Canadian Cervical Spine Rules
High Risk Factors Present?
- Age > 65
- Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
- Paresthesias in extremities
Low Risk Factors that allow safe assessment of range of motion?
- Simple rear-end motor accident
- Normal sitting posture in emergency department
- Ambulatory at any time since injury
- Delayed onset of neck pain and absence of midline tenderness
Is the patient able to actively rotate the neck > 45 degrees to the right and the left?
If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck > 45 degrees to the right and the left, radiographs are indicated
Cervical Myelopathy
- Gait deviation
- Positive Hoffmann’s test
- Positive inverted supinator sign
- Positive Babinski test
- Age > 45 years
Cervical Radiculopathy
- Upper Limb Tension Test A
- Involved cervical rotation < 60 degrees
- Distraction Test
- Spurling’s A
Closed Cervical Fractures
- Age < 55 years old
- Single (Marital status)
- Condition involved trauma
- Acute condition
- Condition involved ER visit
Lumbar Stenosis
- Bilateral symptoms
- Leg pain > back pain
- Pain during walking/standing
- Pain relief upon sitting
- > 48 years old
SIJ pain
Laslett et al., 2003/05 SI Distraction SI Compression Thigh Thrust Test Gaenslen’s Test Sacral Thrust
van der Wurff et al., 2006 SI Distraction SI Compression Thigh Thrust Test Gaenslen’s Test Patrick’s Sign (FABER
Vertebral Compression Fracture
- Age > 52 years
- No presence of leg pain
- Body mass index < 22
- Does not exercise regularly
- Female gender
Cervical Manipulation for Neck
- Symptom duration of less than 38 days
- Positive expectation that manipulation will help
- Side-to-side difference in cervical rotation ROM of 10° or greater
- Pain with posteroanterior spring testing of the middle cervical spine
Manipulation for Low Back Pain
- Duration of symptoms < 16 days
- At least one hip with > 35° of internal rotation
- Lumbar hypomobility
- No symptoms distal to the knee
- FABQ-W score < 19
Mechanical Traction for Low Back Pain
- FABQ-W score < 21
- No neurological deficit involvement
- Age older than 30
- Non-manual work job status
Mechanical Traction for Neck Pain
- Patient reported peripheralization with lower cervical spine (C4-7) mobility testing
- Positive shoulder abduction test
- Age > 55
- Positive upper limb tension test A
- Positive neck distraction test
Stabilization for Low Back Pain
Stabilization CPR Age < 40 years old Straight leg raise > 91° Aberrant movement present Positive prone instability test
Modified Stabilization CPR
Aberrant movement present
Positive prone instability test
Thoracic Manipulation for Neck Pain
- Symptoms < 30 days
- No symptoms distal to the shoulder
- Looking up does not aggravate symptoms
- FABQ-PA score < 12
- Diminished upper thoracic spine kyphosis
- Cervical extension ROM < 30 degrees
Canadian Cervical Spine Rules
High Risk Factors Present?
- Age > 65
- Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
- Paresthesias in extremities
Low Risk Factors that allow safe assessment of range of motion?
- Simple rear-end motor accident
- Normal sitting posture in emergency department
- Ambulatory at any time since injury
- Delayed onset of neck pain and absence of midline tenderness
Is the patient able to actively rotate the neck > 45 degrees to the right and the left?
If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck > 45 degrees to the right and the left, radiographs are indicated.
Exercise for Ankylosing Spondylitis
- SF-36: Physical role > 37
- SF-36: Bodily pain > 27
- Bath Ankylosing Spondylitis Disease Activity Index > 31
Ankylosing Spondylitis (IBP Criteria)
- Age at onset < 40 years old
- Insidious onset
- Improvement with exercise
- No improvement with rest
- Pain at night with improvement on getting up
Ankylosing Spondylitis (Berlin Criteria)
- Morning stiffness > 30 min
- Improvement in back pain with exercise but not with rest
- Awakening because of back pain during the second half of the night only
- Alternating buttock pain
