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3 Therapeutic Exercise > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

Causes of neck pain

A

OA
trauma
RA
tumors, infection
cardiac involvement
cranial nerve dysfunction
fracture

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2
Q

Bottom line of neck pain

A

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

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3
Q

RF for neck pain

A

previous neck pain
female

Lower levels of evidence: age >40, LBP, low social/work support, worrisome attitude, high job demands, ex-smoker

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4
Q

RF that are not useful for determining neck pain

A

details of the accident
angular deformity of neck

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5
Q

What determines prognosis?

A

pain intensity
level of self-rated disability
pain related catastrophizing
PTSD

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6
Q

Trajectories of recovery

A

Mild = rapid recovery, about 45%
moderate = some incomplete recovery, 40%
severe = w/no recovery 15%

usually about 6 to 12 weeks post-injury

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7
Q

Categories of Neck pain injries

A
  1. Neck pain w/mobility deficits
  2. neck pain w/movement coordination impairments
  3. Neck pain w/headaches
  4. Neck pain w/radiating pain
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8
Q

Neck pain w/mobility deficits symptoms

A

central/unilateral neck pain
limitation in neck motion that reproduces symptoms
referred pain to shoulder girdle or UE

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9
Q

Neck pain w/mobility deficits expected exam findings

A

limited ROM
neck pain reproduced at end ROM
restricted mobility
deficits in strength and motor control

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10
Q

Neck pain w/movement coordination impairments (WAD) Symptoms

A

onset from trauma
referred shoulder girdle or UE pain
concussion symptoms
active level of distress

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11
Q

Neck pain w/movement coordination impairments (WAD) expected exam findings

A

positive neck flexor muscle endurance test
strength/endurance deficits
neck pain with mid-range motion
point tenderness
sensoriomeotor impairment

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12
Q

Irritability

A

the tissue’s ability to handle physical stress related to the physical status of tissues and the extent of inflammatory activity that is present

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13
Q

Acute interventions for neck pain w/mobility deficits

A

cervical ROM, stretching, isometrics
stay active
strengthening that is supervised

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14
Q

Subacute interventions for neck pain w/mobility deficits

A

endurance exercises

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15
Q

Chronic interventions for neck pain w/mobility deficits

A

mixed exercises
neuromuscular exercises
stretching, strengthening, endurance, aerobic, cognitive
stay ACTIVE

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16
Q

acute interventions neck pain with movement coordination impairments

A

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

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17
Q

subacute interventions neck pain with movement coordination impairments

A

education: active and counseling
combined exercises: cervical ROM, isometrics, strengthening, manual therapy
supervised exercise–neuromuscular, endurance, stabilization, ROM, strengthening

18
Q

chronic interventions neck pain with movement coordination impairments

A

education: prognosis, encouragement, reassurance, pain management

cervical mobilization
coordination, vestibular training, endurance, flexibility

19
Q

Whiplash injury mechanisms

A

Extension: mandible is pulled open and jaw elevators strained

Flexion: mandible forced posteriorly, possible injury to TMJ disc

20
Q

Clinical presentation of WAD

A

pain during contraction/elongation of muscles
localized swelling
tenderness to palpation
muscle guarding or spasms
decreased AROM in c-spine and UE

21
Q

Impairments associated with WAD

A

acute: rolling over, turning over, sitting, checking rearview mirror

subacute/chronic: push/pull, lift, carry, limited ROM, sleep disturbed

22
Q

What are some improvements that need to be made to lower levels of disabilities?

A

self-efficacy
psychological distress
fear

23
Q

TMJ and WAD

A

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

24
Q

Closed packed position of TMJ

A

teeth touching and tightly clenched

25
Q

Open packed position of TMJ

A

mouth slightly open, lips together, teeth not touching, tongue on hard palate

26
Q

Neck flexor muscle endurance test norms

A

men: 38.9 s
women 29.4 s

stop test when head touches hand or when chin tuck is lost

27
Q

Exercises for segmental activation of deep neck flexors

A

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

28
Q

Proprioceptive training

A

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

29
Q

T/F Female sex is one of the two strongest predictors for new neck pain

A

TRUE
the other is previous episodes of neck pain

30
Q

T/F Direction of impact at the time of a motor vehicle accident is significant for determining a prognosis

A

FALSE
it has no bearing on prognosis, along with all details of the car crash

31
Q

T/F The Neck Disability Index is a patient reported measure that includes items on self-efficacy and fatigue

A

FALSE
there are no items on the NDI that address SE or fatigue.
PROMIS has measures specific to these areas

32
Q

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

A

FALSE
improvements slow and are insignificant after 12 weeks. While TE is absolutely indicated, the duration of time in this statement is false.

33
Q

Acute phase–Acuity and Irritability

A

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

34
Q

Subacute phase–acuity and irritability

A

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

35
Q

Chronic phase–acuity and irritability

A

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

36
Q

What if your pt is showing abnormal actuity/irritability?

A

Consider all parts of the ICF and biophysical model
fatigue, social support, level of self-efficacy, co-morbidities

37
Q

If self-efficacy, psychological distress, and fear are mediators for pain and disability, how will you proceed with treatment for a pt with WAD?

A
  1. Use pt reported measures that specifically address areas of biopsychosocial model
  2. Use the reported measures over time to see improvements
  3. Tailor treatment towards low reported measures
  4. Use feedback to increase measures
38
Q

What is recommended interventions for pts with neck pain with WAD?

A

Chronic phase = functional training and CBT
Acute = little to no cervical collar, home exercises
Subacute = utilize therapy if recovery is going longer than normal

39
Q

Explain the MOI for a whiplash injury and how it affects both anterior and posterior structures along with TMJ

A

Extension or flexion component
the mandible is either forced one posteriorly or forced open

40
Q

Interventions for whiplash?

A

-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.

3 Therapeutic Exercise (12 decks)

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