Cervical spine examination and assessment

Question 1

CAD testing

Answer 1

coronary artery disease, symptom/history screening, objective screening, involves attempts at occluding/kinking the artery (extension/ SF/ rotation)

Question 2

CAD test

Answer 2

minimum tests= Cx rotn sustained for 10 secs and sustain painful position for 10 secs min (Ax for dizziness/ nystagmus/ nausea- signs of alterations in blood flow)
additional tests- Cx ext 10 secs, combined rotn and ext (both sides), if using end range technique then test in the treatment position

Question 3

treatment for CAD

Answer 3

blood thinners, anticoagulants, can lead to stroke

Question 4

observations

Answer 4

posture, offloading, asymmetries, COG, muscle bulk, guarding/ bracing, fear avoidance

Question 5

AROM

Answer 5

head to chin, shoulder to ear, forehead to ceiling, look over shoulder

Question 6

PPIVMs- SF and rotation

Answer 6

SF- use pillow and body to get movement, come into squat position, ask patient to lift head up and place both hands on Cx spine (where facet joints are), slide pillow to both sides
rotation- head on bed- both hands around Cx and rotate, can do with head off bed as well

Question 7

PPIVMs- extension and flex

Answer 7

extension- head off bed, bring head down by squatting
flex- head off bed, squat down and push head ip, or do it in supine lying with hands either side of Cx spine- lift head up

Question 8

PAIVMs

Answer 8

central PA, unilateral PA, lateral glide (hook hand under soft tissue and rotated to the side then apply glide)

Question 9

MLT- upper trap

Answer 9

patient supine, stabilize shoulder girdle (push down), side flex head away and flex- look for pain and ROM

Question 10

MLT- levator scapulae

Answer 10

patient supine, stabilize scapula by placing hand on it, add contralateral rotation, with SF and F

Question 11

MLT- scaleni

Answer 11

support under C2-C4 and fix rib 1
anterior- patients head in neutral- rotate towards and SF away
middle- patients head in neutral, SF away
posterior- patients head in neutral, rotate away and SF away

Question 12

MLT- sternocleidomastoid

Answer 12

flex Cx, SF away, rotate towards

Question 13

palpation of surrounding soft tissue

Answer 13

palpate- muscle tone, bulk, pain provocation, hyperalgesia

Question 14

what are functional assessment

Answer 14

aggs and limitations in their day, goals?, evaluate them doing activity- how are symptoms reproduced

Question 15

common functional assessment

Answer 15

lifting/ reaching/ UL activity, turning to look over shoulder/ reversing a car, reading a book, standing/walking, sports or gym activities

Question 16

excluding other joints

Answer 16

GHJ, ACJ, SCJ, Thoracic spine, 1st rib, TMJ

Question 17

treatment options

Answer 17

education/reassurance/reduce threat, address the patients beliefs and any yellow flags, exercise (strength, endurance, power, control, proprioception, stretching), mannual therapy (PPIVMs, PAIVMs, MWMs/SNAGs, NAGs), activity modification/function

Question 18

treatment examples

Answer 18

length tests= stretch muscle, strengthen cervical spine- isometrics- theraband- lean forward/side/backward and keep head stable or place gym ball on the wall- lean onto it- progress to bouncing on the ball, proprioception- same exercise with gym ball or place laser pen on head and aim at target- close your eyes turn head and turn back to target (observe where target goes), poor quality of movement= give them feedback (mirror, laser pen, reduce load (work across gravity) or could add slight resistance to correct movement pattern), reduced movement control- similar to reduced control

Question 19

principles of application- MWM

Answer 19

functional technique; WB and/or combined with functional movement, subtle handling and directional changes, PILL (pain free, instantaneous and long lasting), if no change- change technique, use active movement towards restricted/symptomatic range with glide constant/maintained, 6-10 reps, tape or teach self-mobs, neuromodulatory response= decreased pain
aim technique towards eye- orientation of facet joints

Question 20

SNAGs

Answer 20

sustained end range technique combined with active movement, movement induced symptoms, anterior-superior, central or unilateral, severe but not irritable, active movements with passive OP, maintained to returns, SNAG increases ROM, <6X

Question 21

SNAGs- technique

Answer 21

thumbs on Cx spine, unilateral- pain on one side- same side facet joint below, central- as you press they rotate/side flex/ ext

Question 22

NAG technique

Answer 22

use bicep of other arm around forehead and wrap around to back of Cx, little finger hook under SP of Cx, other thumb to moralise towards eyes

Question 23

self tissue techniques

Answer 23

stretches, SSTM’s, massage, TrP work