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PHTY3260 > L1: Biopsychosocial approach and biomechanics > Flashcards

L1: Biopsychosocial approach and biomechanics Flashcards

1
Q

What is the neck pain experience?

A

The course of neck pain is best described as episodic occurring over a lifetime with variable degrees of recovery in between episodes

Often incomplete recovery from an initial episode

  • After first episode -high chance of repeated episodes throughout the course of a lifetime
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2
Q

What are 9 features of epidemiology for neck pain?

A
  1. Neck pain now ranked number 1 chronic condition -global years with disability
    • Attributed not just to computer and device use but the aging population
  2. 12-month prevalence of neck pain ranges between 30% and 50% –Adults 30-50%, Children 2-42%
    • All ages affected (no specific age range)
  3. 12-month prevalence of activity-limiting neck pain 1.7% to 11.5%
  4. 1 in 5 adults previously pain free report new episode annually (Croft et al 2001)
  5. ~ 2.5m Australians suffer activity limiting neck pain/year. Huge future role of physio
  6. While the natural history is favourable, 37-80% have persistent and or recurrentepisodes
  7. Between 50% and 85% of those who experience first episode neck pain will report neck pain again 1 to 5 years later
  8. Similar incidence: general population workers following motor vehicle accident
  9. Challenges in rehabilitation to decrease recurrence rates, not just alleviate pain
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3
Q

What are the 4 focuses for cervical physio?

A
  1. successfully alleviate the pain state
  2. decreasing recurrence rate
  3. preventing /slowing disease progression
  4. Prevention /minimising neck pain disorders
    1. Occupational health
    2. Vehicle modifications
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4
Q

What are 5 cervical disorder presentations?

A
  1. neck pain only
  2. neck pain and headache (upper cervical dysfunction)
  3. neck and arm pain (C4 to T2 can refer into the arm)
  4. neck pain and jaw pain
  5. associated symptoms such as:
    1. dizziness
    2. unsteadiness,
    3. visual disturbances
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5
Q

What are 5 neck pain categories?

A
  1. Mechanical / idiopathic (Unknown cause) neck pain –80-90% ***
  2. Radiological imaging: nospecific patho-anatomical diagnosis, no positive lab tests (No correlation between imaging and symptoms (similar to LBP))
    1. postural strain –overload on cervical structures
    2. occupational induced neck pain
    3. degenerative joint disease (Z joint or disc)
  3. Cervical radiculopathy
    • Nerve root compression or irritation (lateral or central canal stenosis -disc, osteophytes) 0.1-0.35% population
    • Compressions of facet or vertebral joints
  4. Cervicogenic headache 2.2%
  5. Trauma induced neck pain -egwhiplash -motor vehicle crash (MVC), sporting injury, fall, or blow to head
    • Problems with sensitisation (but if similar symptoms –> try like mechanical neck pain)
  6. Non mechanical neck pain – Red flags/Refer to medical team : eg. AS, RA, tumour, congenital disorder
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6
Q

What does the biopsychosocial framework look like for patients with neck pain disorders?

A
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7
Q

What are the 6 pathophysiological, biological features of neck pain in the biopsychosocial framework?

A
  1. Pain/sensory features
  2. Altered psychosocial features resulting
  3. Altered articular and movement features
  4. Nerve tissue: irritation, compression mechanosensitivity
  5. Altered neuromuscular control; muscle properties
  6. Altered postural control
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8
Q

What are the 6 psychological features of idiopathic neck pain in the biopsychosocial framework?

A
  1. Anxiety
  2. Distress
  3. Depression
  4. Fear avoidance behaviours
  5. Poor coping skills
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9
Q

What are the 4 psychological features to consider in idiopathic neck pain in the biopsychosocial framework?

A
  1. Need to differentiate between idiopathic and traumatic neck pain
  2. 85% of patients don’thave psych problems
  3. Few studies on what normalphysiological reactions are to having neck pain
  4. Moderators/mediators
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10
Q

What are the 6 psychological features to consider in whiplash associated disorders in the biopsychosocial framework?

A
  1. Post-traumatic stress reactions
  2. Psychological distress; anxiety, depression
  3. Fear avoidance behaviours
  4. Catastrophization
  5. Lower self-efficacy
  6. Perceived injustice (“not their faulty” –> now they get chronic pain)

PTS needs to be diagnosed and treated by psychologist but nottoo early

  • ?PTSD if not resolved in 2-3 months
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11
Q

What are 4 work factors in the in the biopsychosocial framework?

A
  1. Impact of computer use on musculoskeletal symptoms and productivity emerging as important issue
  2. 12 month prevalence neck symptoms in office workers estimated at 50-76%
  3. 60-80% office workers report recurrence of neck pain one year after initial episode
  4. Loss productivity –absenteeism, presenteeism
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12
Q

What are 7 social factors in the in the biopsychosocial framework?

A
  1. Gender
    • Female > Male
  2. Emotional problems
  3. Poor job satisfaction
  4. Poor physical work environment
    • Unable to control tasks at work
  5. Occupation type
  6. Smoking
  7. Awkward work postures
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13
Q

What is the changing biopsychosocial model?

A

Key to effective management = doing a thorough examination

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14
Q

What is the summary of biological, psychological and social factors of patients with neck pain disorders are considered within a Biopsychosocial framework?

A
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15
Q

What are the 5 systems in the patho-anatomy of the neck?

A
  1. Articular
  2. Muscles
  3. Nerves
  4. Arteries- 4 main arteries
  5. Sensorimotor
    • Proprioceptors in neck joint/muscles
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16
Q

What are the 7 differences between the cervical spine and lumbar spine?

A
17
Q

What are 7 characteristics of the lumbar spine?

A
  1. Fewer articulations
  2. Load bearing
  3. Stability
  4. Large vertebrae
  5. Large discs
  6. Motor control
  7. Protective of abdominal organs
18
Q

What are 7 characteristics of the cervical spine?

A
  1. Many articulations
    • Uncovertebral clefts?, facet joints
  2. Mobility
    • ​only taking the weight of the head
  3. Load bearing
  4. Small vertebrae
  5. Thin discs
  6. Motor control
  7. Sensorimotor function
19
Q

What are the 3 main features of the cervical spine as a multi-joint complex?

A
  1. flexible structure
    • 3D movement of head
  2. mechanical stability
    • at any given orientation
  3. load bearing
    • anterior, posterior elements –head; upper limb
20
Q

In the cervical spine, 20% of stability supplied by _____ (_____)

A

ligaments (end of range)

21
Q

In the cervical spine, 80 % of stability supplied by _____ system

A

muscle

22
Q

What are the 4 features of kinematics in the cervical spine?

A
  1. Functional cervical spine: C0-1 T3-4
  2. Cranio-cervical complex: - Rotation
    • C0-2 (head on neck movement)
  3. Cervical region: - Flexion and extension
    • C2-7 (neck movement)
  4. Cervico-thoracic junction
    • C7-T4 (neck on thorax movement)
    • Areas of increased stress
23
Q

What are the 4 units of functional anatomy in the cervical spine?

A
  1. Atlas (cradle)
  2. Axis (axis)- Allows rotational movement
  3. C2-3 junction (the root)
  4. Remaining cervical vertebrae (the column)
24
Q

What are the ranges of motion between C2-7?

A
25
Q

What are 3 anatomical parts that cervical movements are guided by?

A
  1. Disc
  2. Shape of facets
  3. Uncinate processes
26
Q

What are the movements coupled for cervical flexion and extension?

A

Due to the facets (will be coupled movements)

  • Flexion: anterior rotation and translation
  • Extension: posterior rotation and translation
27
Q

What is the role of uncinateprocesses in the cervical region?

A
28
Q

What are the movements coupled for cranio-cervical (C0-2) flexion and extension?

A

Flexion

  • C0-1: forward rotation,backward translation,occiput on atlas
  • C1-2: atlas rotates forward and translatesbackwards on axis

Extension

  • C0-1: backward rotation,forward translation,occiput on atlas
  • C1-2: atlas rotates backwardand translatesforwardson axis
29
Q

What are 4 restraints to cervical flexion?

A
  1. alar ligaments
  2. posterior short and long ligaments
  3. short suboccipitalextensors
  4. dura mater
    • attaches to the foramen magnum
    • back of the body of C2
    • fibrous connection with RCPM (Rectus capitus posterior medial), nuchal ligament
30
Q

What is the primary restraint to cervical extension?

A

Transverse ligament

31
Q

What are 2 clinical implicatiosn for cervical flexion and extension?

A
  1. Craniocervicalflex in cervicogenicheadache patients –neural tissue mechanosensitivity
  2. Trauma egwhiplash injury
32
Q

What are 3 movement couples for lateral flexion?

A
  1. lateral rotation
  2. ipsilateral axial rotation
  3. medial translation
33
Q

What are 3 movement couples for axial rotation?

A
  1. rotation
  2. ipsilateral lateral flexion
  3. medial translation
34
Q

What are movement couples for rotation and lateral flexion or C1-2, C0-2, C1-2?

A
  1. C1-2 (axis) ~ 50% of cervical Rot
  2. C0-2 Rotand LFcoupled
  3. C1-2 Rot coupled with contra-lateral LFat C0-1
35
Q

What are 2 clinical implications for movement couples for rotation and lateral flexion for C1-2, C0-2, C1-2?

A
  1. Limitations of extension/ rotation-what structures likely to be involved?
  2. Positions of deformity wry neck
36
Q

What are the differences between the cervical spine discs and lumbar spine discs?

A
37
Q

What are 4 clinical implications for cervical spine disc VS lumbar spine disc?

A
  1. Lumbar disc herniations-common younger people 20-30s-big and juicy discs
  2. Lumbar worse am
  3. Cervical disc disease –middle age to older = degenerative condition
  4. Cervical generally not worse am, worse through the day
38
Q

What are 5 clinical pointers for the cervical region?

A
  1. incidence of neck pain increasing
  2. adverse effects of sedentary postures
  3. adverse effects of overload from muscles suspending the scapula/upper limb
  4. no evidence of muscle function returning without specific training
  5. In rehabilitation we need think of decreasing the recurrence rate

PHTY3260 (27 decks)

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