Week 9 Upper cervical spine issues Flashcards

Question

Underlying pathology Cervical headaches

Answer 1

 Convergence C1,C2, C3 and trigeminal nerve  Convergence within the Trigeminocervical Nucleus  Neurones receive both cervical and trigeminal input (extensive receptive fields)  Unable to correctly interpret the source of the information  Pain is perceived in the head, as well as in the neck

Answer 2

``` Neck pain related to the headache • Head pain reproduced by neck movement /postures • Head pain produced by PAIVMs • Findings on PPIVMs • Restricted ROM neck (espec upper C/S) • Ipsilateral neck, shoulder, arm pain • Confirmatory pain blocks • Unilaterality ```

Answer 3

``` • Mod-severe non-lancinating, nonshooting pain starting in neck • Fluctuating continuous pain • Varying duration episodes • 5 D’s • Female • Only marginal response to indomethacin • May be Hx neck or head trauma > medium severity ```

Answer 4

 Severe headache of sudden onset ( +/- neck stiffness , nausea & vomiting)  Subacute headache progressively worsening  Severe headache with nausea and vomiting  Headache with associated neurological signs or change in Csness  Temporal headache onset > 50 years  Headache with no associated aetiology

Answer 5

cervicogenic | components of a headache consistent with a neck component

Answer 6

``` Focus on treating movement impairment & clinical signs: Manual therapy such as PJMs and SNAGs • Identification of precipitating factors • More rapid response to treatment ```

Answer 7

``` • Focus on aetiological & perpetuating factors • Greater emphasis on selfmanagement & exercise (motor re-training) • Concurrent pharmacological treatment • Slow response to treatment ```

Answer 8

Articular system dysfunction- treat joint/signs limited motion segments : joint mobilisations, SNAGs • Muscle – treat length, strength and endurance deficits • Treat altered neuromuscular motor control muscle (deep neck flexors, extensors) • Postural – forward head posture • Neural – neural tissue mechanosensitivity • Identification of precipitating factors eg work station • Self-management & exercise (motor re-training)

Answer 9

– Long standing, continuous headaches – Irregular, low grade headaches – Global cervical tenderness • Particularly when irritable – Headaches associated with upper cervical instability – Post trauma cervicogenic headaches eg MVA – Questionable headache diagnosis or overlap

Answer 10

Pain processing can be influenced by past experiences, culture, attitudes, and beliefs about pain Despite the Headache type the CT nucleus can be influenced by allergies, dietary intolerances, sleep disturbances, stress, anxiety and hormonals changes Also visual, somato-sensory and olfactory changes can influence response

Answer 11

``` PAIVMS Heat/cold Sensorimotor training Analgesics PPIVMS Traction Therapeutic exercise Trigger points ```

Answer 12

Activity restrictions due to headaches | Quality of life outcome measures

Answer 13

Switches off in response to neck pain (as in lumbar spine) | does not automatically switch back on with resolution of symptoms

Answer 14

•The global muscle system dominates the movement pattern and take over to provide postural stability with consequent aberrant movement patterns

Answer 15

Longus capitis Longus colli Rectus capitus anterior Rectus capitus lateralis

Answer 16

SCM scalenes trapexius levator scapula

Answer 17

Deep Neck Flexor Muscle Function • To stabilize the cervical joints • (Type 1 fibres – slow twitch)

Answer 18

Abundant evidence that there are changes in cervical muscle function in patients with neck pain disorders (Falla , Jull, Hodges 2004) • Muscle responses do not automatically reverse in response to pain alleviation in cervical region • There is a relationship between the magnitude of change in pain and improvement in DCF activation after training (Falla, O’Leary, Jull 2010) • Therefore all patients with cervical pain episode should have retraining of these muscles to help prevent recurrence of episodes of pain

Answer 19

``` Ask patient to gently nod the head forward • Look for: – overactivity of superficial muscles – activity too fast/ too strong – should NOT provoke neck pain – precision is emphasized If the patient can do this start ``` Can be trained with PBU NB It is not a retraction movement

Answer 20

Progressively increasePBU t0 30 mm Inc. time held Inc. repetitions 1. Add load – ask patient to hold position in supine and just lift the weight of head off the bed 2. Gently apply pressure to forehead 3. Add rotation to right and left maintaining head position • Other strategies: • Perform in sitting – good to do at home, in car, at work ( ask patient to feel the superficial muscles to ensure they are relaxed ) • Add in to functional tasks

Answer 21

``` Local Deep Neck Extensors • Rectus capitus posterior minor and major • Semispinalis capitus and cervicus • Splenius capitus and cervicus • Obliquus capitus superior and inferior ```

Answer 22

Chin lead | Head drop