Cx Spine Stabilization

Question 1

what are the superficial neck flexor and extensor muscles?

Answer 1

flexor:
SCM and anterior scalene
Extensor:
splenius capitus

Question 2

superficial muscles tend to become hypo or hypertonic?

Answer 2

hypertonic - protective spasms, inhibiting local muscles

Question 3

what are the deep neck stabilizers?

Answer 3

multifidus (segmental attachments)
longus capitis and longus colli (anterior stability)
semispinalis cervicis (lower cervical posterior stability)

Question 4

deep neck stabilizers are static or dynamic stabilizers?

Answer 4

dynamic

Question 5

what two criteria are required for “clinical instability”? (NOT panjabi)

Answer 5

1) increase in NZ of C-sp ROM

2) less resistance to passive motion in the elastic zone than one would expect

Question 6

according to Panjabi, what are the three subsystems of spinal stability?

Answer 6

passive system
active system
neural system

Question 7

what three things does the passive subsystem do (C-sp stability)?

Answer 7

• provides stabilization of the elastic zone
• limits the size of the neutral zone
• provides neural subsystem info on vertebral position and motion

Question 8

what four things does the active system do (C-sp stability)?

Answer 8

• generates forces to stabilize the spine
• controls the motion that occurs within the neutral zone
• contributes to maintaining the size of the neutral zone
• provides the neural subsystem with info on forces generated by muscles

Question 9

what does the neural subsystem do other than receive info from the other two systems (C-sp stability)?

Answer 9

from the info: it determines the requirements for stability and acts on spinal muscles to produce the required forces

Question 10

what is Panjabi’s definition of spinal instability?

Answer 10

“Inability of the spine under physiologic loads to maintain its pattern of displacement so that no neurologic damage or irritation, no development of deformity, & no incapacitating pain occur”

• essentially this is an increase in NZ that the three subsystems cannot compensate for, resulting in poorly coordinated mvt within this increased NZ leading to symptoms

Question 11

what is the cause of this increased NZ with C-sp instability? what are four contributing factors?

Answer 11

• degeneration and mechanical injury of spinal stabilizers

- contributing factors: Poor posture, repetitive microtrauma, macrotrauma, poor motor control of ms

Question 12

for Hypermobility of the C-sp, what are some MOIs?

Answer 12

• macrotrauma (MVA, FOOSH)

- poor posture (repetitive or sustained…)

Question 13

what is the pain site and pain type for hypermobility of the C-sp?

Answer 13

pain site: local

pain type: feeling unstable, lack of control, may feel noise

Question 14

what is the pain pattern for hypermobility of the C-sp?

Answer 14

pain increases with prolonged static postures, plus there is a feeling of fatiguability and inability to hold head up. Sharp pain with sudden movements

pain decreases with self or therapist manipulation, or with external support

Question 15

what might you see on a patient with hypermobility (observation)?

Answer 15

• poor posture

- cutaneous creases

Question 16

what might you notice during ROM assessment on a hypermobile C-sp?

Answer 16

• painful and increased ROM
• clicks, clunks
• creases with movement
• movement is not smooth, look for aberrant movement

Question 17

what might you see with PAs and PPIVMs with a hypermobile C-sp?

Answer 17

• increased NZ, R1 & R2 and soft or normal EF

Question 18

what might you notice during a biomechanical assessment of a hypermobile C-sp?

Answer 18

• Cranio-cervical flexion test (CCFT) = increased use of superficial muscles and reduced use of deep neck flexors.

Question 19

name one condition associated with C-sp hypermobility/instability…

Answer 19

UNLT 1 may be +ve

Question 20

what are five principles to include when dealing with C-sp hypermobility/instability?

Answer 20

• train tonic endurance of deep ms: should be a slow, tension type contraction
• exercise should be pain-free
• add outer unit after good inner unit recruitment
• incorporate in functional activities
• note progression and increase pressure and reps accordingly

Question 21

what are four tests for C-sp hypermobility/instability that have to be performed in ordeR?

Answer 21

1) low resistance - CCFT
2) add deep neck extensors
3) add anterior mobilizers
4) add posterior mobilizers

Question 22

what is the ultimate goal of conservative Rx for C-sp hypermobility/instability? What are three elements of treatment that can be used to achieve this goal?

Answer 22

Decrease stress on involved segments by:

• patient education on posture, which will decr stress on segments and put them in a more efficient position.
• mobs above and below hypermobility may decr stress on passive system.
• neuromuscular control exs: improve function of the active subsystem, in hopes that the deep muscles compensate for the increase in NZ that happens with hypermobility/instability. Improving coordination and quality of mvt of deep muscles may also help to inhibit superficial ones.

Question 23

what three elements of a HEP have been shown to improve outcomes?

Answer 23

• deep neck flexors strengthening
• stretching ms that tend to tighten (U trap, levator)
• strengthen scap adductors and retractors

Note how these three are all the most typical postural corrective measures ever.