Clinical Pattens On Neck Pain

Question 1

What is a description for neck pain with mobility deficits and what populations are common to have it

Answer 1

Younger ages less than 50 years
Have acute neck pain for less that 12 weeks
Restricted cervical ROM
There is segmental hypomobility of the cervical and thoracic spine
Symptoms are usually isolated to neck, some referred pain may be present

Question 2

Common symptoms of neck pain with mobility deficits

Answer 2

Central and unilateral neck pain
Limitation in neck motions that consistently reproduces symptoms
Associated (referred) shoulder girdle or upper extremity pain may be present

Question 3

What are expected exam findings for neck pain with mobility deficits

Answer 3

Limited cervical ROM
Neck pain reproduced at end range
Restricted cervical and thoracic segmental mobility
Intersegmental mobility testing reveals characteristics restriction
Provocations around area will reproduce symptoms

Question 4

What intervention strategies are there for neck pain with mobility deficits in the acute stage

Answer 4

Thoracic and cervical manipulations
C spine ROM, stretching, isometric strengthening exercise
Advise staying active and doing exercises at home
Cervicoscapulothoracic supervised exercise including stretching and strengthening

Question 5

What intervention strategies are there for neck pain with mobility deficits in the sub acute phase

Answer 5

Thoracic and Cervical manipulation or mobilisation
Cervicoscapulothoracic endurance exercise

Question 6

What intervention strategies are there for neck pain with mobility deficits in the chronic phase

Answer 6

Thoracic manipulation
Cervical mobilisation
Combined Cervicoscapulothoracic exercise with mobilisations
Mixed exercise for upper extremities - neuromuscular, coordination, postural training, stretching and strengthening
Endurance and aerobic training
Stay active lifestyle
Dry needling

Question 7

What is a description of neck pain with radiating pain, common symptoms

Answer 7

Neck pain with radiating pain involved in the upper extremity
Upper extremity paresthesias, numbness and weakness may be present
May have imaging findings of spondylosis or disc herniation

Question 8

Common populations with neck pain with radiating pain

Answer 8

Adults with degenerative changes like disc degeneration
Cervical spinal stenosis patient
Traumatic injury patients
Occupation exposure like repetitive neck movement, prolonged sitting
Poor posture
Systemic conditions

Question 9

Expected findings of patients with neck pain with radiating pain

Answer 9

Neck and neck-related radiating pain reproduced or relieved with radiculopathy testing
Positive test cluster includes upper limb nerve mobility:
Spurlings test
Cervical distraction
Cervical ROM

Upper exetremity deficits = sensory, strengths, or reflex asscoacited with involved nerve roots

Question 10

What is the intervention strategy for patients with neck pain with radiating pain that is in teh acute stage

Answer 10

Exercise including mobilising and stabilising elements
Low lever laser
Possible short term collar use

Question 11

What intervention strategies are there for neck pain with radiating pain in the chronic phase

Answer 11

Combined exercise including stretching and strengthening elements plus manual therapy for c and t spine - mobilisations and manipulations
Education to encourage participation in exercise activities
Intermittent traction

Question 12

What are the 3 main types of headaches

Answer 12

Migraine
Tension
Cerviogenic

Question 13

What are common populations and risk factors for client with neck pain with headaches

Answer 13

Office workers or computer users
Manual Laborer and tradespeople
Students with heavy backpacks
Athletes and sports participation
Poor posture
Stress and psychological factors
Smokers
Age and degenerative changes
Previous trauma
Systemic conditions

Question 14

What are common symptoms of patients with neck pain with headache
(cerviogenic)

Answer 14

Non continuous, unilateral neck pain and referred headache
Headache is precipitated or aggravated by neck movements or sustained posistions

Question 15

What are expected exam findings, clinical signs and measures for patients with neck pain with headaches

Answer 15

Positive cervical flexion - rotation test
Headache reproduced with provocation of involved upper cervical segments
Limited cervical ROM
Restricted upper cervical segmental mobility
Strength endurance and coordination deficits of the neck muscles

Question 16

What intervention strategies are used for patients with neck pain with headache in acute phase

Answer 16

Exercises on C1-C2 self-SNAG

Question 17

What does self-SNAG treatment involve

Answer 17

Using fingers or hands to apply sustained gentle pressure to specific spinal joints while performing controlled movements of neck or back, with the goal of mobilising affected joints to reduce stiffness and alleviate pain

Question 18

What intervention strategies are used for patients with neck pain with headache in subacute phase

Answer 18

Cervical manipulation and mobilisations
Exercise C1-2 self-SNAG

Question 19

What intervention strategies are used for patients with neck pain with headache in chronic phase

Answer 19

Cervical and thoracic manipulation
Strengthening and endurance for cervical and scapulothoracic region, with neuromuscular training including motor control and biofeedback elements
Combined manual therapy plus exercise

Question 20

What is a description of neck pain with movement coorindation impairments

Answer 20

Long standing neck pain (greater than 12 weeks)
Abnormal performance on cranial cervical flexion test and deep flexor endurance
Coordination strength and endurance deficits of neck and upper quarter muscles
Flexibility deficits of upper quarter muscles
Ergonomic insufficiencies with performing repetitive activities

Question 21

What are common populations and risk factors with neck pain with movement coordination impairments

Answer 21

Office workers
Manual Laborours
Older adults
Whiplash and neck trauma patients
Chronic pain
Postural disorders
Anxiety or stress
Vestibular disorders

Question 22

What are common symptoms for patients with neck pain with movement coordination impairments

Answer 22

MOI linked to whiplash or trauma
Referred shoulder girdle or upper extremity pain
Associated nonspecific concussion signs and symptoms
Dizziness / nausea
Head ache, concentration or memory difficulties

Question 23

What are common clinical signs and reliable measures for neck pain with movement coordination impairments

Answer 23

Positive cranial cervical flexion
Positive neck flexor muscle endurance test
Strength and endurance deficits
Neck pain with mid range motion that worsens with end range
Point tenderness, may include myofascial trigger points
Sensorimotor impairments
Neck and referred pain reproduced by provocation if involved cervical segments

Question 24

What are intervention strategies for patients with movement coordination impairments in acute phase

Answer 24

Education - advise remaining active and act as usual
Home exercise program - pain free cervical ROM and postural element
Monitor for acceptable progress
Minimise collar use

Question 25

What are intervention strategies for patients with movement coordination impairments in subacute phase

Answer 25

Education on activation and counselling
Combined exercise - active cervical ROM and isometric low load strengthening plus manual therapy and physical agents like ice and heat
Supervised exercise

Question 26

What are intervention strategies for patients with movement coordination impairments in chronic phase

Answer 26

Education on prognosis, encouragement reassurance and pain management
Cervical mobilisation plus individualised progressive exercise = low load Cervicoscapulothoracic strengthening, endurance, flexibility and functional training using CBT principles
TENS

Question 27

Describe WHIPLASH, cervical acceleration / deceleration injuries

Answer 27

Whiplash is a umbrella term for a wide range of disorders of varying severity
Frequently associated with collisions where the cervical spine is involved in high velocity hyperextension or hyper flexion movements
Damage can occur to bony, ligamentous, muscular, vascular and nervous tissue
results from rapid unguarded stretching and compression forces which elongate tissue beyond its normal limits

Question 28

How is WHIPLASH classified

Answer 28

Quebec classification = 0-4

Question 29

What are the common population / risk factors with whiplash

Answer 29

Car drivers and passengers
Contact sports and high velocity sports
Injury mechanism influences structures which are damaged
Anticipation of impact, properly fitted headrest can reduce degree of damage
Underlying pathology may affect recovery

Question 30

What are common symptoms of whiplash in the acute phase

Answer 30

There is a Miriad of symptoms depending on the structures damaged and the emotional and psychological impact of the incident

Localised to neck but pain tenderness and stiffness is felt in lumbar spine with Radicular symptoms radiating into both arms
Headaches, hoarseness, difficulty swallowing or speaking
TMJ pain
Vertbral artery damage may cause symptoms affecting the eye or ear

Question 31

What are symptoms that occur in the chronic phase of whiplash syndrome

Answer 31

May exhibit pain, stiffness, loss of function
Pain may be due to central sensitisation of CNS

Question 32

What are clinical signs and reliable measures of whiplash

Answer 32

Variable presentation depending on extent of injury and early management
Reduced AROM
Reduced functional activity
Difficulty finding comfortable position
Fear of movement and ADL
Muscle weakness - neck, shoulder girdle, upper limbs
Joint tenderness - neck, thoracic and lumbar spines, shoulders
Neurology +ve
Positive nuerodynamic signs

Question 33

What investigations will show what for whiplash patients

Answer 33

X ray will detect bony damage
MRI shows soft tissue damage

Question 34

What are some management techniques with evidence for whiplash patients

Answer 34

Education and reassurance is widely recommended but limited evidence
Activity and exercise therapy has moderate evidence
Manual therapy with combined exercise has moderate evidence
Cervical collars not supported
Medications = limited
CBT and relaxation techniques has some evidence