Manual Interventions for C-Spine Flashcards
How many directions can we mobilize/manipulate spine?
5 side gliding- Antlantooccipital side bending- lower cervical rotation- predominately C1-C2 traction- all neutral
if their is a problem CLOSING, what structure involved?
articular lesion
if problem with OPENING, what structure involved?
capsular restriction
C1 Rotary Pull
DIP of my right hand goes on the posterior aspect of the transverse process of C1 on the left
Stabilization hand (my left hand) is under the opposite cheek/zygomatic arch region
Side bend the head to the left, rotate the chin to the right.
Gently rock the head back and forth until your end feel is found
Try to time your pull or impulse as the patient exhales without making them aware
Quick pull as it you are going to pull your right elbow into your side suddenly
lower cervical opening and closing technique
opening- bias flexion, mobilize superior (toward eyes)
closing- bias extension, mobilize inferiorly (toward arm pit region)
CT jxn manipulation in prone
stabilize head by cupping ear and cheek
mobilize with key fob grip lateral to C7
Mulligan’s Idea
mobilization with movement
Our example was with transverse process of C1
Maitland’s Idea
Central PA mobilization
Jones Strain-Counterstrain Technique
find tender point put that spot in lax position Basically opposite of stretching hold for 3 min and slowly release "Fold and Hold"
What is a trigger point
Injury caused an energy crisis in the muscle and because calcium leaks out of the sarcoplasmic reticulum and activated actin and myosin and ultimately cause depletion of ATP. Decreased O2 eventually leads to ACh and more Ca release which reinforces contractures
Clinical Prediction Rule for C-Spine Manipulation
- Initial scores on NDI less than 11.50
- Presence of bilateral pattern of involvement
- Not performing sedentary work for more than 5 hours each day
- Report of feeling better while moving the neck
- No report of feeling worse while extending the neck
- The diagnosis of spondylosis without radiculopathy
Four or more 89% chance of immediate positive response to manipulation
CPI has not been validated like the low back CPI has
Alternative Clinical Prediction Rule for C-Spine Manipulation
- Symptoms less than 38 days
- Positive expectation that manipulation will help
- Side to side difference in cervical rotation ROM of 10 degrees or greater
- Pain with posterior anterior spring testing (PAIVM) of the mid cervical spine
Three out of the Four=90% likelihood they will respond to manipulation
Not validated
Clinical Prediciton Rule For Neck Pain that will Respond to THORACIC Manipulation
- Duration of symptoms less than 30 days
- NO symptom distal to the shoulder
- Looking up does not aggreviate their symptoms
- FABQ assessment score of less than 12
- Diminished upper thoracic spine kyphosis at T3-T5
- Cervical Extension range of motion less than 30 degrees
(excluded stensosis patients, red flags, WAD
Clinical Prediciton Rule for Cervical Radiculopathy
+ Spurlings
+ ULTT Median nerve
+Cervical Distraction Test
+Less than 60 degrees of cervical spine rotation toward the involved side
Three/Four present=94% specificity/Moderate correlation
Four/Four present =99% specificity Significant/Strong correlation
Clinical Prediction Rule for Neck Pain and CERVICAL TRACTION
- Patient reported peripheralization with lower cervical spine (C4-C7) mobility testing
- Positive Shoulder abduction test
- Age >54
- Positive ULTT A
- Positive Cervical Distraction Test
Three out of Five 79.2% probability (moderate likelihood ratio)
Four out of Five 94.8% probability (strong/significant likelihood ratio)
Not validated
