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PHTY3260 > L19-20: Cervical muscle and sensorimotor treatment > Flashcards

L19-20: Cervical muscle and sensorimotor treatment Flashcards

1
Q

What are 7 impairments in muscle function in neck pain?

A
  1. Altered relationships within
    1. neck flexor synergy
    2. neck extensor synergy (probable)
    3. axioscapular muscles
  2. Loss of feedforward response
    1. Muscles are delayed (acting in feedback pattern–> more risk of injury)
  3. Morphological changes
  4. Loss of muscle support in posture and movement
  5. Loss of endurance at different contraction intensities
  6. Loss of strength/ endurance
  7. Fatigability
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2
Q

What are 5 exercise mode(s) best for neck pain disorders?

A
  1. Motor relearning
  2. Flexibility training
  3. Endurance training
  4. Strength training
  5. Cardiovascular training

All beneficial for pain management: Depends on primary outcome

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3
Q

What are 2 exercises if pain is the primary outcome for neck pain disorders?

A

Evidence:

  1. both motor learning
  2. strength training
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4
Q

What are exercises if prevention/prevention of recurrent neck pain is the primary outcome?

A

Suggest exercise must restore normal muscle behaviour and function

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5
Q

What type of exercise should be prescribed?

A
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6
Q

What are 5 outcomes tested in motor relearning and strength training?

A
  1. CCFT
  2. Functional tasks
  3. Posture
  4. Feedforward
  5. Strength/ fatigue of the SCM and AS
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7
Q

What is the ouctome of CCFT for strength training?

A

Strength Training ✖

General head lift exercise failed to address altered muscle behaviour

Strength training did not improve in CCF (therefore must target management)

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8
Q

What is the ouctome of CCFT for motor relearning?

A

Motor relearning ✔

Specific low load exercise successfully addressed altered muscle behaviour

Both deep and superficial muscles improved with CCF low load training (motor control)

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9
Q

What is the variations between individuals (idiopathic neck pain) in initial presentation related to pain intensity?

A

High levels of pain = less effect of training (might take longer)

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10
Q

What is the relationship between change in pain and magnitude of improvement in deep cervical flexor activation after training?

A

Once deep flexors are changed –> some changes are seen

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11
Q

What are 2 ways that very high pain states can affect motor relearning?

A
  1. Chronic WAD- No change SCM activity in CCFT after 10 weeks training
  2. in higher NDI and widespread mechanical and cold hyperalgesia
  • No sensory change threshold (cold..etc) = improved better
  • Sensory changes = less improvements
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12
Q

What is outcome for the functional task (tapping task)? What does does the outcome mean?

A
  • no significant change activity post-intervention for either exercise group✖
  • Similar results trapezius ✖

Suggests task specificity is also required in training

  • Eg. scapular while adding functional task
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13
Q

What is the outcome of posture change? What does does the outcome mean?

A

Change in cervical angle during the computer task in response to training?

  • motor relearning program ✔
  • strengthening program ✖

To postures (since they are low load endurance muscles)

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14
Q

What is the outcome of feed forward? What does does the outcome mean?

A

Improved timing of the deep cervical flexors motor learning program better

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15
Q

What is the outcome of strength? What does does the outcome mean?

A

Higher load exercise required to improve strength

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16
Q

What is the outcome of fatiguability? What does does the outcome mean?

A

Higher load exercise required to improve SCM and AS fatigability

17
Q

What are 2 types of tasks?

A
  1. Formal
  2. Functional –task specific
18
Q

What are 5 tasks for muscle system in neck pain disorders?

A
  1. Some evidence that improvements following exercise translate to improvements in automatic function of the cervical muscles
  2. Similar changes observed with specific training of the deep trunk muscles (TrA)
  3. Better response to low load craniocervical flexion training which emphases a motor learning approach
  4. More work to be done on dose of training
  5. Specific training of the DCF is associated with improvements in control of working posture
19
Q

What are 4 ways to correct postures?

A
  1. Higher neck extensor muscle activity in slumped posture
  2. Comparison of correction with thoracic extension versus lumbopelvic neutral technique
  3. Both Th Ext and L/P correction → more neutral head neck posture (but thoracic extension → high thoracic erector spinae activity)
  4. Neither changed activity in the upper trapezius (ie scapular posture)**
20
Q

What is the study: request to sit up straight versus facilitation of neutral upright posture?

A

Higher activation levels in DCF and lumbar multifidus

  • Facilitation (activating muscles) is more effective then instructing to sit up
21
Q

Does task specific exercise help muscle control?

A
  • Conscious elongation of cervical spine facilitates longus colli
  • Outcome of CCFT after two weeks of training with posture correction with ‘occipital lift’ (not retraction)
    • Most effective for activating CCF
22
Q

Can exercise assist fatty infiltrate extensors ?

A
  • Current data suggests that fat index can be changed with exercise
  • Further development of measure
23
Q

Does therapeutic exercise- change pain?

A
  1. RCT cervicogenic headache
  2. RCT in the management of chronic whiplash
24
Q

What are 4 characteristics of scapular retraining?

A
  1. Motor control perspective: can change pattern of activation the three portions of trapezius with a scapular postural correction exercise
  2. Can address control, strength and endurance of axio-scapular muscles with specific exercise (evidence in shoulder disorders)
  3. Case studies neck pain - efficacy of treating scapular dysfunction
  4. No RCTs as yet looking uniquely at the effect of re-educating scapular in neck pain
25
Q

What are 3 characteristics of “correcting” scapular position (deloading)? What is the main feature?

A
  1. reduced neck pain
  2. increased cervical ROM
  3. improved proprioception

Active correction of scapular position, not passive, decreased neck tenderness

  • Tape can be used in adjunct to other active treatment (not on its own)
26
Q

What are 3 features in Phase 1: Rehabilitation of muscle control aspects of the exercise program? What are 3 impairments?

A

Deeper muscles (turn off superficial muscles)

27
Q

What is a feature in Phase 2: Strengthening and endurance program of the exercise program? What are 2 impairments?

A

Of all muscles

28
Q

What are 9 exercise pointers?

A
  1. Pain = immediate change in cervical muscle function
    1. Pain inhibits muscle activity
  2. Both cervical motor control and peripheral adaptations
    1. Eg. when doing CCF –> should not be getting pain, if they start to get excessive superficial neck or scapula muscles (could be due to pain compensation)
  3. Tailored exercises for specific impairments based on assessment
  4. Commence exercise early usually day 1
    1. (at least one exercise)
  5. Exercise should not provoke neck pain
  6. Precision in exercise is emphasized in the motor learning process
    1. Ensure that exercises are done correctly (if not, will add to the poor movement –> can cause pain)
  7. Train muscles specifically and task specific
  8. Repetition is essential muscle control
  9. Compliance is critical- Patient’s must understand the rationale

Ensure that exercises are done correctly (if not, will add to the poor movement –> can cause pain)

29
Q

What are 2 symptoms of sensorimotor control disturbances?

A
  1. light-headedness, unsteadiness, dizziness
  2. visual disturbances - blurred vision, reading difficulties
30
Q

What are 4 signs of sensorimotor control disturbances?

A
  1. Altered Neck joint position* and movement sense*
  2. Eye movement - eye follow*, gaze stability,
    • eye head co-ordination
  3. Balance
  4. Trunk head co-ordination
  • Occurs neck pain - idiopathic, wad, elderly and younger
  • Worse in those with dizziness
31
Q

What are 4 treatment directed to neck only in sensorimotor control management?

A
  1. Manual therapy/ Acupuncture-Decreased dizziness, improved JPE improved balance
  2. Craniocervical retraining - improved JPE
  3. Chiropractic management-manip, mob, massage, spine stab exercises- improved JPE
  4. Improve muscle fatigability- improved balance WAD

JPE: joint position error

32
Q

What are 5 treatment not directed to neck only in sensorimotor control management?

A
  1. Revel’s Eye-head coupling rehab program- Decreased neck pain, drug intake, increased JPE and ROM
  2. Oculomotor convergence and motility exercises - improved balance eo and ec wad
  3. Tailored JPE, gaze, SPNT and eye head co-ord improved JPE, pain and disability
  4. Gaze stability- head, arm movement improved JPE, pain?
  5. Vestibular rehab program improved balance and dizziness
33
Q

What are 2 management suggestion- multimodal?

A
  1. Normalise afferent input
  2. Tailored Sensori-motor control exercises
34
Q

What are 5 characteristics of “normalise afferent input” in multimodal management suggestion?

A
  1. Manual therapy
  2. Acupuncture
  3. Address muscle changes
  4. Pain relief
  5. Increased range of motion
35
Q

What are 5 characteristics of “tailored sensori-motor control exercises” in multimodal management suggestion?

A
  1. cervical joint position and movement sense
  2. eye head co-ord, smooth pursuit, gaze stability
  3. balance
  4. trunk head co-ordination
  5. based on vestibular type program but bias neck- ie slower movements
36
Q

What are 6 recommendations for exercises for sensorimotor control?

A
  1. Base selection of exercises on assessment findings
  2. Relate exercises to level of dysfunction
  3. Address each individual impairment
  4. Consider combinations of eye and balance exercises
  5. Exercise 2-3 times per day
  6. Need to provoke dizziness but not exacerbate neck pain or headache

Vestib, visual and proprioception system interaction

37
Q

When should treatment start (4)?

A
  1. JPE appear early after WAD, especially in those with moderate to severe symptoms
  2. Balance changes also seen within three weeks
  3. Treatment begin immediately and be non-pain provocative
  4. Can be primary treatment in acute whiplash when manual or exercise treatments are pain provocative
38
Q

What are the 4 characteristics of the change in muscle and sensorimotor control improves pain and disability for therapeutic exercise approach for the cervical region?

A
  1. RCT cervicogenic headache:
  2. RCT in the management of chronic whiplash
  3. RCT sensorimotor
  4. RCT kinematics

PHTY3260 (27 decks)

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