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ORTHO 2 > C-spine ther-ex > Flashcards

C-spine ther-ex Flashcards

1
Q

ther-ex for neck pain w/ mobility deficit

A

stretching
coordination
strengthening
endurance

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2
Q

ther-ex for neck pain w/ headache

A

stretching
coordination
strengthening
endurance

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3
Q

ther-ex for neck pain w/ coordination movements

A

stretching
coordination
strengthening
endurance

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4
Q

ther-ex for neck pain w/ radiating pain

A

nerve mobilization

traction

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5
Q

ther-ex for impaired muscle performance

A

strength

endurance

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6
Q

ther-ex for impaired joint mobility

A

hypomobility:

  • ROM
  • flexibility
  • neural glide

hypermobility:
-stabilization

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7
Q

ther-ex considerations

A
  • 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
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8
Q

deep neck flexor weakness

A

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

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9
Q

re-ed of deep neck flexors phase 2

A

supine
ask patient to tuck chin w/out pushing back into table
hand assist–>no hand–>resistive sandbag on forehead

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10
Q

DNFs with SCM/scalene assist

A

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

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11
Q

cervical extensors

A

NME can be effective in initial stages of training

teach patient to apply resistance to the contraction of specific muscle determined to be weak

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12
Q

ther-ex– strength/endurance

A

manual resistance

  • all directions + rotation
  • in neutral
  • out of neutral (flex, lat flex, rotation)

isometric

dynamic

use theraband, weights

***gentle, pain-free contractions!

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13
Q

manual resistance to cervical extensors

A

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.

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14
Q

rotation and side flexion components

A
  • 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

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15
Q

to activate & strengthen the side flexors and rotators

A

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
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16
Q

hypomobility

A
  • segmental articular mobility restriction
  • capsular thickening and contracture
  • degenerative bony changes
  • segmental muscle spasm
  • myofascial extensibility
  • adverse neuromeningeal tension
17
Q

overall c-spine ROM

A 
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
18
Q

flexibility testing

A

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

19
Q

hypermobility

A

=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

20
Q

ther-ex stabilization

A

alternating isometrics

  • all directions
  • neutral
  • out of neutral
  • eyes open/closed

resistance at head (craniovertebral) vs. intersegmental

21
Q

stage 1 stabilization

A

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

22
Q

stage 2 stabilization

A

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

23
Q

stage 3 stabilization

A

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)
24
Q

nerve glides

A

“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
25
Q

posture impairment

A

due to:

  • muscle imbalance
  • neuromeningeal extensibility
  • articular hypomobility
  • proprioception
26
Q

muscle imbalance-posture impairment tx

A

lengthening short muscles and strengthen weak

27
Q

neuromeningeal extensibility-posture impairment tx:

A

side flexion and elevation of scapula

28
Q

articular hypomobility-posture impairment tx:

A

manual therapy and mobility exercises

29
Q

proprioception-posture impairment tx:

A

postural correction

ORTHO 2 (18 decks)

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