C-spine ther-ex Flashcards
ther-ex for neck pain w/ mobility deficit
stretching
coordination
strengthening
endurance
ther-ex for neck pain w/ headache
stretching
coordination
strengthening
endurance
ther-ex for neck pain w/ coordination movements
stretching
coordination
strengthening
endurance
ther-ex for neck pain w/ radiating pain
nerve mobilization
traction
ther-ex for impaired muscle performance
strength
endurance
ther-ex for impaired joint mobility
hypomobility:
- ROM
- flexibility
- neural glide
hypermobility:
-stabilization
ther-ex considerations
- postural education- correct FHP
- ROM exercises in restricted planes (consider gravity!)
- exercise localized segment according to mobility test
- stretch shortened muscles
- strengthen long muscles in shortened range
deep neck flexor weakness
common-impaired muscle performance)
patient is taught to perform a preset not to activate deep stabilizing muscles (cervical core) prior to any motion of the head
discourage use of SCMs
consider gravity minimized position initially
wall slide–> supine
re-ed of deep neck flexors phase 2
supine
ask patient to tuck chin w/out pushing back into table
hand assist–>no hand–>resistive sandbag on forehead
DNFs with SCM/scalene assist
supine on towel roll. patient lifts up w/out losing towel contact or chin poking forward (substitution w/ SCM)
patient in inclined seated position. patient nods to point of c-spine neutral and then lifts head off surface to take the weight of the head as resistance while maintaining neural neck posture- not allowing dominant superficial muscles to cause a chin poke of anterior translation
cervical extensors
NME can be effective in initial stages of training
teach patient to apply resistance to the contraction of specific muscle determined to be weak
ther-ex– strength/endurance
manual resistance
- all directions + rotation
- in neutral
- out of neutral (flex, lat flex, rotation)
isometric
dynamic
use theraband, weights
***gentle, pain-free contractions!
manual resistance to cervical extensors
retrain weak superior oblique by applying resistance to AO into joint side (lat) flexion and extension on the same side
supine- concentric muscle contraction into the R or L extension quadrant over a foam roll or rolled towel.
rotation and side flexion components
- foam wedge can be used for auto resistance
- sidelying w/ towel/roll as a fulcrum
once patient is able to perform movements w/out hypertranslation, graduate to multiplanar movements
to activate & strengthen the side flexors and rotators
supine, knees bent, w/ head on foam wedge to 1 side. (will have to use muscles on same side as peak to hold head still)
- -> hold slight nod to activate Deep neck muscles
- ->slow and controlled, lower head down the slope to end range. (stop before any pain)
- -> slowly roll back up the slope
hypomobility
- segmental articular mobility restriction
- capsular thickening and contracture
- degenerative bony changes
- segmental muscle spasm
- myofascial extensibility
- adverse neuromeningeal tension
overall c-spine ROM
maximal downslope (close) -Quadrant: w/out and w/ overpressure from ipsilateral hand
Maximal upslope (open) -flex, contrallateral lat flexion and rotation: w/out and w/ overpressure from contralat. hand
- *beware of tendency to overstretch hypermobile segments above and below.
- may need to improvise to focus exercise at desired level (position, and added hand positions for stabilizations
- self exercise: stabilize segment below and turn neck against hand
- use towel across neck and in each hand- 1 side stabilizes below, other at intended segment and assists rotation
flexibility testing
levator & splenius cervicis
upper trap & SCM
middle & anterior scaliness
sub occipitals ( uni & bi)
3x30” or 3xage”
a coupe of times a day to increase ROM
to increase posture: shorter duration but more frequently
hypermobility
=excessive motion of the intervertebral segment
treatment:
- postural correction exercises
- consider taping of scapula to reduce pull on segment
- manually stabilize hypermobile segment or perform co-contractions at involved levels
- gradually challenge cervical musculature while preventing excessive motion at involved segment
ther-ex stabilization
alternating isometrics
- all directions
- neutral
- out of neutral
- eyes open/closed
resistance at head (craniovertebral) vs. intersegmental
stage 1 stabilization
isolated control of deep neck flexors, extensors, lat flexors, and rotators
- AROM–>RROM of chin tuck in variety of positions
- AROM–>RROM of intersegmental extensors in variety of positions
- supine head roll up/downhill on a foam wedge
beginning co-activation
-quadriped chin tuck w/ lower c-spine extension –>gradually increase duration
stage 2 stabilization
watch for loss of position
gradually increase intensity and duration
co-activation to control of c-spine position during arm movements
- supine position most stable
- quadriped- 1 min
- upright
- positioned on unstable surface (foam roller, wobble board, ball)
bilateral arm movements less challenging
<90 deg shoulder flexion less challenging
progress to hand held weights
stage 3 stabilization
watch for loss of position/control
gradually increase intensity and duration
intersegmental control during neck movements and functional tasks
- straight plane –> diagonals
- single plane–> multiplane
- whole body movements (don’t emphasize neck movements; do emphasize neck movements)
nerve glides
“flossing” the nerve, freeing up tethering points
attain position then move
- wrist to “pull from distal”
- neck lateral flexion to pull from proximal
- can move other joints to focus stretch at a specific place
posture impairment
due to:
- muscle imbalance
- neuromeningeal extensibility
- articular hypomobility
- proprioception
muscle imbalance-posture impairment tx
lengthening short muscles and strengthen weak
neuromeningeal extensibility-posture impairment tx:
side flexion and elevation of scapula
articular hypomobility-posture impairment tx:
manual therapy and mobility exercises
proprioception-posture impairment tx:
postural correction
