Cervical Spine Manual Therapy

Question 1

What should you do before cervical manipulation?

Answer 1

Screening.

Cancer, OA, RA, VBI/CAI, Fracture, myelopathy, ligaments

Question 2

Spinal Fx

Answer 2

Trauma- MVA, Fall, direct blow.
Severe limitations in C ROM
*Refer

Question 3

Myelopathy

Answer 3

UMN, sensory distributions, muscle wasting or weakness, unsteady gait
*Refer

Question 4

Neoplastic

Answer 4

> 50, hx cancer, unexplained weight loss, constant pain, night pain.
*Refer

Question 5

Ligamentous Instability

Answer 5

Head “feels heavy”, cervical muscle spasm, C ROM limitations, signs of myelopathy

Question 6

Cervical Artery Insufficiency

Answer 6

5 Ds And 3 Ns

Question 7

Vertebral Artery

Answer 7

11% of cerebral blood flow
Posterior cranial BF
Stressed with upper cervical rotation

Question 8

Carotid Artery

Answer 8

89% of contralateral cerebral blood flow.
Anterior cranial BF
Stressed with mid cervical extension

Question 9

CA Dissection

Answer 9

80% present with head and neck pain.
“Pain unlike anything I have ever had before”
Can look like neck pain and cervicogenic headaches.

Question 10

Extension-Rotation test psychometrics

Answer 10

0% Sensitivity
High number of false negatives
High - LR ratio= tells you nothing.

Question 11

Stroke at chiro and physician

Answer 11

The rates are equal because they’re seeking treatment for the symptoms:

Question 12

Canadian C-Spine Rules

Answer 12

High Risk: >65, dangerous mechanism, paresthesias in extremities.
Low Risk: Simple rear-end MVA, sitting position in ED, delayed onset neck pain
Final: Unable to rotate 45 degrees

Question 13

Transverse Ligament

Answer 13

Controls AP movement at AA joint

Question 14

Alar Ligament

Answer 14

Provides AO stability

Question 15

Ligamentous Stability Progression

Answer 15

Sharp Purser 1st

THEN Transverse

Question 16

Therapy sequencing

Answer 16

1. Canadian C Spine
2. AROM+ Extension and rotation
3. Slowly increase loads.
4. Hold end range or manipulative placement for 10 s.
5. Don’t manipulate the 1st week if unsure.

Question 17

Best results

Answer 17

Strengthening PLUS manipulation is better than just manual therapy at 1 year.

Question 18

Thoracic in Cervical Treatment

Answer 18

Decreased T-spine mobility triples risk of neck and shoulder pain.

• Manipulation at T improves CROM and improves pain and disability at neck.
• Manipulation>Mobilization

Question 19

Clinical Prediction Rule

Answer 19

These don’t work or are not proven in C-Spine.

C Spine Manipulation=Mobilization more research needed.

Question 20

Cervicogenic Headaches

Answer 20

Unilateral and provoked with motion.

Exercise, mobilization, and manipulation all help.

Question 21

Review

Answer 21

Review pages 435-442. 
I don't see there being a ton of questions on this because it varied from instructor to instructor. 
OA: Upper Cervical Flexion+ Side bend
AA: Full flexion + Rotation
Upslope: Rotation+Side glide