Week 9 & 10

Question 1

How much thoracic extension is needed for bilateral arm elevation?

Answer 1

15 degrees

Question 2

How do the ribs move during thoracic extension & ipsilateral rotation?

Answer 2

posterior rib rotation

Question 3

How do the ribs move during thoracic flexion ipsilateral lateral flexion?

Answer 3

anterior rib rotation

Question 4

When would we use PA glides for thoracic hypomobility?

Answer 4

restriction in the sagittal plane (flexion/extension), use unilateral for z joint involvement vs central

Question 5

When would we use segmental rotation mobilisation for thoracic hypomobility?

Answer 5

loss of rotation or LF, as the movements are coupled

can also use segmental LF mobilisation for either

Question 6

When would we use a cervical lateral glide technique?

Answer 6

to treat painful C5/C6 nerve roots (gap the joint to allow more space for the nerve during radiculopathies)

Question 7

What indicates traction?

Answer 7

radiculopathy or general hypomobility

Question 8

How & why do we use PA glides at the costotransverse joints?

Answer 8

to address rib mobility at the costotransverse & costovertebral joints (CT overlay CV)

PA performed in a caudad direction will assist with posterior rotation (which occurs during inhalation)

PA performed in a cephalad direction will assist with anterior rotation (which occurs during exhalation)

Question 9

When is a high-velocity manipulation of the thoracic spine indicated?

Answer 9

general hypomobility over several thoracic segements

when muscle spasm is not allowing movement of a joint and mobilisation is aggravating the joint

when there is residual hypomobility not responding to mobilisation

Question 10

What are the contraindications to high-velocity manipulation of the thoracic spine?

Answer 10

non-mechanical pain
systemic inflammatory disease
metastatic disease/cancer
pregnancy
spinal cord or cauda equina compromise
osteoporosis
severe nerve root pain
fractures
vertebral or internal carotid artery compromise

Question 11

What are some precautions for high-velocity manipulation of the thoracic spine?

Answer 11

post-partum
adolescents or children
muscle spasm
patient unable to understand/consent
patient not relaxed
recent trauma
older patients

Question 12

Is the key to a good high-velocity thoracic manipulation speed or force?

Answer 12

speed

Question 13

3 MWM techniques for thoracic mobility.

Answer 13

transverse glide with assisted active rotation (& slight extension) (sitting head supported)

caudad PA glide with assisted active extension (sitting head supported)

cephalad PA glide with active flexion (sitting)

Question 14

How do we manage cervicogenic headaches?

Answer 14

A&E (explanation of neck involvement and referral into headache, assurance)

Posture/ergonomics advice if applicable

Manual therapy for joint hypomobility (including thoracic spine if hypomobile) i.e. PA, unilateral PA, SNAG

Therapeutic exercise for found impairment i.e. CCFT, extensors, axio-scapular muscles (motor control, strength, endurance)

SNAG and/or sensorimotor exercise for dizziness if applicable

Question 15

How do we manage migraines?

Answer 15

Manual therapy for neck pain associated with migraine

Aerobic exercise 60-70% MHR, 2x week, 40 minutes (evidence says helps duration/frequency of migraines)

Find/avoid triggers

Mindfulness/manage stress

Medications (preventative/abortive), new meds coming out all the time, talk to GP/pharmacist

Question 16

How do we manage tension-type headaches?

Answer 16

Manual therapy for neck pain associated with TTH

Aerobic exercise (much like migraine)

Sleep/stress management

Question 17

How do we differentiate C0/1 and C1/2 dysfunction in cervicogenic headache?

Answer 17

C0/1 will have restriction in extension

C1/2 will have restriction in rotation

Question 18

4 causes of wry neck.

Answer 18

z joint sprain (younger)

discogenic (older)

muscular

atlanto-axial rotary fixation (children/adolescents)

Question 19

Typical history of a z joint wry neck.

Answer 19

female, younger person, happened suddenly i.e. with a head movement, localised unilateral neck pain, usually non-irritable, can be locked or unlocked, pain provoked with movement toward side of pain (closing the joint)

Question 20

What segments are most commonly involved with a locked acute z joint wry neck?

Answer 20

C1/2 or C2/3 as these have the largest menisci

Question 21

Treatment of a z joint wry neck.

Answer 21

A&E (good prognosis 2-3 days, reduce fear around condition, rest for 24 hours while it settles, analgesia)

1st day: unlock joint (if locked)
-manual traction in line of deformity, progressively bringing it back into neutral

-LF & rot away from side of pain

-manipulation if proficient

THEN
-gentle unilateral PA of affected z joint if tolerated

-heat/ice as tolerated

-US for inflammation and pain

-activate DNF & extensors

Day 2: residual pain
-PA affected z joint

-address any muscular impairments i.e. axio-scapular, DNF, extensors

Question 22

Typical history of a discogenic wry neck.

Answer 22

older person, insidious onset, may have history of unaccustomed movement, deep ache that builds up and spreads, may be irritable, extension most limited then LF & rot.

Question 23

Treatment of a discogenic wry neck.

Answer 23

similar to z joint, avoid manipulation in older people, may take longer ~2 weeks to subside, monitor as prone to radiculopathy

Question 24

What is atlanto-axial rotary fixation?

Answer 24

AKA Grisel’s syndrome

rare disorder in children with a fixed rotary subluxation of C1 on C2

Can be spontaneous, traumatic or congenital

medically managed through traction or surgical fixation

Question 25

What is spasmodic torticollis?

Answer 25

AKA cervical dystonia

issue with the CNS/basal ganglia

medical intervention needed i.e. botox or surgical

physio to address secondary msk impairments

Question 26

What is the prognosis for a full recovery from whiplash?

Answer 26

about 50% of people

30% have persisting mild to moderate pain & disability

20% have moderate to severe pain & disability

Question 27

How do we treat whiplash?

Answer 27

by addressing the patients presenting neuromuscular, articular and sensorimotor impairments

Question 28

What are some red flags for whiplash?

Answer 28

paraesthesia/numbness in arms, legs or tongue

severe neck and arm pain

breathing difficulty

difficulty supporting the head

deformity

Question 29

Canadian C Spine rule.

Answer 29

Any high-risk factors (>65, dangerous mechanism, paraesthesia in extremities)

Any low-risk factors (not ambulatory, unable to sit, midline cervical tenderness)

Unable to actively rotate head 45 degrees L & R

Question 30

Useful outcome measures for whiplash.

Answer 30

neck disability index, pain VAS, PSFS