Cervical spine clinical interventions Flashcards
What is the most mobile region of the spine?
cervical region
What part of the cervical vertebrae transfers force between posterior and anterior portions?
pedicles
What forms a ring for the vertebral artery for protection along with a trough for peripheral nerve roots?
transverse processes
What part of the vertebrae protects the spinal cord?
lamina
The ratio of intervertebral disc height to a vertebral body height is greater in the ___ spine.
cervical
zygapophyseal joints are oriented in the __ plane.
frontal
Greater amounts of ____ movements occur at the lower segments of the C-spine. The greatest amount of movement occurs at the ___segments.
FLX/EXT, C5/C6
What joints promote FLX/EXT in the C-spine?
zygapophyseal joints
Motion of the c-spine occur in __ planes.
3
There is a (low/high) contribution of stability from the non-contractile structures of the C-spine.
low (20%)
What does the PLL resist?
forward bending
What does the ALL resist?
hyperextension
What does the cruciform ligament resist?
movement of the dens from contacting the spinal cord
What does the ligamentum nuchae resist?
FLX
What ligament guides movement in the upper c-spine?
alar ligament
What ligament provides upright posture in the C-spine?
ligamentum flavum
What are the primary muscles of cervical flexion?
SCM and scalenes
What are the secondary muscles of cervical flexion?
longus capitis and longus colli
What are the muscles of cervical extension?
upper traps, lev scap, splenius capitis/cervicis, erector spinae, semispinalis muscles
What muscle(s) are responsible for extension of the occiput?
suboccipital muscles
What muscles perform side bending of the c-spine?
scalenes, SCM, upper trap, lev scap, suboccipital muscles
What muscles perform ipsilateral ROT of the c-spine?
lev scap, splenius capitis/cervicis, erector spinae, semispinalis, suboccipital muscles
What muscles perform contralateral ROT of the c-spine?
scalenes, SCM, upper trap
The line of gravity falls (anterior/posterior).
anterior
Vertebral bodies and IV discs bear approx. ___ of the compressive load of the spine.
2/3
Zygapophyseal joints bear approx. ___ of the compressive load of the spine.
1/3
Loads are highest at ___ range.
end
The upper trap and lev scap tend to become tight because they are countering ___ shear forces of the head created by the line of gravity.
anterior
What is the annual incidence rate of neck pain?
15%
What is the neck pain recurrence rate?
~ 25%
What factors cause an increased risk of neck pain?
- Females
- indiv. with high psychological stress
- prolonged sitting
- desk jobs
- poor posture
What are the results of neck pain dysfunction?
- atrophy
- decreased muscular function
- decreased joint position sense
- compensation w/ superficial muscles for stability
What are the treatment based classifications?
mobility
centralization
headache
pain control
conditioning
What is the presentation of a patient needing mobility treatment?
- recent onset of central and/or unilateral neck pain
- limitation in neck motion that produces symptoms
- limited cervical ROM
- restricted CT joint mobility
What are the primary treatments used for a patient needing mobility treatment?
Cervical and thoracic mobilization
AROM exercises
Grade I mobilizations are ___ oscillations at the ___ range.
small, beginning of ROM
Grade II mobilizations are ___ oscillations at the ___ range.
small, mid range
Grade III mobilizations go from ___ range to the ___ range.
end range to mid range
Grade IV mobilizations are ___ oscillations at the ___ range.
small, end
What is the presentation of a patient needing conditioning?
- low pain/disability scores
- chronic symptoms
- no centralization or nerve root compression
- poor motor control
What is the treatment used for a patient who needs conditioning?
strength and endurance for the neck and upper quarter of the body
What is the presentation of a patient with centralization?
- radicular or referred symptoms
- peripheralization or centralization w/ neck ROM
- signs of nerve root compression
- (+) spurlings
- (+) distraction
- (+) ULTT
- ipsilateral ROT < 60 degrees
What is the primary treatment methods for centralization?
- manual traction
- repeated movements
What is the presentation of a patient with pain?
- high pain and disability scores
- acute symptoms
- MOI
- poor tolerance for exam and assessment
What are the primary treatments used for pain control?
- gentle AROM w/in pain tolerance
- patient education
What are the primary treatments to treat headaches?
- cervical spine mobilizations
- strength and endurance exercise programming
- postural education
A progressive decrease in intervertebral disc (height/width) increases demands on surfaces facilitating degenerative changes and ligamentous laxity.
height
When do degenerative changes start to occur?
30-50 y/o
When does stenosis start to occur?
> 50 y/o
Degenerative disc disease, degenerative joint disease, spondylosis, and stenosis are most commonly between the __-___ segments.
C5-C7
What can occur due to disc height decrease, disc herniation/bulging, narrowing of the intervertebral foramen, and/or spondylosis
Nerve root compression (centralization)
What is the most common cause of centralization?
disc herniation and stenosis
What population is most commonly affected by disc herniation and/or stenosis?
males >50 y/o
The most common levels of the c-spine that result in radicular symptoms are __-___ when nerve root compression is present.
c5-c7
During rehabilitation for nerve root comrpession, the dominant arm (is/is not) involved
is not
What are treatments for centralization?
- traction
- ther. ex
- manual therapy
- patient education (posture)
Who has the highest incidence of acute joint pathologies (sprain/strain)?
20-35 y/o
pathology:
- may be tender to palpation over the affected muscle
- may be tender to palpation over TP and SP due to involved ligament
- non-radicular
- insidious onset in the morning
acute joint pathology
definition: damage to a muscle belly and/or tendon
strain
definition: damage to a ligament
sprain
What treatments are used for acute joint pathologies?
-traction
- retraction
- prone PA glides
- ther. ex.
Traumatic neck pain (whiplash) is usually associated with ___.
MVA
~ ___% of those with whiplash develop chronic symptoms that last at least 1 yr.
50%
pathology:
- neck pain
- headache
- decreased ROM
- dizziness
- visual disturbances
- radicular symptoms
- cognitive impairment
whiplash
(true/false) You should use a neck collar after a whiplash injury.
FALSE
What is the prevalence of cervicogenic headaches?
1-4%
Cervicogenic headaches account for ___% of all headaches.
20%
(men/women) are more likely to get cervicogenic headaches.
women
pathology:
- unilateral
- “ram horn pattern”
- pain originates in neck and progresses up the head
- C1-C3 major contributors
- superficial neck muscle tightness
- tenderness of upper cervical joint and muscles
- decreased ROM
- decreased strength and endurance
cervicogenic headaches
(true/false) it is best to use ice to treat cervicogenic headaches.
FALSE DO NOT USE ICE
What are the tight muscles of upper cross syndrome?
upper traps, lev scap, pec major, pec minor
What muscles are weak with upper cross syndrome?
middle/lower traps
deep neck flexors
For a general exercise prescription, older and frail individuals should perform __-___ reps for __-__ sets.
1-3 sets x 10-15 reps
(OKC/CKC) may provide a more functional technique for strengthening of injured muscles and joints in athletes
CKC
