Neck P! with Movement Coordination Impairments (Clinical Instability) Flashcards
What are the 3 subsystems of functional spinal stability?
- Neural (The neurological structures responsible for coordinating muscle contraction through CNS and PNS)
- Passive (Bone, joint, lig., disc)
- Active (Musculature)
With the proposed underlying causes of movement coordination impairments, what are the 2 zones of the spine? What is Clinical Instability?
- Neutral Zone
–Motion around mid-positon; minimal passive resistance. (similar to loose-packed position) - Elastice Zone
–Motion around end-range; against passive resistance
Clinical Instability:
- Increased size of the neutral zone
- Reduction of passive resistance to motion in elastic zone
- Inability for the active and neutral subsystem to accommodate this lack of passive control
With the proposed underlying causes of movement coordination impairments, what happens if the patients has recurrent Sprains/Strains?
–What are some ways a patient can get these recurrent sprains/strains?
This results in increased extensibility of the passive structures in the presence of muscle performance deficits are the likely impairments of body structure and function that are contributing to the patients symptoms.
- Recurrent strain to lig., muscle, tendinous, and/or joint can be cause by prolonged end-range positioning; stress from awkward and dysfunctional movement pattern
- Muscle performance deficit can be caused by lack of coordination and endurance; as well as flexibility and strength
With the proposed underlying causes of movement coordination impairments, what are Local Muscle Performance Deficits?
Impairment coordination and Endurance
- Cervical Multifidus {Deep neck extensor}
(Provides control via segmental attachments posteriorly) - Longus Coli and Longus Capitus {Deep neck flexor}(Provides control anteriorly)
With the proposed underlying causes of movement coordination impairments, are Global Muscle Performance Deficits?
Impaired Flexibility, Coordination, and Resting Tone
- Upper Trap.
- Levator Scapulae
- Scalenes
- SCM
Differential Diagnosis for Clinical instability should include other impairment-based diagnoses. What are those different diagnosis?
- Neck pain with movement coordination deficit (WAD)
- Neck pain with headache
- Neck pain with mobility deficit
- Neck pain with radiating pain
- Rotator cuff related shoulder pain
- Thoracic and/or rib pain with mobility deficit
What system, structure, pain mechanism, and phase of healing are unique to this patient presentation?
System
- Musculoskeletal
Structure
- Ligaments
- Muscles and Tendons
- Nervous system
Pain mechanism
- Nociceptive
Phase of healing
- None
In the subjective exam, what are common reports of patients with movement coordination impairments?
- Neck pain and related referred upper extremity pain
- Possible remote history of trauma
- Fatigue and “instability to hold head up”
- Feel better with external support (Hands or collar)
- Frequent need for self-manipulation
- Feeling of instability, shaking, or lack of control with head movement
- Frequent episodes of acute attacks
- Sharp pain possibly with sudden movements
- Nociceptive pain
In the subjective exam, what are common reports of their Aggravating and Easing factors?
Aggravating Factors
- Prolonged static weight-bearing positioning
–Prolonged sitting or standing
- Uncontrolled movement
Easing Factors
- Change of position
- Non-weight bearing positions or external support
- Cervical active ROM and stretching
- Self-manipulation (like cracking their own neck)
In the subjective exam, what are common reports of 24 hour pain behavior?
Morning
- Often wakes up without neck pain, may be the best time of day
Noon to evening
- Symptoms may vary throughout the day depending on the patients activities
- May have increased pain with maintaining static positions that worsens through the day
- End of day may be worst time of say
Night
- Symptoms may improve with assuming supported
non-weightbearing positions in bed
In the Objective Examination, what you looking for when doing AROM and PIVM with the patient?
We are looking at the patients ability to move and for Pain Provocation
In the Objective Examination, What will you typically find with AROM with Clinical Instability?
- Aberrant motions (sudden accelerations/decelerations)
- Poor recruitment and disassociation of cervical segments
- Motion that is not smooth throughout ROM
- AROM is greater in supine (non weightbearing) than in standing/sitting (weightbearing)
- Pain occurs in mid-range motions that worsens at end range
In the Objective Examination, What will you typically find with PIVM (Passive Intervertebral Motion) with Clincial Instability?
What Passive Intervertebral Motion (PIVM) we could see:
- Hypermobility at involved segment(s) with loose end-feel
- Neck pain and related UE pain (somatic referred) reproduced with provocation of the involved segments
- Possible hypomobilites at adjacent segments
For Motor Coordination Impairments (Clinical Instability) in the Muscle performance examination, what test(s) should be done that test muscle recruitment and endurance?
- Craniocervical Flexion Test
- Deep neck flexor endurance test
- Deep neck extensor endurance test
- Cervical joint position sense test
- Parascapular muscle recruitment and endurance testing
For Motor Coordination Impairments (Clinical Instability) in the Muscle performance examination, what muscles should you MLT?
- Upper Trap
- Levator Scapulae
- SCM
- Suboccipitals
- Pec Major/Minor
