Cervical Spine TBC Flashcards
Neck Pain Impact
One-month prevalence of activity interfering neck pain is from 7.5% -14.5%. The 12-month prevalence of neck pain-limiting activities was estimated as 1.7% (limited ability to work due to neck pain) 2.4% (limited social activities due to neck pain) 11.5% (limited activities due to neck pain).
Three levels of classification
- First Level: Is the patient appropriate for physical therapy management? 2. Second Level: What is the level of acuity? (staging the patient) 3. Third Level: What treatment should be used? (classification)
Red Flags - Spinal Fractures
Major trauma, severe limitation during active range in ALL directions
Red Flags - Cervical Myelopathy
Sensory disturbance of the hands; Muscle wasting of hand intrinsic muscles; Unstead gait; Hoffman reflex (flick middle finger); hyperreflexia; bowel and bladder disturbances; multisegmental weakness, sensory changes, or both
Red Flags - neoplastic conditions
Age over 50; previous history of cancer; unexplained weight loss; constant pain w/out relief at rest; night pain
Red Flags - Upper Cervical ligamentous instability
Occipital headache and numbness; severe limitation during neck active range of motion in all directions; signs of cervical myelopathy
Red Flags - Vertebral artery insufficiency
Drop attacks, dizziness, dysphagia, dysarthria, diplopia, positive cranial nerve signs
Red Flags - Inflammatory or systemic disease
fever >100*F, BP >160/95 mmHg, resting pulse > 100 bpm, resting respiration >25 bpm, fatigue
Red Flags - Vertebrobasilar Insufficiency
The Five D
Yellow Flags
Belief that pain is harmful or disabling resulting in guarding and fear of movement; believe that all pain must be abolished before returning to work; expectation of increased pain with activity or work; lack of ability to predict capabilities; catastrophizing; belief that pain is uncontrollable; passive attitude toward rehab; use of extended rest; reduced activity level; withdrawal from daily activities; avoidance of normal activity and progressive substitution of lifestyle awy from productive activity; reports of extremely high pain intensity; excessive reliance on aids (eg braces or crutches); sleep quality reduced following onset of back/neck pain; high intake of alcohol or other substances with pain onset; smoking
Stage 1 findings
substantial functional limitations that interfere with ADLs; difficulty concentrating at work, driving, reading for a prolonged period, or sleeping; NDI scores > 20%
Stage 2 findings
Able to perform most ADLs without difficulty; unable to perform demanding or prolonged physical activity especially when attempting complex tasks; NDI <20%
Mobility Classification
Recent onset of symptoms; no radicular signs/symptoms; no hx of surgery; age manual therapy and exercise; manipulation/mobilization of thoracic or cervical spine
Centralization Classification
Radicular signs/symptoms; symptoms distal to elbow; peripheralization/centralization of symptoms with neck movements -> activities to promote centralization; mechanical or manual traction; repeated movement to centralize symptoms
Exercise and Conditioning Classification
Longer duration of symptoms (>30 days); no signs of nerve root compression; lower pain and disability scores -> neck muscle strengthening; upper extremity strengthening
Pain Control Classification
Recent traumatic onset (whiplash); high pain and disability scores; intolerance for most activities -> cervical mobilization; active range of motion; avoid cervical immobilization
Reduce headache classification
chief complaint of headaches accompanying neck pain; headache affected by neck movement; no history or signs of migraine; unilateral headache; headache reproducible w/palpation to C0-3; restricted neck ROM -> manipulation/mobilization of the cervical spine; strengthening of the cervical deep neck flexors; scapular muscle strengthening
Hoving et al NNT
3 for manual therapy, 7 for traditional therapy
Costs
Manual therapy < traditional therapy < general practitioner
Mobilization vs Manipulation
no significant difference!
Manual techniques for cervical spine
mobilization, manipulation, muscle energy techniques
Walker et al results
Manual therapy and exercise group only 22% sought follow up care, Minimal Intervention 46% sought follow up care
Walker et al Conclusion
impairment-based manual therapy and exercise provides superior short and long term outcomes for MND patients
Reference standard for success
quite a bit better, a great deal better, and a very great deal better -> statistically/clinically significant improvement
