Cervical Lecture 3 Flashcards
What is the main goal of the acute phase?
Increase pain free ROM
How soon should we encourage return to normal ADLs after an acute injury
2-4 days
is absolute rest recommended
no
When should we initiate cervical stabilization program for cervical injury patients
At earliest opportunity (in acute phase if possible)
What is a great choice for initial cervical spine tx
walking
Should we use manual techniques on cervical patients in the acute phase
Yes, in the T-spine
What does research say about cervical collars
May delay recovery
What are the goals for the subacute phase for c-spine
postural retraining
ergonomic changes
overall strength and CV fitness
achieve significant decrease in symptoms
What stage of healing is most important for preventing longterm disability
sub-acute
T or F: Patients never change what bucket they’re in once classified
F, patients will switch between buckets and correctly categorizing and recategorizing the is vital
Pt with central or unilateral neck pain
May refer to UE or shoulder girdle
Limitation in neck ROM that CONSISTENTLY reproduces symptoms
Neck pain with mobility deficits
Neck pain is reproduced at end range of AROM and PROM,
restricted mobility throughout Cspine and Tspine
May have deficits in cervico-scapulo-thoracic strength
Neck pain with mobility deficits
What should PTs do for Neck pain w/ Mobility deficit patients in the Acute Phase
Thoracic Manip + neck ROM + shoulder strengthening- B level evidence
Cervical mob/manip - C level evidence
What should PTs do for mobility deficit patients in the subacute phase?
B level evidence- NEck and shoulder girdle ENDURANCE training
C level evidence- Cervical and thoracic manip/mob
What does PTs do for mobility deficit patients in the chronic phase?
B level evidence- Cervical/thoracic mob/manip
mixed exercises
may do modalities like dry needling and laser/ traction
C level evidence- endurance exercise
Pt with MOI linked to trauma OR general hypermobility
Referred pain to shoulder girdle and UE
Dizziness/nausea
Headache/concentration problems
Hypersensitivity
heightened affective distress
Neck pain w/ movement coordination deficit
Pt w/
Positive cranial cervical flexion text
Positive Neck Flexor Muscle Endurance test
Positive pressure algometry (motor control test w/ BP cuff)
Point tenderness
Strength and endurance deficits
Neck pain with mid-motion that worsens w/ end range positions
Neck pain w/ movement coordination impairment
What is the prognosis for a pt with movement coordination impairment
Recovery expected in 2-3 months
WITH manual therapy + exercise + Pt education
What education needs to be given to pts with a movement coordination deficit
Stay active
Early pain science education
Acute recommendations for Movement coordination deficits
B level evidence:
Return to normal activities as soon as possible
minimize use of collar
perform ROM and posture exercises
reassure pt of prognosis
Subacute recommendations for Movement coordination impairments
B level evidence: Multi-modal intervention
C level evidence: if PT perceives pt as low risk of chronicity, they can do a single session with just education and HEP
Chronic recommendations for movement coordination impairments
C level evidence: Patient education and advice focusing on assurance, encouragement, prognosis, and pain management
Mobilization + submax exercise
TENS
Pt w/ noncontinuous unilateral neck pain with headache
Headache precipitated or aggravated by neck movements
Neck pain w/ headaches
(note that these patients DO NOT have a constant headache)
Neck pain w/ headache patients will typically have what positive test
Cervical flexion and rotation test
Expected exam findings of Neck pain w/ headaches
HA reproduced w/ provocation of ______________
limited _______________
Upper cervical segments
(typically facets or AA joint)
strength, motor control, joint mobility, ROM
What segments most commonly cause cervicogenic headaches
OA, AA, and facets of C2 C3
What should PTs do for Neck/Headache patients in the acute phase?
B level evidence: supervised instruction in active mobility exercise
C: “self SNAG” exercise to AA joint
What should PTs do for Neck/headache pts in the subacute phase
B level evidence: Cervical manip and mob
C level evidence: Self SNAG exercise to AA joint
What are the 2 kinds of HAs that we refer for?
What are the 2 we treat?
Refer: Migraine, Cluster
Treat: Tension, Cervicogenic
What should PTs do for Neck/headache pts in the chronic phase
B level evidence: Cervical or cervicothoracic manips
Tension headaches commonly affect what age range and gender?
20-40, more common females
What is the treatment for a tension headache
Stress management, exercise, posture, MT, dry needling
What tests will likely be positive for a person with Neck pain w/ Radiating symptoms
positive spurling test
positive compression/distraction
positive ULTT
Neck pain w/ radiating symptoms pts will display what kind of weaknes
Myotomal
What is recommended for Radiating neck pain patients in the acute phase
Mobility/stability exercises, laser, and potential short term use of cervical collar
What is recommended for Radiating neck pain patients in the chronic phase
Traction, stretching, strengthening, mobs/manips
education and counseling
CPR for if T-spine thrust wi;l help a patient w/ neck pain
- Duration: ___________
- No symptoms _________________
- Looking ______________
- FABQ score of ____________
- diminished ___________________
- __________________ ROM __________
Duration: less than 30
No symptoms distal to shoulder
looking up does NOT aggravate
FABQ less than 12 (not catastrophizing)
Diminished upper thoracic kyphosis
Cervical extension ROM less than 30
If 3/6 theres an 86% chance of helping
What should assess for hypomobiltiy/dysfunction in all cervical spine patients
T-spine hypomobility/dysfunction
When working with patients who have a cervical dysfunction where should we start
Start at CT junction and work up
T or F: there is no superior type of exercise for pts with chronic neck pain
T
Cervicogenic headache RX:
________ in the short term
___________ in the long term
Manual Therapy
Neck exercise
Surgical intervention is reserved for what C spine patients
Fx/instability
significant weakness
PROGRESSIVE neurological deficits
severe unremitting pain
persistent radicular pain
surgery is most likely to help a neck pain patient if they have what
Radiating arm pain
Should we focus our treatment on mobility and restoring full ROM in pts who’ve had cervical fusion
No, they won’t get full ROM back and you dont want to overstress the metal
What will you see in patients who have had multiple ACDFs (anterior cervical discetomy and fusion)
Loss of natural curve of C spine
What is an Anterior Corpectomy and fusion
Replacement of damaged bone in vertebrae w/ fusion to level above and below
When is a laminectomy indicated
Spinal Stenosis
Multi level DDD w/ anterior spinal cord compression
works best to fix a patients radiating arm pain
What’s the problem with getting a laminectomy at too many levels
Too unstable
What is a laminoplasty, and what is the goal for PT after
metal hinge added to lamina to create more space,
typically these patients can keep normal ROM with therapy
If we have a post-op cervical patient what do we need to do
Get the operative report, ask for the post-op protocol
Know what levels were operated on
Note: there is currently little data on PT intervention post-spinal surgery
