Cervicothoracic Spine: Test 2 Flashcards
What might happen if the there is hypo mobility in an area of the cervicothoracic spine that is left untreated? Give and example
stiff area may not be painful, and if it is not addressed it will typically cause painful hyper mobile compensations elsewhere
Example: stiff facet leads to hyper mobile adjacent facets or stiff upper thoracic regions lead to hyper mobile lower cervical spine
how can you obtain more uniform/distributed motion in the presence of hypo mobility
mobilize stiff areas
what determines the direction and amount of motion at the facet joints
orientation
describe the motion/location of the facet joints between C2-C7
they lie between the frontal and transverse planes
these facets favor all motion equally; this is not true for other spinal segments
describe the location/motion of the upper thoracic facet joints
mostly lie/move in the frontal plane
favors SB more (because the facets are more vertically oriented) BUT ribs limit the ROM of the SB
Thoracic vertebrae actually have more rotation than they do SB because of this even though their orientation would imply otherwise
describe the rotary motion of the upper cervical region
over 50% of neck rotation happens at the upper cervical area
mostly at the AA joint
how would you define stabilization
controlled mobility
more than just strength of superficial and big muscles
what are the 4 variables for stabilization
Joint integrity (i.e. cartilage)
Passive stiffness (i.e. ligaments)
Neural input (least often cause; usually not a conduction issue)
muscle function
describe local muscles
closer to axis of motion
often deeper
used more for stabilization than rotary forces
shunt muscles
tonic/postural
more aerobic than anaerobic (longer endurance)
describe global muscles
further away from the axis of motion
often superficial
used more for rotary forces than stabilization
spurt forces
phasic muscles (not always contracting)
more anaerobic than aerobic (less endurance capacity)
why are global muscle better overall joint movers
they have a longer lever arm that allows them to generate better/more propulsive forces
describe how local and global muscles interact with roles
both muscle types can contribute to both stabilization and movement
Local muscles tend to ensure stabilization first, and global muscles are primarily movers
if stabilizing muscles are inefficient then global muscles tend to act as stabilizers; since their makeup is not as conducive to that there can be pain, stiffness, etc in those global muscles
what are common local muscles in the cervical region
longus Colli and other deep neck flexors
sub occipitals and splenius mm
what are the main local muscles of the thoracic region
rotatores and multifidus (the smaller these muscles are the higher injury rate)
pelvic floor and transversus abdominus (activation of these can increase the contraction of the multifidus)
describe the inhibitory effects of pain, swelling, joint laxity, and disuse
decreased/delayed motor activation/coordination (aka inhibition of local muscles)
inhibition is preferential to type I muscles (endurance/stabilizing)
this inhibition limits the amount of activating muscles which means that the ones that still are activating can tire much quicker
the more inhibition, the more atrophy present with those local muscles (door hinge examples; more damage close to the axis, the more continual damage will occur there)
ultimately more stress put on non-contractile structures
what are some of the changes that take place in the muscles as a result of swelling, joint laxity, and disuse causes
increased/inefficient motor activity of global muscles (too much global muscle movement)
decreased cervical proprioception (motion sense; more likely to get hurt again; less feedback = less injury prevention)
atrophy leads to fatty infiltration (harder to gain back strength later on)
fiber types shift towards type II (less able to do what the muscle was originally designed to do)
describe how muscle activity/activation is the crucial treatment for stabilization
muscle activation of 30% is sufficient tot keep stability and is suitable to improve muscular endurance so it doesn’t take a lot
normal muscle activity does not just return after pain is gone from instability; must retrain
what is pain phenotyping
set of observable pain characteristics of an individual resulting from body and environment interaction
what are the 3 types of pain phenotyping
nociceptive
neuropathic
nociplastic
describe nociceptive pain and the subtypes
non-nervous tissue compromise
MSK pain (including spondylogenic)
viscerogenic (getting pain from organ dysfunction)
describe neuropathic pain and the subtypes
nervous system compromise
radicular, radiculopathy, and peripheral
describe nociplastic pain
qaltered pain perception without complete evidence of actual or treated tissue compromise
what is spondylogenic pain and some key characteristics
pain from the spine
common
can be local and/or referred spinal pain from noxious stimulation of spine structures
cannot cause visceral dysfunction as some providers claim (unless it is a spinal nerve itself; facet/bone/joint itself cannot)
symptoms of spondylogenic pain
non-segmental pain: means its not from a spinal nerve itself
rarely if any paraesthesias
vague, deep, achey, boring pain
referred into ill defined area that settles into a consistent location
what is segmental pain
pain distribution from spinal nerve in a dermatomal pattern
what are signs of spondylogenic pain
neuro scan WNL (because there is no spinal nerve involvement)
can’t reproduce entire symptoms pattern with motion
describe what somatic convergence means in reference to spondylogenic pain
aka referred pain; sensory afferents converge on and share the same innervation
this means that some joints in the neck are also innervated by nerves from some neck muscles
there is greater referral to proximal and deep structures rather than distal and superficial (i.e. the more midline/centered the joint is the more likely it will cause referred pain)
i.e. spinal facet joints refer pain more often than the elbow joint
describe viscerosomatic convergence
viscera and somatic (body) sensory afferents CONVERGE on and SHARE the same innervation
for example approximately C4-T4 there is a shared innervation of the heart and some neck muscles; thus heart issues can cause pain in the left shoulder, UE, neck, and jaw (all shared innervation)
signs and symptoms of viscerogenic pain
not typically able to be mechanically reproduced
neuro scan WNL
what is radicular pain
ectopic or abnormal discharge from highly inflammed spinal nerve (dorsal root)
