Craniocervical muscle retraining

Question 1

neuromuscular system - tests

Answer 1

tests of deep and postural stability muscles

tests of patterns of muscle activation
- cognitive, movement and functional tasks

tests of muscle length

Tests of muscle strength and endurance

Question 2

DNF test

Answer 2

Technique - CCFT (cranio-cervical flexion test)
- to assess the relative activation of longus colli and longus capitis vs superficial cervical flexors (SCM)

Patient position - supine with rolled towel under occiput. Neck must be in neutral with eyes looking towards ceiling

Method - ask the pt to perform a nodding motion similar to a yes and to hold the position for 5-10 sec
Assess quality of CCF movement.
look for overuse of SCM/scalenes or lifting of the head off the bed
normal should be able to do 10x10 sec holds

Question 3

Cervical flexors endurance

Answer 3

same set up as DNF test
clinician’s hand underneath
pt maintains upper cervical flexed position, lifts head up off clinician’s hand 2.5cm
measure holding time in seconds. Terminate test when the pt
- is unable to maintain the correct position
has an incr in pain or discomfort
gets to 1 min
Typical hold times
- without neck pain 38.95 sec
- with neck pain - 24.1 sec

Question 4

Cervical extensors

Answer 4

CET - Cervical extensor test
- assesses for impairement of the neuromuscular control of the deep cervical extensors

pt in 4 poiny kneeling or prone on elbows

Methods- ask pt to perform a cervical flexion/extension motion whilst maintaining the upper cervical spine in neutral. Watch for
- altered movement patterning
-jerky movements
-dominance of craniocervical extension
- pain or discomfort
A patient with normal cervical extensor control should be able to do at least 10x10 seconds

Question 5

Assessment of sensorimotor control disturbances

Answer 5

cervical afferents important for

• knowledge of head in relation to body
• control of postural stability/balance

Disturbed afferent input
- sensory mismatch to postural control

causes of damage

• trauma - WAD
• Function impairment - muscles
• Inflammation
• morphological changes - muscles
• Pain

objective measures -
- cervical joint position error
-cervical movement sense/control
oculomotor : SPNT, Gaze stability, eye/head co-ordination