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PHTY3260 > L7-8: Cervical muscle dysfunction > Flashcards

L7-8: Cervical muscle dysfunction Flashcards

1
Q

What are 7 musculoskeletal impairments in neck pain disorders?

A
  1. Restricted range of motion Cervical joint dysfunction
  2. Neural tissue mechanosensitivity
  3. Nerve tissue dysfunction
  4. Changes in sensory features
  5. Functional/work postures/Static postural shape (FHP)
  6. Changes in muscle behaviour
  7. Disturbances in the sensorimotor control system
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2
Q

20% of stability supplied by ______ (_______)

A

ligaments (end of range)

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3
Q

80% of stability supplied by _____ system _______ postures

A

muscle; mid range functional

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4
Q

______ system is the only system able to substitute for changes in articular integrity

A

Muscle

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5
Q

Muscle system is the only system able to substitute for changes in _______

A

articular integrity

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6
Q

Neck muscle system also intimately related -stabilization of the _____, _______, _____ l orientation and stability

A

head and eyes, vestibular function, postura

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7
Q

What is the topographical arrangement of muscles?

A

cranio-cervical and cervical regions; axio-scapular muscles

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8
Q

What are 2 features of functional specificity of cervical muscles?

A
  1. Superficial muscles have greater torque capacity (eg 87%of flexor torque)
    • important for support of the head and neck but are not arranged anatomically to provide fine segmental control
    • Eg. SCM and scalenes
  2. Deep sleeve of muscles envelopes both the cranio-cervical and cervical regions
    • have appropriate morphology, composition for control of segmental motion and support of the curve
    • Longus capitis and colli (anterior (also posterior) deep muscles attached/blended to the cervical vertebrae) –> stability
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9
Q

What is the deep muscles of the cervical spine?

A
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10
Q

What does the cross section of the cervical spine?

A
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11
Q

What are the suboccipital muscles?

A
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12
Q

What are the posterior suboccipital muscles?

A
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13
Q

What are erect posture?

A
  1. Require adequate strength of larger torque producing muscles to hold the head against gravity
  2. Deep muscle activity to avoid segmental buckling Winters and Peles 1990
  3. Need appropriate balanced activity between the deep and superficial layers of the flexors and extensors
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14
Q

What are 3 features of the control of movement for the cervical spine?

A
  1. Extension and return to upright posture
  2. Flexor moment arms of SCM reduce as extension progresses
  3. Deep cervical flexors play a significant role in the control of gravitational torque as extension progresses
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15
Q

What is the support of the load from the upper llimb?

A

muscles such as levator scapulae and upper trapezius (downward rotation) have the capacity to induce motion and abnormally load cervical motion segments in the presence of impaired axio-scapular muscle function

All muscles are important for motion and support Importance of triparte trapezius and serratus anterior function to prevent unnecessary stress on the neck

Overactive levator scapula –> excessive downward rot. of scap –> abnormal force on the cervical spine

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16
Q

What is the motion induced in the cervical spine in various arm positions in normals?

A

Overactive levator scapula –> excessive downward rot. of scap –> abnormal force on the cervical spine

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17
Q

What is the clinical note for the cervical spine?

A

~80% of a neck pain patients report that upper limb activities aggravated neck pain

Cervical muscle control may also be important to disperse loads and control motion associated with arm movement

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18
Q

What are 3 features of the cervical muscle system?

A
  1. 20 pairs of muscles
  2. reflects complexity
  3. reflects redundancy ie specific forces can be produced by several combinations of muscle actions

Evidence that neck pain induces : number of changes to muscles

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19
Q

What are 6 summaries of impairments in muscle function in neck pain?

A
  1. Changes in muscle behaviour/ motor control strategies - neck flexor synergy - neck extensor synergy - axioscapular muscles
  2. Loss of feed-forward response
    1. Reverses and becomes a feed-back response
  3. Morphological changes
    1. Become weak = poor endurance
  4. Loss of muscle support in posture and movement
  5. Loss of endurance at different contraction intensities
  6. Loss of strength
20
Q

What are 3 features of the CCFT?

A
  1. Targets the anatomical action of deep cervical flexors
  2. Low load, allows some specificity of muscle action
  3. Appears to be a generic impairment in cervical disorders
21
Q

What does the craniocervical flexion test look like?

A
22
Q

What does the electrodes look like for tracking changes is muscle behaviour?

A
23
Q

What are the changes in flexor muscle behaviour?

A
24
Q

What are the consisyent findings of changed patterns of myscle activity in the superficial flexors in neck pain?

A

Increase in SCM and scalenes indicates –> poor control

25
Q

What is the Cranio-cervical flexion test (CCFT)?

A
  • Lesser ability to increase and hold progressively inner range positions of CCF (deep flexors)
  • Concomitant with increased activity in superficial muscles
26
Q

What is the change in extensor muscle behaviour?

A
  • mfMRI measures of shifts in T2-relaxation
  • Initial indications of changed spatial relations between extensors - reduced activity in deep extensors
27
Q

What are the 5 changes in scapular muscle behaviour?

A
  1. Changes in scapular posture and orientation during movement and load (Downwardly rotated scapula)
  2. Relationships between scapular postures and muscle activity
  3. Experimental neck pain causes some reorganisation in axio-scapular muscle activity
  4. Neck pain reorganisation of scapular function
  5. Impaired axioscapular muscle function may place excessive strain on cervical joints and contribute to the neck pain disorder
  6. Relationship shown between scapular protraction, ↑ upper trapezius muscle activity and forward head posture
  7. Computer work resulted in a downwardly rotated scapular and lengthened, painful upper trapezius
  8. Altered scapular movement during arm elevation in patients with neck pain, delay in serr anterior, decreased activation
28
Q

What is the altered directional specificity in the SCM and Splenius Capitis muscles in circular contractions?

A
29
Q

What are 2 characteristics of altered flexion relaxation ratios in neck pain?

A
  1. Ratio of extensor activity in eccentric versus concentric phase of head flexion
  2. Less in neck pain patients – ie neck pain patients have greater activity in the extensors during the eccentric phase of moving into neck flexion
  3. Fatigue, poor endurance and strain (eg, going into cervical flexion)
30
Q

What is the Altered Feedforward mechanisms of motor control?

A

Relative latencies neck muscles in response to perturbations induced by rapid arm flexion and extension

31
Q

What are the 4 moprhological changes in people with neck pain?

A
  1. Transition is from Type I to Type II (Phasic) fibres
    1. No able to be effective for endurance
  2. Occurs in all muscles but first in the neck flexors
  3. Non-pathology specific
    1. Whiplash
    2. Cervical disc disease
    3. Rheumatoid arthritis
  4. Not automatically reversible with pain reduction
32
Q

What is the clinical observation of fatty infiltration in cervical muscles in patients with chronic neck pain?

A
33
Q

What are 3 characteristics of systematic review (US or MRI) for idiopathic/mechanical neck pain?

A
  1. Reduced CSA in the deep neck flexors (longus capitis/colli)
  2. Tendency for increased SCM
  3. Reduced CSA for most extensor muscles
34
Q

What is a characteristic of systematic review (US or MRI) for chronic whiplash?

A

Increased CSA in many muscles – confounder of fatty infiltrate

  • Does not mean that the muscle is more effective because it is bigger
35
Q

What are 5 characteristics of the postural control and support?

A
  1. Diversity in evidence of postural differences in people with neck pain in erect sitting
  2. Higher neck extensor muscle activity in slumped posture
  3. Longus colli controls the angle of the cervical curve
  4. Sitting requires tonic, low level endurance of longus colli
    • Supports the curve of the spine
  5. Mechanical demand on extensor muscles increases 3-5 times during seated tablet computer use versus seated neutral posture
36
Q

What is the loss of postural control and support as postural changes with computer tasks- mouse use?

A

More forward head posture/poor postures (over time) for people with neck pain (due to poor endurance)

37
Q

What are 9 deficits in strength and endurance?

A
  1. Evidence of reduced strength and endurance in cervical flexors and extensors
  2. Cranio-cervical flexors in neck pain
    1. less strength
    2. less endurance at 20% and 50% MVC
  3. Altered axio-scapular muscle strength and fatigability •
    1. Reduced size of lower trapezius with neck pain
    2. Reduced strength in ipsilateral lower trapezius in patients with mechanical neck pain
    3. Increased fatigability of the upper trapezius with repeated arm movement
  4. When muscles are overactive, it doesn’t mean that they are strong (they are usually weak and have poor control)
  5. Neck flexors and extensors more fatigable at 100%, 80% MVC
  6. Variable between patients
  7. Neck flexors, not extensors fatigue at 50% MVC
  8. Neck flexors demonstrate fatigue at 25% MVC
  9. Upper traps in a repeated task

Problems in low functionally applicable loads

Low MVC (not always only extremely heavy loads)

38
Q

What are the changes in muscle behaviour and properties in neck pain?

A

Only using manual therapy = good for short term but need to address muscle system (exercise) for the long term (avoid recurrence)

Manual therapy + exercise = multi-modal intervention

39
Q

What is the craniocervical flexion test when muscle reactions occur early?

A

Even pt with mild neck pain –> still saw effects

Pt with severe neck pain –> saw significant effects

40
Q

What is the muscle responses that do not automatically reverse with the relief of pain?

A

People who received only manual therapy did not improve much as:

  • Manual therapy + exercise
  • Only exercise
41
Q

The observed changes in ______ have often been detected in individuals who are currently in remission at the time of testing

A

motor control

42
Q

What are 4 questions for muscle responses that do not automatically reverse with the relief of pain?

A
  1. Is such potential reorganisation of motor control strategies acceptable?
  2. Are deficits in strength and endurance acceptable?
  3. Note: the recurrent nature of neck pain
  4. Implications for management
43
Q

What are 5 changes in muscle behaviour – not same in every patient –particularly scapular?

A
  1. Scapular postural changes are not always associated with neck pain (normal variations)
  2. Scapular postural changes and impairments are not present in all individuals
  3. Postures and muscle activity highly variable between patients – no consistent pattern
  4. Some slight difference in trapezius muscle size with side dominance
  5. Clinical reasoning required to prove or disprove the role of scapular muscle dysfunction in a patient’s neck pain

Aggravating and easing factors

Unloading joints or change position of muscles

44
Q

What are the 6 summaries of f impairments in muscle function in neck pain?

A
  1. Changes in muscle behaviour
    1. neck flexor synergy
    2. neck extensor synergy
    3. axioscapular muscles
      • formal and functional tasks
  2. Loss of muscle support in posture and movement
  3. Loss of feed-forward response
  4. Morphological changes
  5. Loss of endurance at different contraction intensities
  6. Loss of strength, increased fatigue
45
Q

80% of stability supplied by _____ system primarily in ______ low load functional postures BUT these muscles not working correctly for a variety of reasons: ______; _____

? Increase neck pain ? Control neck pain

These muscle changes don’t resolve when pain subsides

? Recurrence ? Prevention

A

muscle; mid range; altered forces; joints

46
Q

What are 3 clinical assessments?

A
  1. Formal tests of neuromotor control of specific muscles
    • eg CCFT, extensors, sub-occipitals, scapular muscles
  2. Functional and dynamic tests – posture correction, movements and added load, and assess the impact of these changes on symptoms and function
  3. Strength and endurance cervical flexors, extensors and scapular muscles

PHTY3260 (27 decks)

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