Cervical Spine Flashcards
Causes of neck pain
OA
trauma
RA
tumors, infection
cardiac involvement
cranial nerve dysfunction
fracture
Bottom line of neck pain
the exact tissue that is causing a pt’s neck pain is most often unknown
use self-report questionnaires for pts to identify the baseline status and monitor changes
RF for neck pain
previous neck pain
female
Lower levels of evidence: age >40, LBP, low social/work support, worrisome attitude, high job demands, ex-smoker
RF that are not useful for determining neck pain
details of the accident
angular deformity of neck
What determines prognosis?
pain intensity
level of self-rated disability
pain related catastrophizing
PTSD
Trajectories of recovery
Mild = rapid recovery, about 45%
moderate = some incomplete recovery, 40%
severe = w/no recovery 15%
usually about 6 to 12 weeks post-injury
Categories of Neck pain injries
- Neck pain w/mobility deficits
- neck pain w/movement coordination impairments
- Neck pain w/headaches
- Neck pain w/radiating pain
Neck pain w/mobility deficits symptoms
central/unilateral neck pain
limitation in neck motion that reproduces symptoms
referred pain to shoulder girdle or UE
Neck pain w/mobility deficits expected exam findings
limited ROM
neck pain reproduced at end ROM
restricted mobility
deficits in strength and motor control
Neck pain w/movement coordination impairments (WAD) Symptoms
onset from trauma
referred shoulder girdle or UE pain
concussion symptoms
active level of distress
Neck pain w/movement coordination impairments (WAD) expected exam findings
positive neck flexor muscle endurance test
strength/endurance deficits
neck pain with mid-range motion
point tenderness
sensoriomeotor impairment
Irritability
the tissue’s ability to handle physical stress related to the physical status of tissues and the extent of inflammatory activity that is present
Acute interventions for neck pain w/mobility deficits
cervical ROM, stretching, isometrics
stay active
strengthening that is supervised
Subacute interventions for neck pain w/mobility deficits
endurance exercises
Chronic interventions for neck pain w/mobility deficits
mixed exercises
neuromuscular exercises
stretching, strengthening, endurance, aerobic, cognitive
stay ACTIVE
acute interventions neck pain with movement coordination impairments
education–stay active and keep doing daily routine
home exercise–postural and pain free ROM
minimize collar use
support during sleep, build self-efficacy
assure pt that recovery happens within 2-3 months
subacute interventions neck pain with movement coordination impairments
education: active and counseling
combined exercises: cervical ROM, isometrics, strengthening, manual therapy
supervised exercise–neuromuscular, endurance, stabilization, ROM, strengthening
chronic interventions neck pain with movement coordination impairments
education: prognosis, encouragement, reassurance, pain management
cervical mobilization
coordination, vestibular training, endurance, flexibility
Whiplash injury mechanisms
Extension: mandible is pulled open and jaw elevators strained
Flexion: mandible forced posteriorly, possible injury to TMJ disc
Clinical presentation of WAD
pain during contraction/elongation of muscles
localized swelling
tenderness to palpation
muscle guarding or spasms
decreased AROM in c-spine and UE
Impairments associated with WAD
acute: rolling over, turning over, sitting, checking rearview mirror
subacute/chronic: push/pull, lift, carry, limited ROM, sleep disturbed
What are some improvements that need to be made to lower levels of disabilities?
self-efficacy
psychological distress
fear
TMJ and WAD
you need to educate pt to stop chewing gum, start eating soft foods, utilize open packed resting position
opening mouth in neutral and diaphragmatic breathing can help to decrease pain
Closed packed position of TMJ
teeth touching and tightly clenched
Open packed position of TMJ
mouth slightly open, lips together, teeth not touching, tongue on hard palate
Neck flexor muscle endurance test norms
men: 38.9 s
women 29.4 s
stop test when head touches hand or when chin tuck is lost
Exercises for segmental activation of deep neck flexors
active and control muscles that control retraction/axial extension
requires capital flexion, flattening of cervical lordosis
test is done by doing chin to throat. Can increase difficulty by lifting arms
Proprioceptive training
relocating head back into neutral head alignment
can do with eyes open, eyes closed, and in all positions of the neck. Try to focus on a target while keeping neck aligned
T/F Female sex is one of the two strongest predictors for new neck pain
TRUE
the other is previous episodes of neck pain
T/F Direction of impact at the time of a motor vehicle accident is significant for determining a prognosis
FALSE
it has no bearing on prognosis, along with all details of the car crash
T/F The Neck Disability Index is a patient reported measure that includes items on self-efficacy and fatigue
FALSE
there are no items on the NDI that address SE or fatigue.
PROMIS has measures specific to these areas
T/F The literature supports the use of supervised therapeutic exercise as part of a treatment plan for persons with non-traumatic neck pain as gains will be made up to 18 weeks after symptoms begin
FALSE
improvements slow and are insignificant after 12 weeks. While TE is absolutely indicated, the duration of time in this statement is false.
Acute phase–Acuity and Irritability
the condition and related tissues are most irritable during the acute phase. Tissues are less able to handle stress without increasing negative symptoms such as pain, swelling, decreased muscle performance. Inflammation is present and easily increased
Subacute phase–acuity and irritability
the condition and related tissues are more tolerant of stress and
irritability of tissues is referred to as “moderate”. This implies tissues can take some stress before becoming irritable, indicating the inflammatory process is easy triggered but less so
than during the acute phase
Chronic phase–acuity and irritability
conditions and tissues demonstrate a lower degree of irritability, meaning more stress can be applied than in the previous stages before initiating symptoms. An inflammatory response is less likely to occur
What if your pt is showing abnormal actuity/irritability?
Consider all parts of the ICF and biophysical model
fatigue, social support, level of self-efficacy, co-morbidities
If self-efficacy, psychological distress, and fear are mediators for pain and disability, how will you proceed with treatment for a pt with WAD?
- Use pt reported measures that specifically address areas of biopsychosocial model
- Use the reported measures over time to see improvements
- Tailor treatment towards low reported measures
- Use feedback to increase measures
What is recommended interventions for pts with neck pain with WAD?
Chronic phase = functional training and CBT
Acute = little to no cervical collar, home exercises
Subacute = utilize therapy if recovery is going longer than normal
Explain the MOI for a whiplash injury and how it affects both anterior and posterior structures along with TMJ
Extension or flexion component
the mandible is either forced one posteriorly or forced open
Interventions for whiplash?
-Deep neck flexor strength: provide OA nods to engage rectus capitus anterior, rectus capitus
lateralis, longus capitus, longus colli.
-Teach axial extension to bring injured structures into a more neutral length instead of being held
at end range.
-Proprioceptive training for joint position sense deficits.
-Strength and endurance training using isometrics, body weight.
Stretching of scalenes, upper trap, levator.
- Tongue rest position for TMJ.
- Relaxation training with diaphragmatic breathing.
- Support neck in neutral while sleeping using neck roll or buckwheat pillow.
