Cervical and Thoracic Spine

Question 1

How prevalent is DDD in the cervical spine in those over 60 years old?

Answer 1

80% (asymptomatic)

Question 2

At what level of the cervical spine do we see the greatest degree of axial rotation?

Answer 2

C1/C2 (45 degrees of the total 90)

Question 3

At what level of the cervical spine do we see the greatest degree of lateral flexion?

Answer 3

Lower cervicals (35 degrees of total 40)

Question 4

Why does the amount of axial rotation gradually decrease as we descend the cervical spine and transition into more lateral flexion?

Answer 4

Increased incline of cervical facets

Question 5

Which is responsible for contributing more of the non-neural stability to the cervical spine: osseoligamentous system or musculature?

Answer 5

Musculature

Question 6

Which general grow of muscles that impact the cervical spine are tightened in upper cross syndrome? Weakened?

Answer 6

Tightened = global/extrinsic, superficial muscles that produce movement
Weakened = local/intrinsic, deep muscles that control segments

Question 7

What is the normal flexion to extension strength ratio seen in the cervical spine?

Answer 7

60%

Question 8

Which muscles are the deep neck flexors and are responsible for posture more so than providing actual movement?

Answer 8

Longus capitis, longus colli, rectus capitis anterior

Question 9

What kind of presentation do we see with patients with reduced neck strength?

Answer 9

Neck pain (research showed resolution when muscles are strengthened)

Question 10

Which intrinsic muscles aid in upper cervical flexion?

Answer 10

Rectus capitis anterior, rectus capitis lateralis

Question 11

Which intrinsic muscles aid in lower cervical flexion?

Answer 11

Longus capitis, longus colli

Question 12

Which intrinsic muscles aid in upper cervical extension?

Answer 12

Rectus capitis posterior major and minor, obliquus wapitis inferior and superior, semispinalis capitis, splenius capitis, longissimus capitis

Question 13

Which intrinsic muscles aid in lower cervical extension?

Answer 13

Semispinalis cervicis, splenius cervicis, longissimus cervicis

Question 14

What are the functions of the longus colli muscle?

Answer 14

Stiffens and stabilizes, supports curve against weight of head, counteracts buckling forces on cervical lordosis

Question 15

Which muscles make up the global (extrinsic) cervical spine musculature?

Answer 15

SCM, anterior/medial scalene, upper trap, levator scap

Question 16

What muscles are tightened in the upper cross syndrome?

Answer 16

Upper trap, levator snap, pectorals

Question 17

What muscles are weakened in the upper cross syndrome?

Answer 17

Deep neck flexors, lower trap, serratus anterior

Question 18

What is the presentation of cervical extension syndrome?

Answer 18

Rounded shoulders, anterior head carriage, head extension, elevation of shoulders, winging scapulae

Question 19

What muscle causes the rounded shoulders seen with cervical extension syndrome?

Answer 19

Facilitated pecs

Question 20

What muscle causes the anterior head carriage seen with cervical extension syndrome?

Answer 20

Facilitated SCM

Question 21

What muscle causes the head extension seen with cervical extension syndrome?

Answer 21

Facilitated suboccipitals

Question 22

What muscle causes the elevation of the shoulders seen with cervical extensions syndrome?

Answer 22

Facilitated upper trap and levator scap

Question 23

What muscle causes the winging scapulae sometimes seen with cervical extensions syndrome?

Answer 23

Inhibited serratus anterior

Question 24

Where would a patient with cervical extension syndrome experience a headache?

Answer 24

Suboccipital region (tight musculature)

Question 25

What signs are indicative of a failed cervical spine flexion motor pattern when performing the test?

Answer 25

1 chin protrusion occurring first 2 overactive SCM 3 shaking

Question 26

Which has more overall motion: upper or lower cervical spine?

Answer 26

Upper

Question 27

The quadruped rockback involves what musculature?

Answer 27

Levator scap, upper trap

Question 28

What is the purpose of the quadruped rockback?

Answer 28

Assess for extension

Question 29

What is the "George Constanza Method" of spinal rehab?

Answer 29

Do the opposite of what you find

Question 30

To correct for cervical extension syndrome, which general group of muscles must be engaged?

Answer 30

Intrinsic stabilizers

Question 31

How can a patient improve during supine cervical flexion when known to have cervical extension syndrome?

Answer 31

Work on tucking in the chin and holding

Question 32

How can a patient improve during the quadruped rockback when known to have cervical extension syndrome?

Answer 32

Keep spine neutral ("chin to adams apple")

Question 33

What is the primary goal in the rehab of muscle dysfunction?

Answer 33

Retrain control (NOT INCREASE STRENGTH)

Question 34

Which is more common: cervical flexion or extension syndrome?

Answer 34

Extension

Question 35

Which tends to occur to a younger spine: cervical flexion or extension syndrome?

Answer 35

Flexion

Question 36

What is the overall appearance of the spine with cervical flexion syndrome?

Answer 36

Decreased cervical lordosis AND thoracic kyphosis, loss of flexion in thoracic spine ("straight neck/military neck")

Question 37

What is the appearance of the shoulders with cervical flexion syndrome?

Answer 37

Depressed (insufficient recruitment of extensors)

Question 38

Why are patients with cervical flexion syndrome encouraged to "slump" during exercises?

Answer 38

Encourages flexion in the thoracic spine that is lost, helps activate extensors in cervical spine to revert back to neutral position

Question 39

Which major joints of the body are prone to a loss of mobility rather than stability?

Answer 39

Ankle, hip, thoracic, glenohumeral, upper cervical spine

Question 40

What major joints of the body are prone to a loss of stability rather than mobility?

Answer 40

Knee, lumbar, scapula, lower cervical spine

Question 41

What has the research found linking the importance of thoracic spine treatment with cervical neck pain?

Answer 41

Better results following adjustments if thoracics exercises were also administered; thoracic adjustments aided neck pain

Question 42

Thoracic spine manipulation has been shown in research to aid with what other ailments besides general pain?

Answer 42

Rotator cuff tear, adhesive capsulitis, overall ROM

Question 43

What are the negative effects of hyperkyphosis of the thoracic spine?

Answer 43

1 scapular instability 2 impaired cervical motion 3 respiration issues

Question 44

How can hyperkyphosis of the thoracic spine affect the scapulae?

Answer 44

Scapular protraction leading to rounded shoulders with scaps in forward position

Question 45

Why is scapular protraction an issue for the patient?

Answer 45

1 shoulder pain 2 narrows joint space for movement 3 strains shoulder ligaments 4 decreases shoulder strength

Question 46

What is paradoxical breathing as seen with hyperkyphosis of the thoracic spine?

Answer 46

Shoulders elevating and relying on accessory muscles for inspiration

Question 47

What is diaphragm breathing?

Answer 47

Allowing the expansion of the ribs laterally

Question 48

Which breathing style is considered the proper technique and therefore allows for greater space?

Answer 48

Diaphragm breathing

Question 49

What is the test where the patient stands against the wall with arms abducted to 90 degrees with the elbows bent at 90?

Answer 49

Wall angel

Question 50

How does a patient fail the wall angel exercise?

Answer 50

If thoracolumbar junction does not flatten

Question 51

Which exercises involves the patient squatting down while raising the arms against a wall?

Answer 51

Wall slide

Question 52

What is the purpose of the wall slide exercise?

Answer 52

Focus mobility to the thoracic spine to stretch lat and pec

Question 53

What muscles are involved with the wall slide exercise?

Answer 53

Lat and pec

Question 54

What is the purpose of the arm elevation test?

Answer 54

Screen for thoracic mobility

Question 55

When a patient struggles with the arm elevation test, what muscles are potentially involved?

Answer 55

Lats and pecs (hypertonic)

Question 56

How does a patient fail the arm elevation test?

Answer 56

Decreased extension mobility of thoracic spine seen when spine comes off wall

Question 57

What is the purpose of the cat-camel exercise?

Answer 57

Increase thoracic extension

Question 58

What is the name of the "cog-wheel" idea of posture breaks where the patient sits at the edge of the chair with the feet out wide, chin tucked, rotating arms outward, lifting sternum to deeply breathe with the abdomen?

Answer 58

Brugger's posture break

Question 59

How can we add resistance to the Brugger's posture break?

Answer 59

Add elastic band