cervical spine

Question 1

cervical rom

Answer 1

rotation 60deg

flex, ext, lat flex 45deg

Question 2

cervical ZPG angle

Answer 2

45deg

Question 3

cervical coupled motion

what happens to ZPG joints on both sides?

Answer 3

rotation and sidebend same direction
ipsilateral side - close ZPG, downglide
contralateral side - open gap ZPG, upglide

Question 4

intervention for restrictions/to improve downglide/close C4-5 on L side

Answer 4

PA glide/upglide R C4 transverse process

PA glide/upglide L C5 transverse process

Question 5

intervention forward cervical flexion at C4

Answer 5

bilateral facets need to open:
PA upglide bilateral C4 trasnverse processes
PA C4 spinous process

Question 6

intervention to increase cervical extension at C4

Answer 6

PA C5 spinous process (vertebrae below)

Question 7

cervical open pack and closed pack positions

Answer 7

open- midway between flexion and extension

closed- extension

Question 8

capsular pattern of atlanto-occipital joint

Answer 8

extension, side flexion equally limited

Question 9

capsular pattern of cspine

Answer 9

lateral flexion and rotation equally limited

extension

Question 10

how to measure ROM of cspine - flexion/extension

Answer 10

sitting, patients hands on knees

axis: external auditory meatus
stationary: perpendicular or parallel to ground
moving: along base of nares/nose or align goniometer with tongue depressor

Question 11

how to measure ROM of cspine - lateral flexion

Answer 11

sitting

axis: over spinous process C7
stationary: spinous process of thoracic vertebrae/perpendicular to ground
moving: dorsal midline head, occipital protuberance reference

Question 12

how to measure ROM of cspine - rotation

Answer 12

sitting

axis: center cranial aspect of head
stationary: parallel to imaginary line between acromion processes
moving: tip of nose or parallel to tongue depressor

Question 13

intervention

cervical spine “stiff” with active range of motion

Answer 13

• Initiate cervical, thoracic spine mobilization
• thrust manipulation to the midthoracic spine
• apply modalities as needed.

Question 14

upper crossed syndrome intervention

Answer 14

Upper crossed - rounded shoulders, forward head, stretched cervical flexors, cervical extensors are already shortened
Interventions:
- cervical extensor and pectoralis major stretching
- combined with scapular retraction and cervical retraction strengthening

Question 15

cervical radiculopathy CPR

Answer 15

Positive upper limb tension test A (ULTTa)
Involved-side cervical rotation range of motion less than 60 degrees Positive Distraction test
Positive Spurling’s test A

Question 16

forward head and rounded shoulder
upper crossed syndrome posture
what is tight/needs to be stretched?
what is weak/needs to be strengthened?

Answer 16

cervical extensor and pectoralis major are tight - need to stretch
weak scapular retraction and cervical retraction need strengthening
- Lower cervical extensors: splenius cervicis, semispinalis cervicis, longissimus cervicis.
- Upper cervical (capital) flexors: longus capitis, Rectus capitis anterior, Suprahyoid muscles.