C-Spine Intervention Flashcards
PART 1: INTRODUCTION
PART 1: INTRODUCTION
What 5 things are generally done with intervention planning?
- Think Stability vs Mobility
- Educate
- Reduce Pain
- Address Impairments
- Improve Functional Activity Performance and Participation
Generally with MSK health conditions, think __________ vs ___________.
Stability vs Mobility
__________ about the health condition, prognosis, intervention/ management plan is incredibly important as well as activity ________ to better help the patient continue activities.
- Education
- modification
What are common ways to reduce pain?
- Manual Therapy Intervention
- Exercise
- Improve stability (coordination training)
What is done in each of the 3 phases to improve mobility?
Phase I
- activation/ coordination exercises
- mobility exercises
- inhibitory exercises
- soft tissue mobilization
- joint mobs, manipulations
Phase II
-progression to strength/endurance training of stabilizers
Phase III
-increase challenge of exercises
What is done in each of the 3 phases to improve stability?
Phase I
- exercises: physiological effects
- activation/coordination exercises
- joint mobs, manipulations
Phase II
-progression to strength/endurance training of stabilizers
Phase III
-increase challenge of exercises
PART 2: STRETCHES AND SELF-MWM
PART 2: STRETCHES AND SELF-MWM
If we are having guarded musculature, ____ intensity ____ repetition exercise can be helpful for improving motion as well as targeting ___________.
- low, high
- antagonist
If there is an actual shortening of tissue, _______ can be helpful.
stretching
PART 3: DNF EXERCISES
PART 3: DNF EXERCISES
Neck flexor exercises target what muscles?
- Rectus capitus anterior
- Longus capitus
- Longus colli
The longus colli runs along the anterior cervical spine vertebrae, a contraction _________ the cervical lordosis (flex).
straightens
During DNF exercises, patients can __________ SCM and scalenes to make sure there is no compensation from those muscles which are usually overactive in people with chronic/acute neck health conditions.
palpate
For __________________ (CCFEx) we begin at target level and progressively increase (10s x 10 reps) and avoid SCM and Anterior scalene activation.
Craniocervical Flexion Exercise (CCFEx)
What can be used for endurance training for DNF?
Chin tuck/ head lift
-increase hold times and resistance
Which is better, CCFEx or CFEx (chin tucks/head lifts)?
Improved isometric strength observed in both groups; neither group demonstrated significant improvement in muscle performance measures
PART 4: NERVE ENTRAPMENT/NERVE MOBILIZATION
PART 4: NERVE ENTRAPMENT/NERVE MOBILIZATION
With peripheral nerve entrapments and radiculopathy there is a ____ grade of compression on the nerve. Why is this problematic?
- low-grade
- On the outer sheath of the nerve there is a web of micro-vessels that supply blood to the nerve tissue. This limits the blood supply (O2) to that tissue and allows an influx of fluid. This can affect the signal transmission (sensory and motor).
What are nerve mobilizations?
Type of nerve therapy that aims to specifically locate and treat compression of nerves all throughout the body. The treatment is performed by applying gentle, precise pressure to the nerve in order to glide or floss it through the nerve sheath, which is made of connective tissue and surrounds the nerve.
What are the types of nerve mobilizations used for nerve entrapments?
- Gentle Stretching
- Nerve Mobilization (Active vs. Passive) (“Gliders” vs Tensioners”)
What are the proposed mechanisms of nerve mobilizations?
- Decrease adhesions and allow improved movement of peripheral nerves
- May increase neural vascularity allowing increased oxygenation of the nerve
- Dispersion of noxious fluids
- Improvement of axoplasmic flow
What is the difference between “Gliders” and “Tensioners”?
- Gliders involve stretching nerve at 1 joint and favoring it at another joint.
- Tensioners are giving full tension at every joint.
PART 5: GENERAL MANUAL THERAPY CONSIDERATIONS
PART 5: GENERAL MANUAL THERAPY CONSIDERATIONS
What are the joint mobilization types?
- Oscillation Mobilizations
- Manipulations
- Static Stretch Mobilizations
With manual therapy address the _________ impairment FIRST.
limiting
Grades of Oscillatory Mobilizations:
Grade I: _______ amplitude movement performed at the _________ of the range.
Grade II: ______ amplitude movement performed ______ the range but not reaching the limit of the range. It can occupy any part of the range that is free of any stiffness or muscle spasm.
Grade III: ______ amplitude movement performed ___________ of the range.
Grade IV: ______ amplitude movement performed at the ______ of the range.
Grade 1 -small, beginning Grade 2 -large, within Grade 3 -large, up to the limit Grade 4 -small, at the limit
Manipulation Grade V (non-oscillatory) is a ___-______ thrust performed at the limit of the range.
high-velocity
AAOMPT Clinical Guidelines: Proposed Terminology for Joint Mobs:
- ) Rate of ______ of application
- ) Location in range of _______ motion
- ) _______ of force
- ) _______ of force
- ) Relative _________ movement
- ) Patient _________
- force
- available
- direction
- target
- structural
- position
What are the biomechanical proposed mechanisms of joint mobs?
- motion improvement
- positional improvement
What are the neurophysiologic proposed mechanisms of joint mobs?
- spinal cord
- central mediated
- peripheral inflammatory
What are other proposed mechanisms of joint mobs?
- placebo
- pt expectation
Manual Therapy Absolute Contraindications:
- __________ of targeted region
- _____ ______ Syndrome
- Red flags including indicators of ________, ________, or __________ disturbance
- Rheumatoid collagen _______
- ______ ________ instability
- Concern for _______ ________ __________ (___)
- malignancy
- cauda equina syndrome
- neoplasm, fracture, or systemic disturbance
- necrosis
- upper c-spine instability
- Cervical Arterial Disease (CAD)
Manual Therapy Relative Contraindications:
- Active, acute _________ conditions
- ________ diseases
- __________ deterioration
- ____________ (depending on intent and direction of movement)
- Acute nerve root irritation (__________)
- Immediately ___________
- blood-_______ disorder
- inflammatory
- systemic
- neurological
- osteoporosis
- radiculopathy
- postpartum
- clotting
Absolute Contraindications to Joint Manipulation:
- __________ of targeted region
- _____ ______ lesions
- Red flags including indicators of ________, ________, or __________ disturbance
- Rheumatoid collagen _______
- ______ ________ instability
- Practitioner ______________
- spondylolisthesis
- gross foraminal ____________
- children/teenagers
- pregnancy
- joint ________
- _________ disorders
- immediately __________
- malignancy
- cauda equina
- neoplasm, fracture, or systemic disturbance
- necrosis
- upper c-spine instability
- lack of ability
- encroachment
- fusion
- psychogenic
- postpartum
Relative Contraindications to Joint Manipulation:
-1
1
PART 6: MANUAL THERAPY CONSIDERATIONS FOR C-SPINE
PART 6: MANUAL THERAPY CONSIDERATIONS FOR C-SPINE
For neck pain, _______ manual therapy techniques of the T-spine demonstrate better short-term results than mobs.
thrust
______ thrust of C-spine and upper T-spine associated with greater improvement in pain and disability, passive C1/2 rotation ROM, and deep c-spine flexor motor performance
HVLA (High velocity low amplitude)
Cervical mobilization/manipulation in combination with exercise for cervicogenic headache shows evidence for _______ reduction and ___________ improvement.
- pain
- functional
Cervical MWM for patients with cervical dysfunction shows a relation to populations with cervicogenic _________ and ___________.
headaches and dizziness
PART 7: NECK PAIN CLINICAL PRACTICE GUIDELINES
PART 7: NECK PAIN CLINICAL PRACTICE GUIDELINES
What is the Evaluation/Intervention Component 1 of the practice guidelines?
Medical Screening
- Appropriate for PT eval/intervention
- Appropriate for PT eval/intervention along w/ consultation with another health care provider
- Not appropriate for PT
What is the Evaluation/Intervention Component 2 of the practice guidelines?
Classify condition through eval of clinical findings suggestive of MSK impairments of body functioning (ICF) and the associated tissue pathology/disease
What are the classifications of neck pain?
- ) Neck Pain w/ Mobility Deficits
- ) Neck Pain w/ Movement Coordination Impairements (WAD)
- ) Neck Pain w/ Headache (Cervicogenic)
- ) Neck Pain w/ Radiating Pain (Radicular)
What are the common symptoms of Neck Pain w/ Mobility Deficits?
- central or unilateral neck pain (w/ possible referral to the shoulder girdle/UE)
- symptomatic ROM limitations
What are the common physical exam findings of Neck Pain w/ Mobility Deficits?
- ROM impairements
- Cervical and thoracic joint hypomobility
- Symptomatic provocation testing for involved structures
- Motor control impairements (subacute and chronic)
For patients with ACUTE Neck Pain w/ Mobility Deficits, clinicians should provide __________ manipulation, a program of neck ______ exercises, and scapulothoracic and UE __________ to enhance program adherance. Clinicians may also provide cervical ___________ and/or ____________.
- thoracic
- ROM
- strengthening
- manipulation and/or mobilization
For patients w/ SUBACUTE Neck Pain w/ Mobility Deficits, clinicians should provide neck and shoulder girdle ________ exercises. Clinicians may also provide __________ manipulation and cervical ____________ and/or ___________.
- endurance
- thoracic
- manipulation and/or mobilizations
For patients with CHRONIC Neck Pain w/ Mobility Deficits, clinicians should provide a ____________ approach of the following:
- __________ manipulation and __________ manipulation and/or mobilization.
- Mixed exercises for ________/____________ regions
- Dry needling, laser, or intermittent mechanical/manual traction
- multimodal
- thoracic, cervical
- cervical/scapulothoracic
What are the common symptoms of Neck Pain w/ Movement Coordination Impairements (WAD)?
- Hx related trauma/whiplash
- Associated shoulder girdle/UE pain referral
- Concussive SxS
- Dizziness/nausea; HA,; confusion;concentration impairements; hypersensitivity to stimuli; distress
What are the common physical exam findings of Neck Pain w/ Movement Coordination Impairments (WAD)?
- strength/ endurance/ coordination/ sensory impairments
- neck pain worsens with mid and end-range ROM
- tenderness to palpation
- painful w/ provocation testing
For patients with ACUTE Neck Pain w/ Movement Coordination Impairments (WAD), clinicians should provide:
-________ to the patient on return to normal, minimize the use of a ____________, perform postural and mobility exercises to decrease _____/increase _____, and reassure the patient that recovery is expected to occur within - months.
-Clinicians should also provide a multimodal intervention approach including ________ ___________ techniques plus _______ for patients expected to experience a moderate to slow recovery.
- education
- cervical collar
- decrease pain/ increase ROM
- 2-3 months
- manual mobilization
- exercise
For patients with ACUTE Neck Pain w/ Movement Coordination Impairments (WAD), clinicians may provide the following for patients whose condition is perceived to be at low risk of progressing toward chronicity:
- A _________ session consisting of early advice, exercise instruction, and education
- A comprehensive _______ program
- ____
- single
- exercise
- TENS
For patients with CHRONIC Neck Pain w/ Movement Coordination Impairments (WAD) clinicians may provide the following:
- Patient _________ and advice focusing on assurance, encouragement, prognosis, and pain management
- __________ combined with an individualized progressive submaximal exercise program.
- ______
- education
- mobilization
- TENS
What are the common symptoms of Neck Pain w/ Headache (Cervicogenic)?
- non-continuous neck pain w/ referred headache
- pain provoked with neck movement/ sustained positions
What are the common physical exam findings of Neck Pain w/ Headache (Cervicogenic)?
- Cervical Flexion Rotation Test +
- HA reproduction with provocation testing of upper c-spine segments
- impaired cervical spine ROM and joint mobility
- c-spine strength/endurance/coordination impairements
For patients with ACUTE Neck Pain w/ Headache (Cervicogenic) clinicians should provide a supervised instruction in ________ mobility exercise. Clinicians may also provide C_-_ self-sustained natural apophyseal glide (Self-SNAG) exercise.
- active
- C1-C2
For patients with SUBACUTE Neck Pain w/ Headache (Cervicogenic) clinicians should provide ________ manipulation and mobilization. Clinicians may also provide C_-_ self-SNAG exercise.
- cervical
- C1-C2
For patients with CHRONIC Neck Pain w/ Headache (Cervicogenic) clinicians should provide cervical or _____________ manipulation or mobilization combined with shoulder girdle and neck stretching, strengthening, and endurance exercise.
cervicothoracic
What are the common symptoms of Neck Pain w/ Radiating Pain (Radicular)?
- neck pain with band-like pain in UE
- UE dermatomal paresthesia/anesthesia and myotomal weakness
What are the common physical exam findings of Neck Pain w/ Radiating Pain (Radicular)?
- concordant UE symptoms reproduced/alleviated with radiculopathy testing procedures
- LMN impairments with neurologic testing
For patients with ACUTE Neck Pain w/ Radiating Pain (Radicular) clinicians may provide ________ and _________ exercises, laser, and short-term use of a _____________.
- mobilizing and stabilizing
- cervical collar
For patients with CHRONIC Neck Pain w/ Radiating Pain (Radicular) clinicians should provide mechanical intermittent cervical ________, combined with other interventions. Clinicians should also provide _________ and counseling to encourage participation in occupational and exercise activities.
- traction
- education
