A chin tuck exercise targets which musculature and is an important exercise why?
- Rectus capitus anterior
- Longus capitus
-** Longus Colli** - Longus Capitus
- Straightens the c-spine and holds it rigid
Your patient was able to make it to 26 mmHg with the stabilizer cuff when performing the craniocervical flexion exercises. How would you set up training them for intervention?
Begin at target level (26 mmHg) and progressively increase. (10 sec holds x 10 reps)
When performing Deep Neck Flexor training, what muscles do you want to avoid activating?
SCM and scalene activation
Is there a benefit of completing craniocervical flexion exercises over conventional cervical flexion exercise?
No, both show improvement
What is the goal of nerve mobilizations?
to attempt to restore the dynamic balance bteween the relative movement of neural tissues and surrounding mechanical interfaces.
What are the proposed mechanisms of nerve interventions?
- Decrease adhesions + allow improved movement of peripheral nerves.
- Increase neural vascularity = increased oxygenation of nerve and a decrease in ischemic pain
- Dispersion of noxious fluids
- Improvement of axoplasmic flow
Grade I Oscillation Mobilization
Small amplitude, beginning of range
Grade II Oscillation Mobilization
Large amplitude, within range - not limit of range (free of stiffness/muscle spasm)
Grade III Oscillation Mobilization
Large amplitude, up to the limit of the range
Grade IV Oscillation Mobilization
Small amplitude, at the limit of the range
Grade V Manipulation
high velocity thrust, at the limit of range.
Proposed mechanisms for joint mobilizations
- Biomechanical: motion/positional improvement
- Neurophysiologic: spinal cord, central mediated, peripheral inflammatory
- Other: placebo, pt expectation
Absolute Contraindications for Manual Therapy/Passive Movements (mobilization, stretching, manually assisted movements)
- Malignancy of targeted region
- Cauda Equina Syndrome
- Red flags that indicate neoplasm, fracture, or systemic disturbance
- Rheumatoid collagen necrosis
- Upper C-spine instability
- Concern for Cervical Arterial Dysfunction (CAD)
- Practitioner lack of ability
- Spondylolithesis
- Gross foraminal encroachment
- Children/teenagers
- Pregnancy
- Fusions
- Psychogenic disorders
- Immediately post-partum
Relative Contraindications for Manual Therapy/Passive Movements (mobilization, stretching, manually assisted movements)
- active, acute inflammatory conditions
- Significant segmental stiffness
- Systemic diseases
- Neurological deterioration
- Irritability
- Osteoporosis
- Condition is worsening with present treatment
- Acute n. root irritation (radiculopathy): mismatch between subjective/objective, pt condition worsening, oral contraceptive use, long-term corticosteroid use
- Immediately post-partum (cervical/lumbar)
- Blood clotting disorder
- Significant segmental stiffness
- Systematic diseases
- Neurological deterioration
- Irritability
- Osteoporosis
T-spine manipulations can address mechanical neck pain and give short term or long term pain relief?
Short Term
High velocity, low amplitude thrusts of C-spine and upper T-spine is associated with greater improvements in:
- pain and disability
- Passive C1/2 rotation
- Deep c-spine flexor motor performance
CPG for neck pain and manual therapy advocate for
- Mechanical neck pain: cervical thrust and non-thrust techniques (part of POC) and Thoracic Thrust/Non-Thrust (Short term)
- Cervicogenic HA: Mobilization/manupulation + exercises (pain reduction + functional improvement)
- Cervical Dysfunction/Dizziness/HA: MWM
Classifications of the Neck Pain CPG include
- NP with mobility deficits
- NP w/movement coordination impairments (incl: WAD)
- NP w/HA
- NP w/radiating pain
When instructing a patient to perform a MWM for the c-spine, how do you know which way to tell them to apply force?
Stabilize on ipsilateral side with limited rotation, use contralateral side to push further into limited ROM
Scheuermann’s Disease Interventions Include:
- Postural control muscle performance
- Mod of aggravating activities (FLEX)
- Strengthen + stretch trunk
- Bracing
Examples of strengthening and stretching for Scheuermann’s disease
- Seated rotation
- Extension in lying
- Thoracic extensor strengthening
- Scapular abductor strengthening
PT Interventions for ankylosing spondylitis include
Active exercises with a mobility focus
- Spine ext + peripheral joint exercises
- breathing exercises
- Prone lying several times/day
- Sleep on firm mattress + avoid SL position
- Swimming
- Pt education on active > sedentary
Intervention for Adolescent idiopathic scoliosis
- Strengthen postural muscles
- Address muscle length impairments/strength impairments of extremity musculature
- Maintain/improve respiration + chest mobility
- Resume functional tasks
- Strengthen abdominals
T4 Syndrome Interventions
- Thoracic joint manual therapy
- Thoracic mobility exercises
- Scapulothoracic motor performance
- Thoracic extensor strengthening
