Cervical Spine Flashcards by Jocelyn Flores

Components of Upper / Mid / Lower Cervical Spine

Upper: Occipital Condyles / C1 and C2 vertebrae

Mid: C3-C6 vertebrae

Lower: C7-T4

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What structural feature is unique to the Cervical Spine?

Transverse Foramen

Arteries pass through the area / it must be considered during manipulations

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50% of the motion in the neck comes from the ___ Cervical Spine.

Upper

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Atlas (C1 Vertebrae)

No vertebral body / SPs

Large concave superior facets / inferior facets slightly convex

Facet along anterior arch for Dens of C2

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Primary Function of Axis (C2)

Transmit load from head / Atlas

Rotate head and Atlas

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Axis (C2) Structural Characteristics

Vertebral body extends inferiorly and projects Odontoid Process (Dens) superiorly

Dens has a facet anteriorly for the Atlas and groove posteriorly for Transverse Ligament

Superior Facet - up and out (convex)

Inferior Facet - down and forward (concave)

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C1/C2 is ___ on ___ motion.

convex, convex

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Coupling motion of C1/C2 is ___.

contralateral

When head rotates to the right, C1 side bends to the left

This is because articular condyles of C1 and C2 are both convex - posterior condyle of C2 is twice as steep as the anterior surface

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In the levels of the spine below C2 (C3 and below), rotation / SB motions are coupled ___.

ipsilaterally

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C3-C7 vertebrae have a greater ___ diameter than ___.

transverse, A-P

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Uncovertebral Joints

Located C3-T1

Create stability and decrease likelihood of disc herniation

One of the first locations of degeneration in the c-spine and can significantly restrict cervical SB (think these joints if pt has relatively normal flexion / rotation / extension but restricted SB)

Restriction at these joints will present as normal flexion / extension segmental mobility on each facet but hypomobile sideglides

Treatment requires gapping mobilization / manipulation of the segment

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Superior Facet Joints (C3 - C7)

Flat and oval shaped

Face superior and posterior

Angle between transverse and frontal plane

Height / depth increase from C3 to C7

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Inferior Facet Joints (C3 - C7)

Face inferior and anteriorly

Angle closer to frontal plane

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Intervertebral Joints (C3 - C7)

Saddle Joints

A: Sagittal Plane - Concave on Convex (ipsilateral coupling)

B: Frontal Plane - Convex on Concave (contralateral coupling)

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Flexion ROM

C0-C1: 20-25 degrees

C2-C7: 35 degrees

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Extension ROM

C0-C1: 20-25 degrees

C2-C7: 45 degrees

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Rotation ROM

C0-C2: 40-45 degrees

C2-C7: 40-45 degrees

Most rotation occurs at C1/C2

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Lateral Bending ROM

C0-C1: 5-10 degrees

C2-C7: 20-45 degrees

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Most rotation occurs at which level of the Cervical Spine?

C1/C2

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If a joint issue is present, will soft tissue / muscular stretching help with maximizing ROM and mobility?

No!

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Suboccipitals Flexibility Assessment

Stabilize C2 posteriorly

Stabilize head between hand and ipsi shoulder on patient’s forehead

Move head into cervical flexion until motion at C2 begins (head should flex 20-25 degrees)

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Anterior and Middle Scalene Flexibility Test

Extend / SB away / rotate towards (more extension to test SCM length)

PT stabilizes ipsilateral clavicle and 1st rib

Levator Scapulae and Posterior Scalene Flexibility Test

Flex / SB and rotate away

PT depresses ipsilateral scapula

Upper Trap Flexibility Test

Flex / SB away

PT depresses ipsilateral scapula

Which intervention is pictured here?

*Suboccipital Self-Stretch* "Bring head down until you feel C2 move."

Which intervention is pictured here?

*Anterior / Middle Scalene Self-Stretch* Extend / SB away / rotate (look) towards

Which intervention is pictured here?

*Levator Scap / Posterior Scalene Self-Stretch* "Look into opposite armpit."

Which intervention is pictured here?

*Upper Trap Self-Stretch* "Bring your ear towards the opposite shoulder." Patient can reach behind to hold chair and stabilize ipsilateral shoulder girdle / scapula

What three muscles upwardly rotate the Scapula?

Upper Trap Lower Trap Serratus Anterior

A tight muscle could be an indication of what related to the surrounding muscles?

They may be activating *less*

CTJ dysfunction often tightens which muscles? What should PTs do as a result?

Levator Scapulae / Upper Trap Work on t-spine mobility

Chin Tucks target which muscles?

Longus Coli / Capitis Rectus Capitis Anterior / Lateralis

What cue during instructing a patient to perform a chin tuck is best for engaging deep flexors?

"Look down at your chin with your eyes."

Chin Tucks overall are good for working towards ___.

stability

What is important to keep in mind about the following Chin Tuck progression?

Increased flexion (middle) makes it harder to engage flexor muscles The chin tuck on the towel roll helps the patient to work more against gravity

What is the purpose of the intervention pictured here?

*Chin Tuck w/ head lift* Endurance of DNF

What is the purpose of the intervention pictured here?

Neck flexor endurance Prevent extension of the neck in this position

How does the patient perform a chin tuck in the quadruped position (pictured here)?

Start in neutral spine with band wrapped around back of the head (held at the floor by both hands) Lift head up and maintain chin tuck position

What can happen at the middle C-Spine as a result of hypomobility at the Upper or Lower C-Spine?

Can become hypermobile to compensate - leading to nerve irritation / facet joint dysfunction

What is this intervention known as? In what area of the C-Spine is this best suited for?

*Coupling Activation* Best for mid / lower C-Spine Ipsilateral rotation and SB (chin tuck maintenance)

How can a biofeedback unit / BP cuff be used during endurance training of the neck flexor muscles?

Place unit at lordotic c-spine and inflate to 20 mmHg Increase by 2s with a chin tuck / nod and maintain mmHg level for 10 seconds Repeat until 30 mmHg is reached - 10x10 second hold Can incorporate arm movement for increased challenge

How can the intervention pictured below help the patient work on neck flexor endurance?

Chin tuck into a lift Can maintain position 30 seconds - 1 minute Can follow training activities such as utilization of biofeedback unit / BP cuff

What is occurring during the interventions pictured below? How is this movement versatile?

*Return to Neutral* Chin tuck maintenance in going from flexion / extension to neutral Can also go into extension (post MT that encourages extension) Assess for hinge points in return from flexion Maintenance of scapular position during movement (incorporating arm movement)

What does this series of photos depict?