Cspine Intervention Flashcards
What should you think about when intervention planning?
- Think stability vs mobility
- Educate (prognosis, management plan)
- Reduce Pain (manual therapy, exercise, improve stability)
- Address impairments
- Improve functional activity performance and participation (patient’s desired goals)
In phase 1 of improving stability/mobility what should you do?
- Activation/ Coordination exercises
- Mobility Exercises (AROM, stretching at end ranges)
- Inhibitory Exercises (Posture stabilizers)
- Soft Tissue Mobilization (guarding musculature)
- Joint mobs (sustained hold vs. oscillations), manipulations
- Guarding and pain – oscillations
- Stretch a tight capsule – sustained hold
In phase 2 of improving stability/mobility what should you do?
Progression to strength/ endurance training of stabilizers
- Retrain/ strengthen motion within newly improved range
In phase 3 of improving stability/mobility what should you do?
Increase challenge of exercises (progress toward activity limitations) -> functional goals
If there is muscle guarding, what type of exercise and stretch can you do to decrease?
i. Low intensity high rep exercise to improve motion
ii. Target antagonist with AROM to improve ROM
What cervical muscle is important to activate to increase ROM?
Longus colli
What muscle doesn’t activate very well in functional activity for patients with chronic neck pain?
Longus capitus
What are 2 deep neck flexor exercises?
- Craniocervical flexion exercise (CCFEx)
2. Endurance Training (Chin-tuck/ Head lift)
How can you make Craniocervical flexion exercise (CCFEx) more difficult/functional?
- alter positions (quadruped vs. sitting), add resistance,
2. Avoid SCM & anterior scalene activation
How can you make neck endurance training more difficult?
Increase hold times & resistance
Describe gentle stretching for nerve entrapments
stretching CT surrounding the nerve and get better movement of nerve
Difference between gliders and tensioner nerve entrapment mobilizations.
Gliders” (“Sliders”) – take up slack on one end and give slack on the other
“Tensioners” take up slack on both sides
What are the proposed 3 mechanisms for nerve entrapment mobilizations?
- decrease adhesions and allow improved movement of peripheral nerves
- increase neural vascularity, allowing increased oxygenation of the nerve and a resultant decrease in ischemic pain
- Dispersion of noxious fluids
What are 5 adverse responses to nerve mobilizations?
- flare up
- pain increases with intensity
- pain begins to peripheralize
- tingling increases
- symptoms do not go away afterwards
When would you use oscillation Mobilizations at mid-range or a manipulation to get neuro inhibitory effect?
For guarding/pain
When would you use static stretch mobilizations with joint held in full range of motion with over pressure?
- Address CT shortening
- Take up slack and put extra force to get plastic deformation (capsule tissue to stretch)
- 30 second holds 3-5x
T/F When using manual therapy for an injury, address the limiting impairment first. (ex)
True, Hypomobility of zygapophyseal joints but maybe muscle guarding – oscillation or soft tissue mob to address guarding first to increase mobility of joints
What type of movement at what range for grade I oscillatory mobilizations?
Small amplitude movement performed at the beginning of the range.
What type of movement at what range for grade 2 oscillatory mobilizations?
Large-amplitude movement performed within the range but not reaching the limit of the range. It can occupy any part of the range that is free of any stiffness or muscle spasm.