Cervical Spine Manipulation Flashcards
For patients with acute neck pain with mobility deficits, their is Grade [A/B/C] for thoracic manipulation, ROM exercises, and scapulothoracic and UE strengthening.
Grade B
For patients with acute neck pain with mobility deficits, their is Grade [A/B/C] for cervical manipulation and/or mobilization.
Grade C
For patients with subacute neck pain with mobility deficits, there is Grade [A/B/C] evidence for neck and shoulder endurance exercises.
Grade B
For patients with subacute neck pain with mobility deficits, there is Grade [A/B/C] evidence for thoracic and cervical manipulation and/or mobilization.
Grade C
For patient with chronic neck pain with mobility deficits, there is Grade [A/B/C] evidence for thoracic and cervical manipulation; mixed exercises including neuromuscular, stretching, strengthening, endurance, aerobic, and cognitive elements; and dry needling, laser, and intermittent traction.
Grade B
For patient with chronic neck pain with mobility deficits, there is Grade [A/B/C] evidence for neck and shoulder and trunk endurance exercise and patient education to promote active lifestyle.
Grade C
For patient with movement coordination impairments (i.e. whiplash), there is Grade [A/B/C] evidence for education to return to normal (i.e. minimize cervical collar use) and perform mobility exercises, reassurance that recovery is expected in 2-3 months, manual therapy plus exercise for patients expected to have a slow recovery.
Grade B
For patient with neck pain with acute headaches, there is Grade [A/B/C] evidence for supervised instruction in active mobility exercises.
Grade B
For patient with neck pain with acute headaches, there is Grade [A/B/C] evidence for C1-2 self-sustained SNAG exercise.
Grade C
For patient with neck pain with subacute headaches, there is Grade [A/B/C] evidence for C1-2 self-sustained SNAG exercise.
Grade C
For patient with neck pain with subacute headaches, there is Grade [A/B/C] evidence for cervical manipulation and mobilization.
Grade B
For patient with neck pain with chronic headaches, there is Grade [A/B/C] evidence for cervical manipulation or cervicothoracic manipulation combined with neck stretching, strengthening, and endurance exercises.
Grade B
For patient with acute neck pain with radiating pain, there is Grade [A/B/C] evidence for mobilizing and stabilizing exercises, laser, short term use of a cervical collar.
Grade C
For patient with chronic neck pain with radiating pain, there is Grade [A/B/C] evidence for mechanical intermittent cervical traction, stretching/strengthening exercises, cervical and thoracic manipulations/mobilizations, and education to participate in exercise and activity.
Grade B
When should you use cervical mobilization/manipulation? (6)
Neck pain without acute radiculopathy
Biomechanical pattern
Non-traumatic history
Pain & stiffness
Cervicogenic headaches
Non-acute cervical radiculopathy
What is the clinical prediction rule for cervical manipulation for neck pain?(4)
symptom duration ≤38 days
positive expectation that manipulation will help
side-to-side difference in cervical rotation range of motion of ≥10°
pain with spring (PA) testing of the middle cervical spine
Motion characteristics and restrictions in the cervical spine may be influenced/originate where?
The upper thoracic spine
Cervical mobilization and manipulation both have shown benefit for what? (2)
(1) neck pain
(2) headaches
What is the thoracic spine clinical prediction rule for neck pain?
Duration of symptoms 30 days or less
Symptoms not distal to the shoulder
Looking up does not aggravate symptoms
FABQPA < 11
Decreased upper thoracic (T3‐T5) kyphosis
Cervical extension ROM < 30
What are some short duration adverse reactions after cervical manipulation? (7)
local discomfort, stiffness, headache, radiating discomfort, fatigue, dizziness, and ringing in ears
Usually begin within 4 hours and disappear within 24 hours (women>men)
What are some mechanisms of cervical arterial dissection?
normal daily movements, trauma (i.e. extreme neck movement, sport, whiplash, domestic violence, medical interventions, and manual therapies), endothelial inflammatory events or disease, or upper cervical instability
Possible associated risk factors for cervical dissection are what?
- Migraines
•Hypertension
•Oral contraceptives
•Smoking
•Vascular disease
•Unilateral headaches
•Posterior cervical pain
•Pulsatile tinnitus
T/F: cardiovascular risk factors are likely not associated with craniocervical dissection in younger patients.
True
What symptoms do patient normally have along with a cervical arterial dissection?
neck pain, headaches, prior minor mechanical trauma, and/or transient ischemic signs in the last month
What symptoms/signs will the patient present with with a vertebral artery dissection?
Ipsilateral posterior upper cervical pain and occipital headache, Vascular dizziness as an effect of rotation (does not improve with movement), Light headedness, Nausea, Facial numbness, Double/blurred vision, Swallowing problems, Slurred speech
What symptoms/signs will patients present with for an internal carotid artery dissection?
Ipsilateral front-temporal headache and upper/mid cervical pain, Thunder-clap, different from previous headaches, Horner’s syndrome in up to 82%, CN’s affected (hypoglossal, glossopharangeal, vagus, accessory), Retinal infarction
What are signs of cerebral anoxia?
anxiety, nystagmus, dizziness, vomiting, or blurred vision
T/F: In most people, cervical positioning/manipulation effects cervical blood flow through vertebral arteries, posterior cerebrum, or cerebellar region.
False!!
What are the 3 N’s AND 5 D’s to screen for prior to cervical manipulation?
nystagmus, nausea, and numbness
ataxia
dizziness, dysphasia, diplopia, dysarthria, and dropattacks
What are the contraindications for cervical manual therapy? (GO!)
What are the precautions to cervical manual therapy? (GO!)
