cervical spine and tmj interventions

Question 1

discuss kinesthetic or postural training

Answer 1

to address improper posture

alw protracted shoulders muna then forward head - scap retraction then chin tucking

use mirror or tape for feedback

10 reps x 1 set - progress c less cues or integrate c ADLs /tasks

HEP - every 20 mins look at mirror and do postural training

Question 2

discuss dry needling

Answer 2

to address pain and trigger points; MPS

Question 3

discuss manual cervical traction

Answer 3

to address pain

do VBI test firsts

15-30 sec hold x 3 reps

HEP - AROM of neck

Question 4

discuss cervical manipulation

Answer 4

to address pain or LOM

no initial grading or distractions just oscillations

gr 1 then progress as pt tolerates

2 mins total tas glide depends

HEP - pain free AROM

always apply on superior segment

Question 5

precautions of spinal manipulation

Answer 5

change in sensation or inc pain that radiates

dizziness or light-headedness

corticosteroid use

excessive pain

Question 6

contraindications of spinal manipulation

Answer 6

unhealed fx

hx of joint or ligamentous laxity

systemic diseases - RA

vertebral artery disease occlusion

Question 7

direction of manipulation to inc cervical extension

Answer 7

caudal posterior glide

Question 8

direction of manipulation to inc cervical flexion

Answer 8

cephalad anterior glide

Question 9

direction of manipulation to inc cervical rotation to (R)

Answer 9

cephalad anteromedial gldie on left

rotation - contralateral

Question 10

direction of manipulation to inc cervical lateral flexion to (R)

Answer 10

cephalad anteromedial gldie on right

lat flex - ipsilateral

Question 11

discuss muscle energy technique

Answer 11

to address paint d/t hypermob or LOM

uses reverse contraction

6 sec hold x 5 reps

HEP - self application

progression by inc range

Question 12

apply MET to inc cervical flexion

Answer 12

hold pt on forehead and occiput

then ask pt to do capital extension

PT stabs the occiput - reverse contraction

occiput will be pulled up = inc flexion

Question 13

contraindication to MET

Answer 13

change in sensation or inc pain and radiates

dizziness or light-headedness

Question 14

discuss calliet neck exercises

Answer 14

to address weak neck muscles

should activate core muscles - if not done correctly it could activate global muscles and create compensations

6 sec hold x 5 reps

progress by:
- inc hold
- sit - stand - unstable
- apply UE loading

HEP - self application

Question 15

discuss cervical stabilization exercises

Answer 15

to address weak neck muscles

targets core muscles - in supine ask pt to flatten neck c chin tucks; SCM should not fire

10 reps x 2 sets

progress by:
- inc hold
- sit - stand - unstable
- apply UE loading

HEP - self application

Question 16

discuss global muscles

Answer 16

crosses multiple segments = gross motion c large guy wire function

SCM
scalenes
lev scap
upper traps
erector spinae

Question 17

discuss deep segmental or core muscles

Answer 17

attach to each segment and controls segmental motion

rectus capitis anterior and lateralis
longus colli

Question 18

discuss progressive limb loading on cervical stab

Answer 18

shoulder flexion to 90°

shoulder abd to 90°

shoulder ER c arms at side

shoulder flexion to end range

shoulder abd c ER to end range

diagonal patterns

reach forward, outward and upward

push/pull and lift

Question 19

discuss progression on surface on cervical stab

Answer 19

supine

sitting

sitting on ball

standing c support

standing s support

standing in unstable surface

Question 20

discuss computer training

Answer 20

part of functional training and pt educ

correct posture and height of chair and table - 90° elbow flexion

middle finger should touch screen

height of scree is eye level and no glare

20-20 rule

Question 21

discuss sleeping ergonomics

Answer 21

sleeping on back is good for neck health
- use thin pillow to avoid excessive flexion
- consider a cervical pillow or memory foam
- place towel under neck for more support

side sleeping
- ensure pillow height keeps neck straight
- pillow that is firmer on edges
- fill space bet neck and mattress s shoulder compression

avoid stomach sleeping

Question 22

discuss extra-oral massage

Answer 22

to address pain and hypomob - spasms and MG of masseter

gentle soft tissue mob x 5 mins

HEP - self application

Question 23

discuss intra-oral trigger point release

Answer 23

to address pain and hypomob

pressing creates ischemic compression, when released produces sudden BF = washes away pain

also can be autogenic inhibition from GTO is spasmic

gentle pressure application x 30 secs x 3 reps