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Spine > Neck Pain with Associated Joint Mobility Deficits AND/OR Soft Tissue Irritability > Flashcards

Neck Pain with Associated Joint Mobility Deficits AND/OR Soft Tissue Irritability Flashcards

1
Q

Common Mid Cervical and Upper Thoracic Joint Mobility Deficits - Common Medical Conditions/Diagnosis

A
  • Facet joint syndrome
  • Degenerative disc disease
  • OA of the facet joint
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2
Q

Common Mid Cervical and Upper Thoracic Joint Mobility Deficits - subjective

A
  • Central or unilateral pain. Fairly specific (Pin point)
  • Limitation in neck motion that consistently reproduces symptoms
  • Referred pain associated with facet joint irritation (C4-5,5-6,6-7 most common)
  • Commonly aggravated with SB or Rotation to the side and/or extension. “pinching sensation”
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3
Q

Mid Cervical & Upper Thoracic Joint Mobility Deficits - Objective

A

AROM Assessment in Sitting
* Pain toward side of Sx and/or extension
* Restricted motion and/or pain especially with overpressure (loading of spine)
* Aberrant motions

PROM Assessment in Supine
* Restriction of motion and/or pain similar to AROM assessment

Joint Mobility
* Manual Traction alleviates (unloading of spine)
* Thoracic: Hypomobility and/or pain mid to endr range with PA assessment
* Cervical: Hypomobility and/or pain mid to end range of down slide assessment on side of closing down

Palpation of Joint Structures
* Pain and/or muscle tone with palpation of relevant articular structures (articular pillar)

Soft Tissue Mobility/Flexibility
* May have associated soft tissue tenderness of muscle in vicinity of pain

Neuro
* Negative neuro screen

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4
Q

Mid Cervical & Upper Thoracic Joint Mobility Deficits - Irritability

A

High:
* Muscle GUARDING before end ranges, AROM and PROM limited
* Very light palpation reproduces symptoms over articulation
* Takes a long time for symptoms to resolve once irritated

Moderate irritability:
* Pain at end ranges of AROM and PROM
* Moderate palpation reproduces symptoms over articulation
* Able to alleviate symptoms when get out of provocative positions

Low irritability:
* Pain with overpressure into end ranges of AROM and PROM
* Deep pressure reproduces symptoms over articulation
* Able to alleviate with change in position

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5
Q

Mid Cervical & Upper Thoracic Joint Mobility Deficits - Intervention

A
  • Education (stay active, downplay imaging)
  • Manual therapy
    –Thrust and non-thrust mobs to thoracic, cervicothoracic, and cervical spine
    – Manual stretching
    – Soft tissue mobilizations as needed.
  • Self ROM - Therapeutic Exercise
    – Self-mobilizations, SNAGS
    – General stretching and self ROM
  • Motor Coordination and movement reducation (as needed)
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6
Q

Cervical Spine

Large percentage ____ of asymptomatic patients present with “degenerative changes” (change in signal intensity of disc, posterior disc protrusion, disc space narrowing) and bulging discs. Even those in their 20’s ____

A

(73-90%)
(73%)

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7
Q

“____ changes” increase as we age

A

Degenerative

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8
Q

Their is poor correlation between ____ and MRI findings

A

persistent pain of WAD (neck)

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9
Q

General patient education

A
  • Majority of neck pain resolves spontaneously
  • Stay as active as possible within the tolerance of pain
  • Downplay MRI and plain films if applicable
  • Early conservative interventions improve outcomes
  • You have ruled out all the “BAD STUFF”
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10
Q

Education specific to joint mobility

A
  • Joints are generally tight and restricted
  • Motion helps to diminish tightness
  • Joint mobilizations help to improve mobility and allow you to move more comfortably
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11
Q

Research Summary about Thoracic Thrust Mobilization Techniques for neck pain

A
  • Within session changes in neck motion
  • More effective than non thrust techniques
  • Favored for short term improvements
  • Is as effective as cervical techniques for neck
  • No harm in performing thoraic thrust mobilizations
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12
Q

Specific study on Development of a CPR for Thoracic Manipulation in the treatment of mechanical neck pain

A

6 Variables
* Acute (Less than 30 days)
* Non Radicular (No Sx distal to shoulder)
* Low Fear avoidance beliefs (less than 12)
* Hypomobile thoracic spine
* Hypomobile upper thoracic and cervical (cervical extension ROM less than 30 degrees)

Results not validated but ALL patients benefited

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13
Q

____ or more out of 6 variable for CPR Thoracic Rule provides a ____ probability of succcess

A
  • 4
  • 93%
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14
Q

Research Summary about Cervical Mobilization Techniques for neck pain

A
  • Cervical manual mobilizations are effective in improving outcomes for patients with neck pain
  • “Cervical manipulation and mobilization produced similar changes. Either may provide immediate- or short-term change; no long term data are available.”
  • Minimal difference in outcomes when comparing thrust to non-thrust techniques

Thrust or non thrust produce similar changes

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15
Q

Thrust vs Non Thrust: Thoracic and Cervical on Cervical Effectiveness

A

Thoracic
* Thrust is more effective than non thrust

Cervical
* Non thrust and thrust are equal

Must consider potential aggravtion of Sx and if not screen properly vascular complications

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16
Q

____ therapy helps to facilitate motion

A

manual

17
Q

To maintain gain, what do we need to give patients?

A

Teach specific exercises

18
Q

High vs Low irritability Tx

A

High:
* Motion in non-provacative ranges
* Avoid pain early

Low:
* Motion in provacative ranges
* Move into pain as long as goes away immediately

19
Q

Mid Cervical and Upper Thoracic Soft Tissue Irritability - Common Medical Conditions/Diagnosis

A
  • Muscle strain
  • Myofascial pain syndrome
  • Active Trigger points
20
Q

Cervical and Upper Thoracic SOFT TISSUE Irritability - Subjective

A
  • More towards chronic symptoms
  • Pain distribution localized to neck/scapula at area of muscle attachments with possible referral pain familiar to muscle (arm or head). Not as pinpoint
  • Unilateral or bilateral
  • Symptoms caused by overuse and/or longer periods of loading of tissue (i.e.: static postures)
  • Pain affected with “stretching” (either better or worse)
  • Sx increase throughout the day
21
Q

Cervical and Upper Thoracic SOFT TISSUE Irritability - Objective

A

Posture:
* Poor posture and unable to maintain “ideal”

AROM Assessment in Sitting
* May be restricted motion and/or pain/stretch esp. with motion away of symptoms (stretching)
* Predominant aggravating motion is flexion and side bending
* Aberrant motions

PROM Assessment in Supine
* More PROM than AROM especially with muscles on slack

Joint Mobility
* Normal mobility. May have mm guarding at end range

Palpation/Flexibility
* Pain, symptom reproduction and increased tone of relevant muscles. Presence of trigger points.

Motor Assessment:
- Poor motor coordination and/or endurance

Neuro:
- Negative neuro screen

22
Q

Trigger point referral patterns for Cervical and Upper Thoracic Soft Tissue

A
  • Suboccipitals
  • Erector spinae
  • Scalenes
  • SCM
  • Levator scapula/ Upper Trapezius
23
Q

Cervical and Upper Thoracic SOFT TISSUE - Irritability

A

High:
* Muscle GUARDING before end ranges, AROM and PROM limited
* Very light palpation reproduces symptoms
* REFERRAL OF SYMPTOMS with palpation (ACTIVE TP)

Moderate:
* Stretch pain at end ranges of AROM and PROM
* Moderate palpation reproduces symptoms
* MAY HAVE REFERRAL OF SYMPTOMS

Low:
* Stretch pain with overpressure into end ranges of AROM and PROM
* Deep pressure reproduces symptoms
* NO REFERRAL OF SYMPTOMS

24
Q

Cervical and Upper Thoracic SOFT TISSUE - Intervention

A

Education

Manual therapy
* Soft tissue mobilization (Instrumented, Manual, Pin and stretch)
* Manual stretching (Static, PNF)
* Thoracic, CT and Cervical non-thrust and thrust mobilization techniques (as needed)

Therapeutic Exercise
General stretching and self ROM

Motor coordination and movement re-education (as needed; especially if more chronic symptoms)

25
Q

Patient education - Specific to Soft Tissue Mobility

A
  • Muscles are sensitive to activity.
  • Motion and stretching helps to desensitize the muscle to activity
  • Need to work other muscles to minimize stress on painful muscles (Motor Coordination)
  • Specific soft tissue mobilization helps “speed the process along”
26
Q

Does soft tissue irritability occur in isolation?

A

No!

  • Reduction of joint motion is related to local muscles innervated by that segment
  • Relationship between presence of trigger points in the upper trap/erector spinae and cervical dysfunction in mid cervical region
  • ALSO, the presence of TP may induce central pain processing centers (central centralization) and treating TP may reduce this central sensitization. More complex than “taut bands in the muscle”
  • “Clinicians should include assessment and tx of BOTH MUSCLE irritability and JOINT hypomobility in management of neck pain”
27
Q

STM as an intervention with neck pain

A
  • Within session changes for chronic neck pain
  • STM exercise is better than STM alone to Tx neck pain
  • STM superior to US to treat neck and arm pain “mechanosensitvity”
28
Q

Ther Ex for Soft Tissue Cervical Pain

A
  • Manual therapy helps to facilitate motion and decrease muscle sensitivity
  • TO MAINTAIN, patient must be taught specific stretching or self-soft tissue mobilization techniques
  • For patients with soft tissue mobility deficits:
    – High irritability: Avoid sustained holds into the stretch but more frequently. LIGHT pressure to the muscle
    – Low irritability: More sustained holds into the stretch Move into pain as long as goes away immediately
  • MOTOR RETRAINING OF AGONIST MUSCLE!
29
Q

No longer thought of as an isolated mechanism or an ____ Tx

A
  • Isolated

When understanding how to implement manual therapy it is best to recognize that often there is not just one way to treat a dysfunction but is truly an integration of:
* education
* encouragement
* focus on positive outcomes
* graded exposure / exercise program to improve both peripheral impairments
* central processing
* coping

Spine (19 decks)

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