Cervical Spine Stabilization Flashcards
About what percent of patients with neck pain develop chronic symptoms?
30%
About what percent of patients seen in outpatient PT have neck pain?
25%
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
d. Movement Coordination Deficits/Whiplash
What tests and characteristics may a patient with neck pain with movement coordination deficits/whiplash present with?
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
T/F Prognosis for neck pain with movement coordination deficits is more clear for those with insidious onset than with whiplash associated disorders.
False, prognosis is more clear for whiplash associated disorders
[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.
Risk Factors
[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.
Non-Risk Factors
What should treatment be for acute neck pain with movement coordination impairment?
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
What should treatment be for subacute neck pain with movement coordination impairment?
Education, the exercise “kitchen sink” with SUPERVISION
**All categories have elements of NMR/strengthening
What should treatment be for chronic neck pain with movement coordination impairment?
Education, CBT, vestibular; cervical manual, exercise, TENS
**All categories have elements of NMR/strengthening
How does altered neuromuscular control of the neck contribute to neck pain?
It leads to alteration of stress distribution which may be responsible for the recurrent nature of neck pain
What is responsible or a source of neck proprioceptors? (3)
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
T/F Altered neuromuscular control can lead to cervicogenic dizziness.
True, those with neck pain develop or have altered neuromuscular control which can lead to this.
What tests can be utilized in a cervical neuromuscular control assessment? (9)
- 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
What does a cervical stabilization assessment inform us of?
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!
For the craniocervical flexion test, the biofeedback cuff should be filled to ____ mmHg.
20 mmHg
Normative data for the craniocervical flexion test is:
Chronic neck pain: _____
Without pain: _____
Chronic neck pain: 24 mmHg
Without pain: 28 mmHg
T/F The craniocervical flexion test is clinically correlated with the NDI, SF36-PCS, and Numeric Pain Rating Scale, making it clinically relevant.
True
Normative data/time for the neck flexor muscle endurance test is:
Without neck pain: ____
With neck pain: ____
Without neck pain: 38.95 seconds
With neck pain: 24.1 seconds
How long should the neck extensor test be conducted? (2)
360 seconds (6 minutes)
or
600 seconds (10 minutes)
What does the cervical joint position error (JPE) test assess?
The patient’s ability to relocate their head to a starting position, assessing their kinesthetic awareness or proprioception
What would a positive gaze stability test or smooth pursuit neck torsion test indicate?
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
What other outcome measures are the gaze stability and smooth pursuit neck torsion test correlated with?
NDI, SF36-PCS, and Numeric Pain Rating Scale
During what positions do aberrant or uncontrolled movements occur in those with neck pain? (2)
cervical extension in 4-point kneeling and cervical rotation in sitting
What aberrant movements might occur in someone with neck pain? (4)
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)
T/F Craniocervical flexion training can lead to improvements in pressure pain thresholds, mechanical hyperalgesia, perceived pain relief, and better proprioception.
True, this has been shown in research
T/F Dynamic muscle training and relaxation training did lead to better improvements in neck pain compared to ordinary activity.
False, these interventions did not lead to better improvements compared to ordinary activity.
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?
subacute
