C-Spine Interventions

Question 1

Generally with MSK conditions think ______ vs ________

Answer 1

stability vs mobility

Question 2

When planning interventions what are some general concepts to keep in mind?

Answer 2

1. stability vs mobility
2. educate the pt
3. reduce pain
4. address impairments
5. improve functional activity performance and participation

Question 3

what is included within Phase 1 interventions pertaining to mobility training?

Answer 3

1. activation/coordination exercises
2. mobility exercises
3. inhibitory exercises
4. soft tissue mobilization
5. joint mobilization (sustained hold vs oscillations) and manipulations

Question 4

what is included within Phase 2 interventions pertaining to both mobility and stability training?

Answer 4

progression to strength/endurance training of stabilizers

must retrain/strengthen motion within newly improved ROM

Question 5

what is included within Phase 3 interventions pertaining to both mobility and stability training?

Answer 5

increase challenge of exercise and progress towards activity limitations

Question 6

what is included within Phase 1 interventions pertaining to stability training?

Answer 6

1. exercises aimed at improved physiologic effects
2. activation/coordination exercises
3. Joint mobs (sustained holds vs oscillations) and manipulations

Question 7

List things to keep in mind with Craniocervical flexion exercise (CCFEx)

Answer 7

1. begin at target level from testing procedure and progressively increase
2. in practice, alter positions (quadruped vs. sitting), add resistance
3. avoid SCM and anterior scalene activation

Question 8

List some interventions that can be used to treat nerve entrapments

Answer 8

1. Gentle Stretching
2. Nerve mobilizations
   
   1. active vs passive
   2. gliders (sliders) vs tensioners

Question 9

what is the propsed mechanism for nerve mobilization intervention techniques?

Answer 9

1. these are thought to decrease adhesions and allow improved movement of peripheral nerves
2. they may increase neural vascualrity, allowing increased oxygenation of the nerve and a resultant decrease in ischemic pain
3. might disperese noxious fluids
4. improve axoplasmic flow

Question 10

when documenting manipulations, what 6 things should be included?

Answer 10

1. rate of force application
2. location in range of available motion
3. direction of force
4. target of force
5. relative structural movement
6. patient position

Question 11

which proposed mechanism is more widely excepted for joint mobilizations?

Answer 11

Neurophysiologic

Question 12

what things are included in manual therapy?

Answer 12

1. Passive movements:
   
   • mobilizations
   • stretching
   • manually assisted movements
2. Manipulations

Question 13

List absolute contraindications to passive movements?

Answer 13

1. malignancy of targeted region
2. Cauda Equina Syndrome
3. red flag indicators of:
   
   1. neoplasm
   2. fracture
   3. systemic disturbance
4. Rheumatoid collagen necrosis
5. Upper C-spine instability
6. concern for CAD

Question 14

list relative contraindications to passive movements

Answer 14

1. previously defined relative contraindications
   
   • active, acute inflammatory conditions
   • sig segmental stiffness
   • systematic disease
   • neuro deterioration
   • irritability
   • Osteoporosis
   • condition is worsening w/present trx
2. acute nerve root irritation (radiculopathy)
   
   • when sub and obj symptoms don’t add up
   • any pt condition (handled well) that is worsening
   • use of oral contraceptives (if c-spine)
   • long-term oral corticosteroid use (if C-spine)
3. immediately postpartum
4. blood-clotting disorder

Question 15

list absolute contraindications to manipulations

Answer 15

1. previously defined contraindications for passive movements
2. practioner lack of ability
3. spondylolisthesis
4. gross foraminal encroachment
5. children/teenagers
6. pregnancy
7. fusions
8. psychogenic disorders
9. immediately post-partum

Question 16

List relative contraindications for manipulations

Answer 16

exact same as those defined for passive movements

Question 17

Describe the clinical presentation of neck pain with mobility deficits

Answer 17

1. Common symptoms
   
   1. generally central or unilateral neck pain (w/possible referral to the shoulder girdle/UE)
   2. symptomatic ROM limitations
2. Common Physical Exam findings
   
   1. ROM impairments (symptomatic at end-range)
   2. cervical and thoracic joint hypomobility
   3. symptomatic provocation testing for invovled structures
   4. motor control impairments (subacute and chronic)

Question 18

describe the clinical presentation of neck pain w/movement coordination impairments (WAD

Answer 18

1. Common symptoms
   
   • Hx related trauma/whiplash
   • associated shoulder girdle/UE pain referral
   • concussive SxS
   • dizziness/nausea; HA; confusion; concentration impairments; hypersenstivity to stimuli; distress
2. Common Physical Exam findings
   
   • strength/endurance/coordination/sensory impairments
   • neck pain worsens w/mid-end range ROM
   • tenderness to palpation
   • painful w/provocation testing

Question 19

decribe the clinical presention of neck pain with headache (cervicogenic)

Answer 19

1. common symptoms
   
   • non-continuous neck pain w/referred HA
     pain provoked w/neck movement/sustained postures
2. common physical exam findings
   
   • • cervical flexion rotation test
   • HA reproduction w/provocation testing of Upper C-spine segments
   • impaired cervical spine ROM and joint mobility
   • C-spine strength/endurance/coordination impairments

Question 20

describe the clinical presentation of neck pain with radiating pain (radicular pain)

Answer 20

1. common symptoms
   
   • neck pain w/band-like pain in UE
   • UE dermatomal paresthesia/anesthesia & myotomal weakness
2. common physical exam findings
   
   • concordant UE symptoms reproduced/alleviated w/radiculopathy testing procedures
   • LMN impairments w/neurologic testing