C-Spine Manual Therapy

Question 1

Vertebral Artery

Answer 1

• anterior (internal carotid) and posterior (VA) systems
• C2 and higher most vulnerable for problems
• contralateral rotation with extension most stressful

Question 2

VBI Insufficiency Tests

Answer 2

• don’t do if VBI suspected – will make worse. get pt to MD/ER
• poor sensitivity/specificity
• all descriptions include sustained (10 sec) end-range rotation, some include distraction and/or extension

Question 3

5 D’s, 3 N’s, 2 H’s 1 A

Answer 3

• dizziness, drop attacks, diploplia, dysarthria, dysphagia
• nausea, numbness, nystagmus
• headaches, hearing disturbances
• ataxia

Question 4

biggest signs VBI

Answer 4

• -pain (may be only symptom)

- high frequency headaches in pts with dissection

Question 5

risk factors VBI (5)

Answer 5

• HTN
• migraine
• smoking
• trauma
• artherosclerosis

Question 6

tests for VBI (6)

Answer 6

• functional positional test, cervical rotation (posterior circulation)
• functional positional test, cervical extension (anterior circulation)
• blood pressure exam
• cranial nerve exam
• eye exam
• handheld doppler ultrasound

Question 7

Who don’t we manip

Answer 7

-whiplash, neck pain with radiating pain

Question 8

What do we treat with manipulation?

Answer 8

-spinal segments that lack adequate mobility and ROM (pain relief)

Question 9

When is treatment provided?

Answer 9

• use of most gentle grade that achieves results

- part of comprehensive tx that includes stretch/strengthen, soft tissue, motor contol/muscle re-ed, pt ed

Question 10

OA Distraction manip

Answer 10

• cup pts chin, cradle hand with dominant forearm
• support head below sup nuchal line
• introduce flexion around an axis through the ear
• introduce L sb, R rot, and translate head L–>R
• engage barrier, HVLA in cephalic direction with both hands

Question 11

OA self mob

Answer 11

use fingers to guide upper C spine into flexion while tucking chin

• avoid excessive lower Cspine motion
• rotating head ~30 focuses tx on one OA jt

Question 12

Sub-occipital distraction

Answer 12

• non-thrust
• assess by side bending head on neck
• inhibited distraction (fingertips)
• mobilization – dom hand on occiput, non dom hand holds C2, PT shoulder on forehead, distract while holding C2
• can add sidebend
• re-assess

Question 13

AA self mob

Answer 13

• flex neck, keep chin tucked
• hands guide into rotation to engage barrier
• perform gentle mobs
• self MET can also be done in this position

Question 14

C2-C7

Answer 14

• central PA pone
• unilateral PA prone
• upslope
• downslope

Question 15

central/unilateral PA prone

Answer 15

• thumbs on SP
• gently pull lateral soft tissue posteriorly
• elbows straight, motion through arms
• mobilize PA

Question 16

Upslope

Answer 16

• 1 rotation 2 sidebend opp (small)

- thrust toward opp eye

Question 17

Downslope

Answer 17

• 1 sidebend 2 roatation opp (small)

- thrust toward opp shoulder