Cervical TherEx Flashcards
What 3 classification groups of the C-spine are treated with stretching, coordination, strengthening and endurance?
- Pain with mobility deficit
- Pain with headache
- Pain with movement coordination impairments
What are 2 treatments for the pain with radiating pain c-spine classification?
- Nerve mobilization
- Traction
What are 2 treatment for impaired muscle performance?
- Strength exercises
- Endurance exercises
What are 3 treatments for hypomobility of a joint in the c-spine?
- ROM
- Flexibility
- Neural glide
What is the treatment for hypermobility of a c-spine segment?
- Stabilization exercises
How are lengthened muscles treated?
- Strengthen in shortened range
How are shortened muscles treated?
- Stretching/ postural correction
Which muscle group is most commonly impaired in the c-spine?
- Deep anterior cervical flexors
What group of muscles are the DNF of the c-spine similar to in the trunk?
- Transverse abdominus/ core muscles
How can a patient activate their DNF muscles prior to movement of the head?
- Chin tuck/ nod
Describe the least vigorous DNF exercise.
- Slide back of head up wall
- Palpate SCMs and scalenes to ensure they are not activating
- Hold for 10 seconds
Describe the self-assist DNF exercise.
- Pt supine
- Hand supporting head
- Hand helps patient lift head off table as well as provide a traction force
- Hand can also assist in eccentric contraction
What are 2 ways to progress the self-assist DNF exercise?
- Progress to unassisted active motion
- Progress to resisted motion with a 1lb sandbag on the forehead
What are 2 methods of deep cervical flexor with SCM and Scalene assistance exercises?
Towel roll:
- Pt supine with towel roll under the head
- The patient lifts their head off the mat while maintaining contact with the towel roll and a chin tuck to avoid dominance of superficial muscles
Incline:
- Pt positioned sitting on a large incline
- Patients lifts head off mat maintaining a chin tucked position
What modality is effective in the early treatment of the cervical extensors?
- Nueromuscular stimulation (e-stim)
How are cervical extensors strengthened?
- Pt is taught to apply resistance with a specific force vector with a direction and magnitude sufficient to cause a muscle contraction in the targeted tissue. (usually sidebending with rotation)
- Pt may be lying or sitting, and reaches up over shoulder and behind head with hand and fingers to apply gentle ipsilateral sidebending and rotation
Describe an exercise targeting segmental activation of the cervical extensors?
- Start in the sitting and forward flexed position (c-spine and some T-spine)
- Begin segmental extension begining at the T-spine, then retracting the cervical region, then extending the upper C-spine and head TO NEUTRAL
Describe manual resistance of the cervical muscles, and progression.
- Begin with gentle isometrics of side bending, flexion, extension, and rotation in different neck positions
- Progress to dynamic, isotonic movements
- Increase force and duration
Describe rotation and side bending exercises.
- Pt hooklying with head on foam wedge, which patient rolls up and down in a controlled fashion
OR
- Pt sidelying with a towel roll used as a fulcrum for sidebending
How are rotation and sidebending exercises progressed?
- Multiplanar movements are introduced
hypertranslation needs to be controlled
What are the 6 causes of hypomobility?
- Segmental articular mobility restriction
- Capsular thickening and contracture
- Degenerative bony changes
- Segmental muscle spasm
- Myofascial extensibility
- Adverse neuromeningeal tension
What neck position creates a maximal downslope of the targeted vertebra?
- Quadrant
What neck position creates a maximal upslope of the targeted vertebra?
- Flexion, contralateral flexion, and rotation
How can a downslope ROM exercise be aided by the patient in their HEP?
- Target with overpressure from the ipsilateral hand
OR
- Use a towel to assist in motion
How can an upslope ROM exercise be aided by the patient in their HEP?
- Target with overpressure from contralateral hand
OR
- Use towel to assist in motion
By what 2 methods can an overstretch of the hypermobile segments above and below the hypomobile segments be prevented?
- Position neck to lock out above and below the targeted segment
- Stabilize with hand pressure
What muscles are targeted by the 4 flexibility exercises/ tests of the c-spine?
- Levator and Splenius Cervicis
- Upper Trapezius and SCM
- Middle and Anterior Scalenes
- Sub Occipitals
- Bilateral
- Unilateral
Describe the flexibility exercise that targets the levator scapulae and splenius cervicis muscles.
- Grasp chair with ipsilateral side
- Place head and neck into flexion, and contralateral rotation and side-bending
- Lean trunk to contralateral side
- Emphasize stretch with hand
- Increase stretch by contracting ipsilateral lower trapezius
Describe the flexibility exercise that targets the upper trapezius and SCM.
- Grasp chair with ipsilateral hand
- Position head and neck into flexion, contralateral sidebending, and ipsilateral rotation
- Lean to contralateral side
- Emphasize stretch with hand
- Nod chin to sharpen stretch
Describe the flexibility exercise that targets the middle and anterior scalenes.
- Pt places contralateral hand over medial clavicle and first rib of ipsilateral side
- Retract chin slightly
- Position neck into extension, contralateral side bending, and ipsilateral rotation
Describe the flexibility exercise that targets the suboccipitals.
- Position one hand on the back of the head, and one on the chin
- Flex upper C-spine with gentle distraction force
- Maintain chin tuck
- To focus stretch to one side, rotate 30 degrees
What are the 4 basic treatments for hypermobility of the C-spine?
- Postural correction exercises
- Taping of scapula to reduce pull on segment
- Manually stabilize hypermobile segment or perform cocontractions at involved levels
- Gradually challenge c-spine musculature while preventing excessive motion at involved segment
Describe the alternating isometric exercise for stabilization.
- Head and neck positioned in neutral (to begin)
- Isometric contractions applied in all cardinal planes with pressure applied on cranium (Hold for 6 - 10 seconds)
- Progressed to different directions
- Progressed to head and neck positioned out of neutral
- Progressed to eyes closed
- Progress from light force to significant (but, don’t break form)
What 3 exercises target the DNF, extensors, lateral flexors, and rotators in stage 1 of stabillization?
- AROM –> RROM of chin tuck in a variety of positions
- AROM –> RROM of intersegmental extensors in a variety of positions
- Supine head roll up/downhill on a foam wedge
How can is co-activation initiated in stage 1 of stabilization?
- Quadriped chin tuck with lower c-spine extension
How are the stage 1 exercises progressed?
- Increase in duration
How are stabilization exercises progressed in stage 2?
- Increase intensity and duration (while maintaining form)
- Coactivate C-spine to control positions during arm movements
List the positions for co-activation of the C-spine form most to least stable.
- Supine
- Quadriped
- Upright
- Unstable surface (foam roller, wobble board, ball)
- Include arm movement
- Include hand held weights
Is position of the c-spine harder to control during bilateral or unilateral arm movement ?
Unilateral
Past what degree shoulder flexion does c-spine stability become more difficult?
- 90 degrees
How are stabilization exercises progressed in stage 3?
- Intensity and duration
- Intersegmental control progressed to neck movements and functional tasks
How are neck movements progressed in stage 3 stability exercises?
- Straight plane –> Diagonal planes
- Single plane –> Multiplanar movements
- Whole body movements with neck not emphasized –> Neck emphasized
What is important for positioning of a self- nerve glide?
- Belt placed around shoulder and ipsilateral thigh in hooklying to depress shoulder
- Make sure shouder is supported so it doesn’t fall into extension
How is the nerve pulled from the distal portion?
- Wrist movement
How is the nerve pulled from the proximal segment?
- Lateral flexion of the neck
What is the position for a median nerve bias glide?
- Shoulder depressed
- Shoulder ER
- Wrist extension
- Forearm supination
- Elbow flexion –> extension
What is the position for a radial nerve bias glide?
- Shoulder depressed and IR
- Forearm pronated
- Wrist flexed and ulnar deviated
- Move from elbow flexion to extension
What is the position for a ulnar nerve bias glide?
- Shoulder depressed and ER
- Shoulder abudcted to 90
- Forearm pronated
- Wrist and fingers extended
- Move from elbow extension to flexion
What is the treatment for FHP due to muscular imbalance?
- Lengthen short muscles
- Strengthen long/ weak muscles
What is the treatment for FHP due to neuromeningeal extensibility impairments?
- Side flexion and elevation of the scapula
What is the treatment for FHP due to articular hypomobility?
- Manual therapy
- Mobility exercises
What is the treatment for FHP due to proprioception impairments?
- Postural correction
What are the 2 types of FHP?
- Forward head position with minimal midcervical lordosis
- Forward head position with excessive midcervical lordosis
How often should postural correction exercises be performed?
- As often as possible
