Neck pain disorders

Question 1

traumatic neck pain disorders

Answer 1

Whiplash associated disorders
Post traumatic headache

Question 2

non traumatic neck pain disorders

Answer 2

cervicogenic headache

Question 3

secondary headaches

Answer 3

PTH, WAD, cervicogenic

Question 4

primary headaches

Answer 4

migraines, tension type, trigeminal autonomic cephalagia

Question 5

Cervicogenic headache - criteria

Answer 5

non-traumatic
disorders of the Cx spine
- imaging of lesion of Cx or neck soft tissue.
- 2 of:
* temporal development with onset of Cx disorder/lesion
* improvement is parallel to that of Cx lesion/disorder
*decreased Cx ROM, headache way worse w provocative manoeuvres
* abolished by diagnostic blockade
- can’t be explained by other classifications

Question 6

Cervicogenic headache - symtoms

Answer 6

• side-lock pain BUT can be bilateral
• provoked by neck muscle palpation + head mvmt
  PAIN PRECEEDS HEADACHE

Question 7

Cervicogenic headache - diary

Answer 7

time
type
duration
intensity + areas
triggers
signs and symptoms (vision, diziness..)

Question 8

Cervicogenic headache - obj findings

Answer 8

limited ROM - active and passive
impaired neuromsk performance - head lift off, craniocervical flxn, axio-scap muscle function)
Headache reproduced with manual assessment (PAIVMs with 2/10 pain + stiffness)

Question 9

WAD - classification

Answer 9

NON TRAUMAIC
- developed within 7days of event.
- associated w neck pain at time.

0- no complaint or physical signs
I- neck pain, stiffness or tenderness only. no physical signs
II - neck pain AND MSK signs (decreased ROM, point tenderness)
III- neck complaint AND neurological signs (impaired tendonreflexes, weakness or sensory deficit)
IV- neck complain AND fracture/dislocation

Question 10

WAD - aetiology

Answer 10

structural changes:
- inflammatory changes + ischemia
- increase fatty infiltration
- decrease CSA of suboccipital muscles
- change from slow to fast muscle fibres
- mechanical disruption of joint surface and muscle

Question 11

WAD - physical assessment

Answer 11

sensorimotor system:
- Cx spine proprioception
- balance
- occulomotor
- coordination

neurodynamic system:
- central sensitisation

Question 12

WAD management

Answer 12

restoring whatever has deficit:
-pain
- mvmt
- neuromuscular
- sensorimotor
- neural mechanosensitivity
- fear avoidance, low self efficacy

Question 13

Concussion - mechanism of injury

Answer 13

forces applied to brain at high magnitude (60-100G).
Brain is shaken around = damage.

Question 14

Brain chemistry of consussion

Answer 14

K+ out, Ca2+ and Na2+ in.
overdrive of ion channels
energy crisis as brian is deprived of blood from inflammation, bv damage, limited space.. BUT ATP needed for ion channels = depressed brain function (drowsy/drunk effect).
impaire mitochondria function = more celllular dysfunction
structural changes to axons

Question 15

Concussion presentation

Answer 15

somatic - headache
cognitive - feeling foggy, slowed rxn time
balance - gait instability
behavioural changes - moody, irritable, sad..
sleep/wake changes - drowsiness

symptoms can take up to 48h to show - hence importance of coming off field (death from re-injury = herniation)

Question 16

Concussion - exercise assessment and prescription

Answer 16

assessment via incremental aerobic: buffalo concussion treadmill test.
acute exercise prescription improves recovery.
use pacing (work to max intensity, decrease to 80-90% and work there for 20min/day, 5-6/week)

Question 17

Concussion recovery

Answer 17

return to normal ADL (school, work before exercise)
MUST BE SYMPTOM FREE and medically cleared for full contact return.
must tolerate aerobic exercise, have normal baance and cognitive functioning

Question 18

Vestibular system - function

Answer 18

to sense the movement of head and its position in space to identify self motion.

Question 19

vestibular system - anatomy ear

Answer 19

outer - ear drum
middle - hearing bones
inner - canals and nerves (receive signals from middle ear.

Question 20

vestibular system - semi circular canals

Answer 20

latera, post, anterior
each have an ampulla at the end, connected to the 8th N to brain.
sense movement of head relative to body (moving head around)

Question 21

vestibular system - otolith organs

Answer 21

utricle and saccule
sense linear direction - elevator
otoconia - Ca2+ crystals

Question 22

vestibular system -main 4 functions

Answer 22

gaze stability
postural stability
autonomic
orientation in space

Question 23

postural stability

Answer 23

uses vestibulo-spinal reflex
for postural adjustments
causes adjustments to keep the head and upright posture - prevent falls

tests: static balance, dynamic balance & gait

Question 24

gaze stability/dynamic vision

Answer 24

uses the vestibulo-ocular reflex (otolith, semi O canals)
stabilises vision during head mvmts

tests: head impulse test, dynamic visual acuity (letters reading w head mvmt

Question 25

vestibular dysfunction -subj assessment

Answer 25

ask to describe dizziness - type - duration - onset - pattern - imbalance other symptoms - visual, hearing, nausea

Question 26

vestibular dysfunction - obj assessment

Answer 26

Cx ROM to see if they can move their head in the positions needed to test canals. oculomotor function - smooth pursuit, saccades positional testing dynamic visual acuity + head impulse test balance and gait analysis

Question 27

vestibular dysfunction - (peripheral) signs and symptoms

Answer 27

signs: - nystagmus - fixed direction, horizontal, decreased fixation - normal eye mvmt - can walk symptoms: - sudden onset - true vertigo - episodic - can have tinnitus/hearing loss - head mvmt -provoked

Question 28

Vestibular dysfunction - (central) signs and symptoms

Answer 28

signs: - nystagmus - changing direction, vertical, increased fixation - eye mvmts can be abnormal - can lose walking ability symptoms: -gradual OR sudden onset - vertigo/imbalance/light headache - continual OR >50% of day - less likely to have hearing loss - 5D, 2N

Question 29

5D, 2N

Answer 29

nausea, nystagmus diplopia, dysphagia, dysarthria, dysmetria, drop attack

Question 30

BPPV - def, signs and symptoms

Answer 30

benign paroxysmal positional vertigo def: when otoconia from otoliths break off and lodges in canals. frequency increases with age, head injury, inner ear infection. signs: - all normal except hall dix pike OR roll test symptoms: - intermittent vertigo - sudden onset - days- months - no hearing/visual loss

Question 31

Dix-Hall pike - procedure, function

Answer 31

test to diagnose BPPV in long sitting, rotate head 45˚, sitting to supine quickly holding their head, extend head 20˚, observe nystagmus, wait until symptoms come on and see how long it takes to leave. must be nystagmus for +ve test. can be nauseous, dizzy - stay in position and eyes open. test, tx, retest. nystagmus direction: - down in eye = anterior canal - up in eye = post canal

Question 32

Canalith repositioning manoeuvre/Eply - function, process

Answer 32

BPPV post canal. check the suspected negative side first, then the positive one. used to remove otoconia crystals from canals 80% effective in 1 tx for free floating ones. go down in hall pike dix position, BUT do slowly, turn head 90˚ to side clearing, gently help roll on to side (eyes looking at floor), slowly sit up (eyes open whole time) RETEST keep head neutral for 20mins

Question 33

Roll test

Answer 33

testing BPPV - horizontal canal supine, head flxn 20-30, quick turn to side to look for horizontal nystagmus and to other side. +ve diagnosis = horizontal eye mvmt in head mvmt to both directions (one more than other). duration + intensity of nystagmus and symptoms determine which side is affected.

Question 34

canalith repositioning manoeuver/BBQ roll

Answer 34

BPPV tx - horizontal canal supine w head turned to affected side, move to neutral, to other side, move onto stomach, back to supine (going in same direction). can do 3/4 and stand/sit up if able. hold each for 30-60secs.

Question 35

Vestibular rehab - obj ass findings

Answer 35

VOR (+ve head impulse test, reduced DVA, +/- symptoms) balance (reduced mCSTIB/FGA score +/- symptoms) motion sensitivity - MSQ

Question 36

Vestibular rehab - aim, 3 mechanisms

Answer 36

aim for compensation of vestibular system. 3 mechanisms involved: - adaptation - long term plastic changes in neural response to head mvmt. - substitution - alternatice strategy to ahcive smt that was done by now damaged sys. - habituation - repeated exposure to provocative stimulus to reduce response to it in long term.

Question 37

Vestibular rehab training - VOR

Answer 37

gaze stability - adaptation -VOR x 1 = head is moving, object still - VOR x 2 both head and object moving (sports) progressions: speed, duration, background, freq, target size/distance, position, envrmt/task specific

Question 38

Vestibular rehab training - balance

Answer 38

static balance, dynamic balance, functional activities. progress: static - BOS, manipulation of somatosensory/visual cues, head motion. dynamic - speed, direction, distance, BOS, head motion function - envrmt, specific task related to goal

Question 39

vestibular rehab training - habituation

Answer 39

exercise prescribed based on MSQ - pick 4 activities and do them at an achievable intensity (don't over do) - symptoms should be 3/5 no more