L9: Skills Prac 5-6 Flashcards
What are the 3 changes in muscle behaviour?
- neck flexor synergy
- neck extensor synergy
- axioscapular muscles
- formal and functional tasks
What are 6 impairments in muscle function in neck pain?
- Changes in muscle behaviour
- neck flexor synergy
- neck extensor synergy
- axioscapular muscles
- formal and functional tasks
- Loss of muscle support in posture and movement • Loss of feed-forward response
- Morphological changes
- Loss of endurance at different contraction intensities
- Loss of strength, increased fatigue
What are 3 analysis of the patient’s functional complaint (neck pain)?
- Determine the influence of work postures and tasks on patient’s presenting complaint
- Determine physical impairments that may be linked to pain at work
- Determine if changes in work postures can change pain state
Articular/muscular/ nerve dysfunction? Neurological changes?
What is the physical examination of the cervical region?
What are the examination of the muscles of the cervical region?
What is the spinal postural analysis?
- Assess the patient’s habitual sitting posture
- Assess patient’s perception of ideal sitting posture
- Look for a predominant use of thoraco-lumbar erector spinae (poor pattern)
- Assess resting pain; cervical rotation: pain and range
- Correct posture to a neutral lumbo-pelvic, thoracic, cervical position
- Assess effect of change in posture on: Resting pain Rotation range of movement/pain response
What is the effect/implication of treatment of neck pain?
Can the patient replicate an ideal sitting
if not what is the reason:
- poor kinaesthetic sense? = Proprioception
- poor active control ?
- loss of passive mobility? = Stiff or tight
What are 4 scapular assessments?
- Scapula resting posture
- Scapula open chain
- Isometric Resistance Tests
- Through range elevation
- Arm above head or to the side
- Scapular closed chain - 4 point kneel
- Scapular prone test
Can do SAT or SRT
What are 6 features of the scapular postural analysis?
- assess in standing and or sitting
- make pattern of muscle imbalance fit
- position scapula in optimal position
- NOTE: Deviation from the ideal is not uncommon
- assess the effect on symptoms and cervical ROM
- assess patient’s pattern of control to reposition the scapula
Does it change the strength? Is there tenderness?
What is scapular posture with isometric resistance under light load?
A test of functional control of scapular posture:
- Resisted flexion – an inability to maintain posterior tilt of the scapula
- Resisted abduction - an inability to maintain an upward rotation of the scapula
- Resisted external rotation - an inability to maintain externally rotation of the scapula
Once load is add –> might be able to see the problem
What is a static posture?
- Flat lumbar and thoracic spine
- Right scapula – downward rotated and protracted
What is a dynamic posture?
- Scapular position worsens with low load GHJ flexion and abduction
- Assisted correction of the scapula - decreased pain on (R) Rot, Ext and (L) LF
- Why? More range = not pulling on muscles
What is the formal test of scapular muscles?
Examination in Prone lying
Holding capacity of scapular stabilizers
- pattern of muscle use
- inappropriate strategies
- fatigue
retest effect on cervical joints by repeating manual examination
What is the correct and incorrect posture in the examination of the scapular muscles?
Low load: Depression + retraction repositioning –> hold position (can they hold?)
Should not be working (compensation):
- UT & levator scap, lats, teres minor and major, lift arm
Should be working:
- Middle and lower trape
Few reps –> might need to test endurance
- If they are poor in the first one –> do not need to repeat
What does the craniocervical flexion test look like?
What are the 3 phases of the craniocervical flexion test (Retest extension: range, pain, pattern)?
- Preliminary Assess: passive range of UCF
- Adverse neural tissue mechanosensitivity
- Tightness suboccipital extensors
- Inadequate cranio-cervical joint motion
- Stage 1 Assess: analyse the CCFT action
- Stage 2 Assess: the staged performance of the test 22, 24, 26, ,28, 30 mm Hg
Dura attaches to C2
- Repeated upper cervical flexion could irritate mechanosensitivity
Stiff: Hard bony end feel
Tight muscles: Gradual increase resistance
Nerve: muscle spasms (protect nerve)
What is the preliminary stage of the craniocervical flexion test? What are 6 characteristics?
Assess for passive upper cervical range, nerve tissue mechanosensitivity
- Supine, no pillow
- Assess craniocervical flexion range- end feel
- Preposition into right BPPT- reassess CCflex range- end feel, symptoms
- Preposition into left BPPT – reassess Ccflex range and end feel, symptoms
- Preposition into right SLR- reassess CCflex range- end feel, symptoms
- Preposition into left SLR – reassess Ccflex range and end feel, symptoms
What is the stage 1 (motion analysis) of the craniocervical flexion test?
Crook lying
- Position neck neutral
- Allow for kyphosis
- Ensure small space for PBU
Might need to add a towel (neutral spine)
PBU
- Folded in 3
- Up against occiput
- Inflate to 20mHg
- Ensure stable- Squeeze the bag first
- Look at movement (pure upper cervical flexion) –> look at change in range or what muscles are recruited –> do not need to look at pressure
- “Slide the back of the hair up the bed”
- See if they can hold the position (might be endurance based problem)
What is the stage 1 (motion analysis) of the craniocervical flexion test? What are 6 characteristics?
Feel the back of the head slide up the bed as nod head
- movement pattern (rotation or retraction)
- movement speed
- use of superficial flexors
- overshoot, undershoot
- kinaesthetic sense
- incremental increase in range of motion of 5 stages of the test.
What is the stage 2 (CCFT) of the craniocervical flexion test? What are 7 characteristics?
- pressure level can hold steadily without dominant activity of superficial flexors
- Asymptomatics – 10X10 sec holds 26-28mmHg
- (in clinic) Usually 4-5 secs (gets fatigued)
- Must retain pattern of CC flexion
- Be alert to a return to a retraction pattern
- Must maintain the pressure increase steadily
- In assessment know outcome within 4 repetitions
- Inability to hold pressure steady
What are 3 characteristics of aysmptomatic subjects in the stage 2 (CCFT) of the craniocervical flexion test?
- Attain 26 -28mmHg
- Perform 10 repetitions of 10sec Holds
- No age effects; No gender effects
- note in elders not as regular
What are 4 characteristics of neck pain patients in the stage 2 (CCFT) of the craniocervical flexion test?
- Attain 22-24 mmHg
- Compensatory movement pattern
- Often dominant use of superficial flexors
- Record pressure level and number of reps can achieve.
What are 2 craniocervical muscles?
Subocciptal muscles
- craniocervical extensors
- craniocervical rotators
What are cervical extensors?
emphasis on cervical extensors (eg semispinalis cervicis/multifidus)
Perform with the CC region in neutral to limit the action of the superficial extensors which attach to the cranium
- Can bias these muscles
Easier test positions: prone on elbows sitting leaning on forearms; 4 point kneel –> SA and scapula
