Neck pain w/ Mobility Deficits

Question 1

What are some common symptoms with patients that have neck pain w/ mobility deficits?

Answer 1

• central and.or unilateral neck pain
• limitation in neck motion that consistently reproduces symptoms
• associated (referred) shoulder girdle or upper extremity pain may be present

Question 2

What are the expected exam findings for patients with neck pain w/ mobility deficits?

Answer 2

• limited cervical ROM
• neck pain reproduced at end ranges of active and passive ROM
• restricted cervical and thoracic segmental mobility
• intersegmental mobility testing reveals characteristic restrictions
• neck and referred pain reproduced w/ the provocation of the involved cervical or upper thoracic segments or cervical musculature
• deficits in cervicoscapulothoracic strength and motor control may be present in individuals w/ subacute or chronic neck pain

Question 3

What physical impairment measures should be measured in the physical exam of patients with neck pain w/ mobility deficits?

Answer 3

Cervical AROM and Cervical/Thoracic segmental mobility

Question 4

For patients in the Neck pain w/ mobility deficits category what interventions are appropriate for the acute phase?

Answer 4

• thoracic manips.
• cervical mobs and manips
• Cervical ROM, stretching, and isometric strengthening exercise
• advice to stay active plus home cervical ROM and isometric exercise
• supervised exercise, including cervicoscapulothoracic and upper extremity stretching. strengthening, and endurance training
• general fitness training (stay active)

Question 5

For patients in the Neck pain w/ mobility deficits category what interventions are appropriate for the sub-acute phase?

Answer 5

• Cervical mobilization or manipulation
• thoracic manips
• cervicoscapulothoracic endurance exercise

Question 6

For patients in the Neck pain w/ mobility deficits category what interventions are appropriate for the chronic phase?

Answer 6

• Thoracic manips
• cervical mobs
• cervicoscapulothoracic exercise plus mobs and manips
• mixed exercise for cervicoscapulothoracic regions-neuromuscular exercise; coordination, proprioception, and postural training
• supervised individualized exercise
• active lifestyle
• dry needling, low-level laser, ultrasound, traction, TENS

Question 7

True or False: Research suggests use of thoracic thrust improves short AND long term outcomes regardless of CPR.

Answer 7

True

Question 8

What are the 4 aspects of the CPR for cervical thrust manipulation?

Answer 8

• Symptoms over 38 days
• positive expectation manipulation will help
• Cervical rotation ROM side-to-side difference of 10 degrees or more
• Pain with PA testing mid-cervical spine

Question 9

True or False: We should perform Cervical thrusts during the initial visit and then incorporate thoracic thrusts when appropriate

Answer 9

False, initial visit should be thoracic manipulations and cervical manipulations should be used when appropriate