Lecture 6: Neck Classifications and Interventions Flashcards
What are two types of clinical yellow flags?
- attitudes and beliefs
2. Behaviors
What are examples of attitudes and beliefs which are yellow flags?
pain is disabling, all pain must be gone before beginning activity, expectation of pain with activity, pain is uncontrollable, expecting the worst
What are examples of behaviors which are clinical yellow flags?
extended rest, reduced activity, high pain, poor sleep, reliance on bracing, ETOH/smoking use
What are the four ICD classifications of neck pain?
- cervicalgia
- Headaches or crevice cranial syndrome
- Spain or strain of cervical spine
- Spondylosis with Radiculopathy or cervical disc disorder with radiculopathy
What are the four ICF classifications of neck pain?
- neck pain with mobility impairments
- neck pain with HA
- Neck pain with movement coordination impairments
- neck pain with radiating pain
What neck pain with mobility impairments what are 2 diagnostic criteria?
- Cervical AROM
2. cervical and thoracic segmental mobility
What neck pain with HA what are 3 diagnostic criteria?
- C AROM
- cervical segment mobility
- cranial cervical flexion test
What neck pain with movement coordination impairments what are 2 diagnostic criteria?
- Cranial cervical flexion test
2. deep neck flexor endurance
What neck pain with radiating pain what are 3 diagnostic criteria?
- upper limb tension test
- Spurling’s
- Distraction
What are common clinical findings in patients with mobility deficits?
usually below 50 years old, acute neck pain under 12 weeks, Sx isolated to neck, restricted cervical ROM
What are common clinical findings for patients with neck pain and headaches?
unilateral HA, associated with neck/suboccipital area aggravated by neck movements, restricted C ROM, restricted cervical segment ROM, abnormal CC flexion test
What are common clinical findings for patients with movement coordination impairments?
chronic neck pain over 12 weeks, abnormal CC flexion test, abnormal DNF test, weakness in neck and upper quarter muscles, tight upper quarter muscles, ergonomic inefficiencies
What are common clinical findings for patients with movement coordination impairments?
UE sx referred or radicular pain, decreased cervical rotation toward involved side, signs of nerve root compression, reduction in sx with first tx or intervention
What are interventions for pts with mobility deficits?
C and T spine mobilization/manipulation, AROM exercise
What are potentially 6 variables to identify if a patient is appropriate for a manipulation?
sx less than 30 days, no sx distal to shoulder, looking up does not aggravate sx, FABQPA less than 12, diminished upper thoracic kyphosis, cervical ext ROM less than 30
What are interventions to centralize radiating pain?
repeated movement to centralize sx, Traction
What are the four directions for related movement?
- retraction
- retraction with extension
- Protraction
- Flexion
What happens at C spine with retraction?
upper flexion and lower extension
What happens at c spine with retraction and extension?
upper and lower c spine extension
What happens at c spine with protraction?
upper cervical extension and lower cervical flexion
What is the purpose of repeated movement testing?
way of testing tissue response to loading or unloading by repeating a movement one direction multiple times
10-15 times needed of movement
What is the desirable outcome with repeated movement?
to centralize sx, controlled AROM at end range, may still have pain but peripheral sx should abolish
What are 3 types of cervical traction?
positional, manual, mechanical
What are 2 modes of cervical traction?
- static- joint and nerve root irritability/severe arm pain
2. Intermittent- acute joint derangement or patients need jt mob, duty cycle 1:1, 1:3
What are the advantages of manual traction?
more specific, easier to adjust force
What are mechanical effects of traction?
separation of vertebral bodies, distraction of facet joints, increased ligamentous, muscle and tendon stretch, widening of intervertebral foramen, straightening of spinal curves
What are physiological effects of cervical traction?
increase circulation, mechanoreceptor, decrease pain
When is traction indicated?
HNP, DJD, joint/facet hypo mobility, muscle guarding
What are contraindications for traction?
structural disease- tumor, fx, severe osteoporosis
vascular compromise, claustrophobia, impaired cognitive function
any time movement is compromised- recent fusion, ligaments rupture, evidence of instability
How much time and force should be used for traction?
actue/ HNP- 5-10 minutes
other conditions- 15-30
Force- 8-10 pounds of 7-10% of pts body weight
What angle of pull should be used for traction?
c1-5- 0-5 degrees of flexion and HNP
c5-7- 25-30 degrees of flexion
have pt flex hip and knees
What are clinical predictor rules to see if patient will benefit from cervical traction?
- peripheralization with lower cervical spine mobility testing c4-7
- positive shoulder ABD test
- age over 55
- positive UTIL A
- positive neck distraction test
What are best interventions for movement coordination impairments?
increased conditioning and increasing exercise tolerance, body mechanic education
What are examples of exercises to improve motor coordination?
- DNF in supine
- C spine isometrics
- prone T’s and Y’s
- SA strengthening
What are some other techniques to help with motor control impairments?
mulligan techniques, muscle energy, STM, strain-counter strain
What are mulligan techniques?
- movement with mobilization
- natural apophyseal glides
- sustained natural apophyseal glides
What is MVM?
sustained accessory mobilization from PT and active physiological motion of patient to end range and possible over pressure
What are there vital parameters for MVM?
- pain free
- instant result
- long lasting
What are SNAGS and NAGS??
PT applies either sustained or oscillating accessory facet joint glide while patient performs painful movements
What are muscle energy techniques?
use of voluntary contractions exerted against a precise counter force to increase jt ROM
How do muscle energy techniques work?
like PNF, joint mob force, autogenic inhibition and reciprocal inhibition
What is procedure for muscle energy techniques?
engage restrictive range, provide iso resistance, hold 5-10 seconds, wait for relaxation and move into new range
What is a popular outcome measure used for neck pain?
Neck disability index
MCID- 5-9.5 points for neck pain
7-8.5 points for cervical radic.
What are scores for NDI?
0-4 no disability 5-14- mild 15-24 - mod 25-34- severe 35-50 complete
What are other outcome measures and their MCID?
PSFS- 2 points for cervical radic
GROC
NPRS- 2 points
What is typical criteria for discharge summary?
functional stability/ endurance pain 2/10 80% ROM strength 4/5 premorbid activity level indt with HEP balance posture
