Cspine Intervention

Question 1

What should you think about when intervention planning?

Answer 1

1. Think stability vs mobility
2. Educate (prognosis, management plan)
3. Reduce Pain (manual therapy, exercise, improve stability)
4. Address impairments
5. Improve functional activity performance and participation (patient’s desired goals)

Question 2

In phase 1 of improving stability/mobility what should you do?

Answer 2

1. Activation/ Coordination exercises
2. Mobility Exercises (AROM, stretching at end ranges)
3. Inhibitory Exercises (Posture stabilizers)
4. Soft Tissue Mobilization (guarding musculature)
5. Joint mobs (sustained hold vs. oscillations), manipulations
   - Guarding and pain – oscillations
   - Stretch a tight capsule – sustained hold

Question 3

In phase 2 of improving stability/mobility what should you do?

Answer 3

Progression to strength/ endurance training of stabilizers

- Retrain/ strengthen motion within newly improved range

Question 4

In phase 3 of improving stability/mobility what should you do?

Answer 4

Increase challenge of exercises (progress toward activity limitations) -> functional goals

Question 5

If there is muscle guarding, what type of exercise and stretch can you do to decrease?

Answer 5

i. Low intensity high rep exercise to improve motion

ii. Target antagonist with AROM to improve ROM

Question 6

What cervical muscle is important to activate to increase ROM?

Answer 6

Longus colli

Question 7

What muscle doesn’t activate very well in functional activity for patients with chronic neck pain?

Answer 7

Longus capitus

Question 8

What are 2 deep neck flexor exercises?

Answer 8

1. Craniocervical flexion exercise (CCFEx)

2. Endurance Training (Chin-tuck/ Head lift)

Question 9

How can you make Craniocervical flexion exercise (CCFEx) more difficult/functional?

Answer 9

1. alter positions (quadruped vs. sitting), add resistance,

2. Avoid SCM & anterior scalene activation

Question 10

How can you make neck endurance training more difficult?

Answer 10

Increase hold times & resistance

Question 11

Describe gentle stretching for nerve entrapments

Answer 11

stretching CT surrounding the nerve and get better movement of nerve

Question 12

Difference between gliders and tensioner nerve entrapment mobilizations.

Answer 12

Gliders” (“Sliders”) – take up slack on one end and give slack on the other
“Tensioners” take up slack on both sides

Question 13

What are the proposed 3 mechanisms for nerve entrapment mobilizations?

Answer 13

1. decrease adhesions and allow improved movement of peripheral nerves
2. increase neural vascularity, allowing increased oxygenation of the nerve and a resultant decrease in ischemic pain
3. Dispersion of noxious fluids

Question 14

What are 5 adverse responses to nerve mobilizations?

Answer 14

1. flare up
2. pain increases with intensity
3. pain begins to peripheralize
4. tingling increases
5. symptoms do not go away afterwards

Question 15

When would you use oscillation Mobilizations at mid-range or a manipulation to get neuro inhibitory effect?

Answer 15

For guarding/pain

Question 16

When would you use static stretch mobilizations with joint held in full range of motion with over pressure?

Answer 16

1. Address CT shortening
2. Take up slack and put extra force to get plastic deformation (capsule tissue to stretch)
3. 30 second holds 3-5x

Question 17

T/F When using manual therapy for an injury, address the limiting impairment first. (ex)

Answer 17

True, Hypomobility of zygapophyseal joints but maybe muscle guarding – oscillation or soft tissue mob to address guarding first to increase mobility of joints

Question 18

What type of movement at what range for grade I oscillatory mobilizations?

Answer 18

Small amplitude movement performed at the beginning of the range.

Question 19

What type of movement at what range for grade 2 oscillatory mobilizations?

Answer 19

Large-amplitude movement performed within the range but not reaching the limit of the range. It can occupy any part of the range that is free of any stiffness or muscle spasm.

Question 20

What type of movement at what range for grade 3 oscillatory mobilizations?

Answer 20

Large amplitude movement performed up to the limit of the range.

Question 21

What type of movement at what range for grade 4 oscillatory mobilizations?

Answer 21

Small amplitude movement performed at the limit of the range

Question 22

What type of movement at what range for grade 5 manipulation?

Answer 22

High velocity thrust performed at the limit of the range

1. Neuro inhibitory effect

Question 23

Proposed terminology when documenting mobilizations:

Answer 23

1. Rate of force of application (oscillation/thrust manipulation/sustained hold)
2. Location in range of available motion (beginning/midrange/end range)
3. Direction of force (mobilized segment relative to stabilized segment)
4. Target of force (where is our hand contacting)
5. Relative structural movement (what are we trying to move on what)
6. Patient position (joint position – open pack vs. near end range of flexion)

Question 24

What are the biomechanical proposed mechanisms for joint mobs?

Answer 24

1. Motion improvement

2. Positional improvement – more anatomical efficient position

Question 25

What are the neurophysiological proposed mechanisms for joint mobs?

Answer 25

1. Spinal Cord 2. Central Mediated 3. Peripheral Inflammatory

Question 26

What are the other proposed mechanisms for joint mobs?

Answer 26

1. Placebo | 2. Pt Expectation

Question 27

What are the 6 absolute contraindications for manual therapy (Mobilizations, Stretching, and Manually Assisted Movements)?

Answer 27

1. Malignancy of targeted region – weakened bone tissue and can cause fractures 2. Cauda Equina Syndrome 3. Red flags including indicators of neoplasm, fracture, or systemic disturbance 4. Rheumatoid collagen necrosis 5. Upper c-spine instability 6. Concern for Cervical Arterial Dysfunction (CAD)

Question 28

What are the relative contraindications of manual therapy?

Answer 28

1. Neurological deterioration 2. Osteoporosis 3. Radiculopathy 4. Immediately postpartum (noncervical) 5. Blood clotting disorder 6. Active, acute inflammatory conditions 7. Long term oral corticosteroid use

Question 29

T/F Thrust manual therapy demonstrated better short term results than mobs

Answer 29

True

Question 30

Common symptoms of neck pain with mobility deficits:

Answer 30

1. Central or unilateral neck pain | 2. Symptomatic ROM limitations

Question 31

Common physical exam findings of neck pain with mobility deficits:

Answer 31

1. ROM impairments (symptomatic at end-range) 2. Cervical & thoracic joint hypomobility 3. Symptomatic provocation testing for involved structures 4. Motor control impairments (subacute & chronic)

Question 32

For acute neck pain with mobility deficits, clinicians should provide what?

Answer 32

1. Thoracic manipulation 2. Program of neck ROM exercises 3. Scapulothoracic and UE strengthening to enhance program adherence 4. Cervical manipulation and or mobilizations

Question 33

For subacute neck pain with mobility deficits, clinicians should provide what?

Answer 33

1. Neck and shoulder girdle endurance exercises | 2. Thoracic manipulation and cervical manipulation and/or mobilizations

Question 34

For chronic neck pain with mobility deficits, clinicians should provide what?

Answer 34

1. Thoracic manipulation and cervical manipulation/mobilization 2. Exercises for cervical/scapulothoracic regions: neuromuscular (coordination, proprioception. and postural training), stretching, strengthening, endurance training, aerobic) 3. Dry needling, laser, or intermittent mechanical/manual traction

Question 35

Common symptoms of neck pain with movement coordination impairments (WAD):

Answer 35

1. Hx related Trauma/ Whiplash 2. Associated shoulder girdle/ UE pain referral 3. Concussive SxS 4. Dizziness/ nausea; HA; confusion; concentration impairments; hypersensitivity to stimuli; distress

Question 36

Common physical exam findings of neck pain with movement coordination impairments (WAD):

Answer 36

1. Strength/ endurance/ coordination/ sensory impairments 2. Neck pain worsens with mid- & end-range ROM 3. Tenderness to palpation 4. Painful with provocation testing

Question 37

For acute neck pain with movement coordination impairments (WAD), clinicians should provide what?

Answer 37

1. Education (return to normal activites as soon as normal, minimize use of cervical collar, postural/mobility exercises to decrease pain and increase ROM) 2. Reassurance to pt that recovery expected 2-3 months 3. Manual mobilizations tech plus exercises 4. TENS

Question 38

T/F cervical collar not used for patients with neck pain with movement coordination impairments (WAD) if cervical instability is ruled out.

Answer 38

True

Question 39

For chronic neck pain with movement coordination impairments (WAD), clinicians should provide what?

Answer 39

1. Patient education 2. Mobilization combined with submaximal exercises of strengthening, endurance, flexibility, and coordination 3. TENS

Question 40

Common symptoms of NECK PAIN WITH HEADACHE (CERVICOGENIC):

Answer 40

1. Non-continuous neck pain with referred headache | 2. Pain provoked with neck movement/ sustained positions

Question 41

Common physical exam findings of NECK PAIN WITH HEADACHE (CERVICOGENIC):

Answer 41

1. + cervical flexion rotation test 2. HA reproduction with provocation testing of upper c-spine segments 3. Impaired cervical spine ROM & joint mobility 4. C-Spine strength/ endurance/ coordination impairments

Question 42

For acute NECK PAIN WITH HEADACHE (CERVICOGENIC), clinicians should provide what?

Answer 42

1. Supervised instruction in active mobility exercise | 2. C1-C2 natural apophyseal glide

Question 43

For subacute NECK PAIN WITH HEADACHE (CERVICOGENIC), clinicians should provide what?

Answer 43

1. Cervical manipulation and mobs | 2. C1-C2 natural apophyseal glide

Question 44

For chronic NECK PAIN WITH HEADACHE (CERVICOGENIC), clinicians should provide what?

Answer 44

1. Manipulation/mobs combined with shoulder girdle and neck stretching, strengthening, and endurance exercises

Question 45

Common symptoms of NECK PAIN WITH RADIATING PAIN (RADICULAR)

Answer 45

1. Neck pain with band-like pain in UE | 2. UE dermatomal paresthesia/ anesthesia & myotomal weakness

Question 46

Common physical exam findings of NECK PAIN WITH RADIATING PAIN (RADICULAR)

Answer 46

1. Concordant UE symptoms reproduced/ alleviated with radiculopathy testing procedures 2. LMN (sensory/motor) impairments with neurologic testing

Question 47

T/F LMN with radiculopathy but not necessarily with radicular pain

Answer 47

True

Question 48

For acute NECK PAIN WITH RADIATING PAIN (RADICULAR), clinicians should provide what?

Answer 48

1. Mobilizing and stabilizing exercises, laser, and short term cervical collar use

Question 49

For chronic NECK PAIN WITH RADIATING PAIN (RADICULAR), clinicians should provide what?

Answer 49

1. Mechanical intermittent cervical traction combined with stretching, stretching, mobs/manipulation 2. Education - participate in occupational and exercise activities