Manual Interventions for the Cervical Spine

Question 1

Examples of Manual Interventions

Answer 1

Mobilization
Manipulations
Soft Tissue Techniques

Question 2

We can mobilize/manipulate the spine in what directions

Answer 2

Side Gliding (C0 - C1)
Side Bending (Mid Cervical)
Rotation (C1 - C2)
Traction (wherever you isolate)
Neutral

Question 3

2 main types of restrictions

Answer 3

Closing - articular

Opening - capsular

Question 4

Side Gliding Mobilizations for C0 - C1 (OA Joint)

Answer 4

• Occipital Gliding for OA side bending/side gliding
• Occipital Push
• Physiological Side Gliding
• Thumb techniques

Question 5

Rotational Mobilizations for C1-C2 (AA joint)

Answer 5

• C1 rotary pull with rotation restriction
• Passive Physiological Rotation
• UPA, UAP with Rotations
• Rotational Mobilization

Question 6

Sidebending Mobilizations for C3-C7

Answer 6

-Mid/Lower Cervical Spine Manipulation
-Lower Cervical Sidebending Mobilization
-Opening and Closing Techniques for Mobilizations
-Unilateral Anterior Glide for Side Bending
-CT Junction Side Bending
(These are all similar, just different levels of mobilization)

Question 7

Types of Traction Mobilization

Answer 7

• Neutral
• Forward Bending
• Extension and Rotation

Question 8

Neutral Position Mobilizations

Answer 8

• Central PA
• Unilateral PA
• Central PA in extension

Question 9

Clinical Prediction Rule for Cervical Spine Manipulation

Answer 9

1. Initial scores on NDI less than 11.50
2. Presence of bilateral pattern of involvement
3. Not performing sedentary work for more than 5 hours each day
4. Report of feeling better while moving the neck
5. No report of feeling worse while extending the neck
6. The diagnosis of spondylosis without radiculopathy

Question 10

Clinical Prediction Rule for Cervical Spine Manipulation interpretation

Answer 10

4 or more then 89% chance of immediate positive response to manipulation

CPR has not been validated like the law back CPR has

Question 11

Alternative CPR for Cervical Manipulation

Answer 11

1. Symptoms less than 38 days
2. Positive expectation that manipulation will help
3. Side to side difference in cervical rotation ROM of 10 degrees or greater
4. Pain with posterior anterior spring testing (PAIVM) of the mid cervical spine

Question 12

Alternative CPR for Cervical Manipulation interpretation

Answer 12

3 out of the 4 = 90% likelihood they will respond to manipulation

Not validated

Question 13

CPR for neck pain pt who will respond to thoracic manipulation

Answer 13

1. Duration of sx less than 30 days
2. NO sx distal to the shoulder
3. Looking up does not aggravate their symptoms
4. FABQ assessment score of less than 12
5. Diminished upper thoracic spine kyphosis at T3-T5
6. Cervical Extension ROM less than 30 degrees

Question 14

CPR for neck pain pt who will respond to thoracic manipulation interpretation

Answer 14

4 out of 6 = 93% likely to improve from thoracic manipulation

Not validated

Question 15

Clinical Prediction Rule for Cervical Radiculopathy

Answer 15

1. • Spurlings Test
2. • ULTT Median Nerve Test
3. • Cervical Distraction Test
4. +

Question 16

Clinical Prediction Rule for Cervical Radiculopathy interpretation

Answer 16

3 out of 4 = 94% specificity/Moderate correlation

4/4 = 99% specificity/significant, strong correlation

Not Validated

Question 17

Cervical Prediction Rule for Neck Pain and Cervical Traction

Answer 17

1. Pt reported peripheralization with lower cervical spine mobility testing
2. Positive shoulder abduction Test
3. Age >54
4. Positive ULTTA
5. Positive Cervical Distraction Test

Question 18

Cervical Prediction Rule for Neck Pain and Cervical Traction interpretation

Answer 18

3 out of 5 = 79.2% probability (moderate)
4 out of 5 = 94.8% probability (strong/significant)

Not validated