Cervical Spine Stabilization

Question 1

About what percent of patients with neck pain develop chronic symptoms?

Answer 1

30%

Question 2

About what percent of patients seen in outpatient PT have neck pain?

Answer 2

25%

Question 3

Which neck pain classification would require cervical spine stabilization rehabilitation?

Neck Pain with:

a. Headache
b. Mobility Deficits
c. Radiating Pain
d. Movement Coordination Deficits/Whiplash

Answer 3

d. Movement Coordination Deficits/Whiplash

Question 4

What tests and characteristics may a patient with neck pain with movement coordination deficits/whiplash present with?

Answer 4

Positive cranial cervical flexion test, positive neck flexor muscle endurance test, strength and endurance, sensorimotor impairments including altered muscle activation patterns, proprioceptive deficit, postural balance or control

Question 5

T/F Prognosis for neck pain with movement coordination deficits is more clear for those with insidious onset than with whiplash associated disorders.

Answer 5

False, prognosis is more clear for whiplash associated disorders

Question 6

[Risk factors/Non-risk factors] for persistent symptoms in acute or subacute whiplash associated disorders are: high pain intensity, high NDI scores, high post-traumatic stress symptoms, strong catastrophic beliefs, and cold hyperalgesia.

Answer 6

Risk Factors

Question 7

[Risk factors/Non-risk factors] for persistent symptoms in acute or subacute whiplash associated disorders are: angular deformity of the neck, impact direction, seating position in the vehicle, awareness of impending collision, headrest in place at time of collision, stationary or moving at time of accident, and older age.

Answer 7

Non-Risk Factors

Question 8

What should treatment be for acute neck pain with movement coordination impairment?

Answer 8

education, HEP, don’t use a collar, check in as needed – PT IN THE ED (research mixed, better for LBP)

**All categories have elements of NMR/strengthening

Question 9

What should treatment be for subacute neck pain with movement coordination impairment?

Answer 9

Education, the exercise “kitchen sink” with SUPERVISION

**All categories have elements of NMR/strengthening

Question 10

What should treatment be for chronic neck pain with movement coordination impairment?

Answer 10

Education, CBT, vestibular; cervical manual, exercise, TENS

**All categories have elements of NMR/strengthening

Question 11

How does altered neuromuscular control of the neck contribute to neck pain?

Answer 11

It leads to alteration of stress distribution which may be responsible for the recurrent nature of neck pain

Question 12

What is responsible or a source of neck proprioceptors? (3)

Answer 12

Facet Joints → mechanoreceptors

Myofascial tissue → muscle spindles highly concentrated in sub occipitals and longus colli

Strong connection between cervical and vestibular receptors → dizziness and balance if not in equilibrium

Question 13

T/F Altered neuromuscular control can lead to cervicogenic dizziness.

Answer 13

True, those with neck pain develop or have altered neuromuscular control which can lead to this.

Question 14

What tests can be utilized in a cervical neuromuscular control assessment? (9)

Answer 14

• Craniocervical flexion test
• Deep neck flexor endurance test
• Superficial neck extensor test
• Cervical Joint Position Error Test
• Gaze stability
• Smooth Pursuit Neck Torsion Test
• Postural Control
• Range of motion
• Cervical movement control dysfunction tests

Question 15

What does a cervical stabilization assessment inform us of?

Answer 15

Aberrant movement patterns, activation and isometric endurance of deep cervical flexors, neuromuscular control preferential motor program (i.e. superficial vs. deep cervical flexors), proprioceptive feedback, symptom irritability

Ultimately, what to address with interventions to improve impairments and functioning!

Question 16

For the craniocervical flexion test, the biofeedback cuff should be filled to ____ mmHg.

Answer 16

20 mmHg

Question 17

Normative data for the craniocervical flexion test is:

Chronic neck pain: _____

Without pain: _____

Answer 17

Chronic neck pain: 24 mmHg

Without pain: 28 mmHg

Question 18

T/F The craniocervical flexion test is clinically correlated with the NDI, SF36-PCS, and Numeric Pain Rating Scale, making it clinically relevant.

Answer 18

True

Question 19

Normative data/time for the neck flexor muscle endurance test is:

Without neck pain: ____

With neck pain: ____

Answer 19

Without neck pain: 38.95 seconds

With neck pain: 24.1 seconds

Question 20

How long should the neck extensor test be conducted? (2)

Answer 20

360 seconds (6 minutes)

or

600 seconds (10 minutes)

Question 21

What does the cervical joint position error (JPE) test assess?

Answer 21

The patient’s ability to relocate their head to a starting position, assessing their kinesthetic awareness or proprioception

Question 22

What would a positive gaze stability test or smooth pursuit neck torsion test indicate?

Answer 22

That the patients nausea, dizziness, or disturbed vision stems from their neck muscles/proprioceptors and neck positioning

More specifically, from the neck position in which their symptoms occurred during the test

Question 23

What other outcome measures are the gaze stability and smooth pursuit neck torsion test correlated with?

Answer 23

NDI, SF36-PCS, and Numeric Pain Rating Scale

Question 24

During what positions do aberrant or uncontrolled movements occur in those with neck pain? (2)

Answer 24

cervical extension in 4-point kneeling and cervical rotation in sitting

Question 25

What aberrant movements might occur in someone with neck pain? (4)

Answer 25

hinging, poor upper vs. lower cervical dissociation, compensatory movements (i.e. glenohumeral joint), or reversed order of movement

(i.e. extension → upper to lower c-spin & flexion → lower to upper c-spine)

Question 26

T/F Craniocervical flexion training can lead to improvements in pressure pain thresholds, mechanical hyperalgesia, perceived pain relief, and better proprioception.

Answer 26

True, this has been shown in research

Question 27

T/F Dynamic muscle training and relaxation training did lead to better improvements in neck pain compared to ordinary activity.

Answer 27

False, these interventions did not lead to better improvements compared to ordinary activity.

Question 28

What stage (i.e. acute, subacute, chronic) of whiplash associated disorders would it be best to incorporate stretching in combination with exercises and manual therapy?

Answer 28

subacute