Week 9 & 10 Flashcards
How much thoracic extension is needed for bilateral arm elevation?
15 degrees
How do the ribs move during thoracic extension & ipsilateral rotation?
posterior rib rotation
How do the ribs move during thoracic flexion ipsilateral lateral flexion?
anterior rib rotation
When would we use PA glides for thoracic hypomobility?
restriction in the sagittal plane (flexion/extension), use unilateral for z joint involvement vs central
When would we use segmental rotation mobilisation for thoracic hypomobility?
loss of rotation or LF, as the movements are coupled
can also use segmental LF mobilisation for either
When would we use a cervical lateral glide technique?
to treat painful C5/C6 nerve roots (gap the joint to allow more space for the nerve during radiculopathies)
What indicates traction?
radiculopathy or general hypomobility
How & why do we use PA glides at the costotransverse joints?
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)
When is a high-velocity manipulation of the thoracic spine indicated?
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
What are the contraindications to high-velocity manipulation of the thoracic spine?
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
What are some precautions for high-velocity manipulation of the thoracic spine?
post-partum
adolescents or children
muscle spasm
patient unable to understand/consent
patient not relaxed
recent trauma
older patients
Is the key to a good high-velocity thoracic manipulation speed or force?
speed
3 MWM techniques for thoracic mobility.
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)
How do we manage cervicogenic headaches?
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
How do we manage migraines?
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
How do we manage tension-type headaches?
Manual therapy for neck pain associated with TTH
Aerobic exercise (much like migraine)
Sleep/stress management
How do we differentiate C0/1 and C1/2 dysfunction in cervicogenic headache?
C0/1 will have restriction in extension
C1/2 will have restriction in rotation
4 causes of wry neck.
z joint sprain (younger)
discogenic (older)
muscular
atlanto-axial rotary fixation (children/adolescents)
Typical history of a z joint wry neck.
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)
What segments are most commonly involved with a locked acute z joint wry neck?
C1/2 or C2/3 as these have the largest menisci
Treatment of a z joint wry neck.
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
Typical history of a discogenic wry neck.
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.
Treatment of a discogenic wry neck.
similar to z joint, avoid manipulation in older people, may take longer ~2 weeks to subside, monitor as prone to radiculopathy
What is atlanto-axial rotary fixation?
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
What is spasmodic torticollis?
AKA cervical dystonia
issue with the CNS/basal ganglia
medical intervention needed i.e. botox or surgical
physio to address secondary msk impairments
What is the prognosis for a full recovery from whiplash?
about 50% of people
30% have persisting mild to moderate pain & disability
20% have moderate to severe pain & disability
How do we treat whiplash?
by addressing the patients presenting neuromuscular, articular and sensorimotor impairments
What are some red flags for whiplash?
paraesthesia/numbness in arms, legs or tongue
severe neck and arm pain
breathing difficulty
difficulty supporting the head
deformity
Canadian C Spine rule.
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
Useful outcome measures for whiplash.
neck disability index, pain VAS, PSFS
