imbalance between deep and superficial muscles will lead to
forward head posture
most common postural dysfunction causing chronic neck and shoulder pain
forward head posture
what can c0-c1 problem lead to
H/A, vertigo, fatigue, poor concentration, irritability
Physical attachment of dura
C0-C2 problem is most likely issue with
fascial connections
what can cause Muscle Impairment with Chronic Neck Pain
delayed cervical neck muscle contraction with upper body movement
Increased use of superficial cervical neck flexors during functional activities
Increased fatigability of cervical neck flexors in pain patients
common injuries of cervical spine
DDD
Posterior disc herniation
Spinal stenosis
Upper cross syndrome
Facet joint irritation
Strains of trapezius muscle, SCM etc.
what can happen if deep muscle of the neck become weak
Superficial muscles- become overactive to protect the neck
= excessive shear and compression
Example Progressions of Cervical Core Training
Seated (avoid gravity)
Laying down
Chin tuck with combined movements
4 point against gravity
Standing with ball behind head
PNF patterning (Diagonal, CARs)
Proper positioning with functional movements
Interventions to Manage a Disc Lesion in the Cervical Spine -> early phase
Early phase
Decrease acute symptoms
Examples: Modalities, massage, traction
Teach awareness of neck position and movement
Scapular movements
Passive cervical nods
Chin in midline gently nod the patient’s head and allow neck to flatten against the table
Patient does in sitting position on their own
Traction
Sustained traction 10 min, intermittent traction 15 min
15lbs of force causes vertebral separation
Management of Disc Lesions in the Cervical Spine -> subacute phase
Completed once S/S of inflammatory process are under control and pain is no longer constant
Increase mobility in restricted muscles/joint/fascia/nerve
Head nods for longus colli and multifidus
Movement of the head with proper postural awareness
Add in upper extremity movement
give exemple of proprio exercise for cervical
Laser pointer
Moving eyes only
Moving cervical spine keeping eyes fixated
Tracing/drawing objects with cervical movement
Balancing object on head with walking
cervical extensor tend to be
Tend to be tonic and tight
Compensatory muscles
people with incorrect FHP can suffer from
chronic or unpleasant conditions such as, pinched nerves and blood vessels, like thoracic outlet syndrome, muscle and tissue pain, syndromes like fibromyalgia, chronic strains and early degeneration and arthritis
FHP can cause tension in
TMJ, give headache and bite problem
cervicogenic headache referred pain where
head or face from first three to four CN
TX of cervicogenic headache
ROM for mobility, Stretches for tight muscles, deep neck flexor activation
_ is an intervention that is often recommended for the treatment of patients with neck pain
mechanical cervical traction
cervical traction is used to
relieved pressure on neural structure
Cervical Traction Parameters
1-3 times/day
10-15 minutes of sustained traction
10-30lbs of traction force
Intermittent vs sustained
Neck position- midway between flexion and extension (acute/subacute), flexion or extension (chronic)
how munch time do put cervical traction for disc herniation
5-10min, 25-40lbstuiioip
is a little post treatment muscle soreness common after cervical traction
yes
indication for spinal traction
Nerve root impingement
Disk herniation
Spondylolisthesis
Narrowing within intervertebral foramen
Osteophyte formation
Degenerative joint diseases
Subacute painJoint hypomobility
Discogenic pain
Muscle spasm or guarding
Muscle strain
Spinal ligament or capsular contractures
Improvement in arterial, venous, and lymphatic flow
contraindication for spinal traction
Acute sprains or strains
Acute inflammation
Fractures
Vertebral joint instability
Any condition in which movement exacerbates existing problem
Bone diseases
Osteoporosis
Infections in bones or joints
Vascular conditions
Pregnant females
Cardiac or pulmonary problems
There is (high/low) level evidence that cervical manipulation and mobilisation as unimodal interventions are effective on pain and range of motion at the immediate follow up
low
There is (high/low) level evidence that traction is no more effective than placebo traction
low
when can you do neuromeningeal mobs
once symptoms have centralized
contradiction of neuromeningial mobs
Acute or unstable neurological signs
Spinal cord injury or symptoms
Neoplasm and infection
**Watch for vascular compromise
Relaxation Techniques Cervical and Upper Thoracic Regions
Seated or standing with arms by the side
Diaphragm breathing
Bend neck forward and backwards
Side bend head and rotate from side to side
Roll the shoulders; protract, elevate, retract and relax scapula
Circle the arms with elbows flexed or extended
Jaw relaxation
exercise that target upper trap
prone rowing
military press
T with neutral glenohumeral rotation
shoulder shrug
shoulder lateral rais
upright row
exercise that target mid trap
prone shoulder extension
prone rowing
sideline GH ER
side line shoulder flexion
T with neutral GH rot or ER
exercise that target lower top
shoulder abd
bilateral GH ER at 0º abd
prone GH ER at 90º abd
prone shoulder rowing
Y
T with GH ER
side line with GH ER
