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Cervical Spine Injury Cont., ACTIVE MOVEMENTS - Coggle Diagram
Cervical Spine Injury Cont.
Testing
Biokinetic Evaluation
OTTL-TYSF
1) Observe
2) Talk (History)
3) Touch (Palpation)
4) Look (Inspection)
5) They move (Active movement)
6) You move (Passive Movement)
Flexibility Tests
Manual/Isometric/Isokinetic Strength Tests
End range
7) Special Tests
8) Functional Tests [ADL vs Sport]
Patient History
Biokinetic Evaluation
Esp:
Age/Occupation/Relieving positions
PQRST (Provocation, Quality, Region, Severity, Timing)
Provocation
Microtrauma: overuse, posture, stress VS
Macrotrauma: did the patients head strike something?
Quality
‘Irritability’ of pain
Burning, headache, neurological deficit in limbs, dizziness/syncope/referred pain
Red flag: pain cannot be reduced through re-positioning or specific activities
Nature of pain
Nature of the pain may indicate the cause
Severe, lancinating pain referred in a dermatomal distribution: nerve root compression
Worse in the morning: inflammatory condition
Mechanical problem: worse with movement
Reading (flex) = pain: intervertebral disc problem
Looking up (ext) = pain: apophyseal joint problem
Talking on the phone (ipsilateral flex) = pain: compression of structures exiting the foramen
Pins, needles, weakness, numbness → nerve root involvement
Dizziness, syncope with turning/looking up or sustained position → vertebral artery insufficiency
Region
Dermatomal radication
Upper/lower cervical, and/or referred to head
Primarily central, right/left sided, or generalized ache?
Note radiation of pain to head/shoulders/arms/hands/fingers
Timing
Sudden: external trauma/abnormal movement VS
Insidious: result of repetitive movement or prolonged abnormal posture VS
Delayed, following trauma: acute acceleration/deceleration (whiplash) VS
Bone pain → immediate VS
Muscle/ligaments → take several hours/days to manifest VS
Biokinetic Evaluation
PALPATION
Trigger points, point tenderness, muscle spasm, severe atrophy
Skin texture & surrounding bony & soft tissues on the posterior, lateral & anterior aspects of the neck
Posterior Aspect:
Spinous processes & facet joints of the cervical vertebra
Facet joints palpated 1.3-2.5cm lateral to spinous process
Palpate i.e. upper traps, levator scapulae, spleni group & paraspinal muscles
Anterior Aspect
First three ribs + sternum
Check movement of ribs (breathing)
Supraclavicular fossa
Sternocleidomastoid
Inspection (POSTURAL ANALYSIS)
Dynamic Posture
How patient walks/removes clothing
Demonstration of painful movements
Head & neck posture
Sitting
Standing
Note orientation of lumbopelvic region, thoracic spine and axio-scapular region; as well as head & neck orientation
Head & neck posture
Midline
Normal lordotic curve (30-40°)
Neck deformities
Forward head posture
Tortiollis
Shoulder levels
Rounded shoulders
Muscle spasm/asymmetry
Atrophy/hypertrophy
Bony & soft-tissue contours
PASSIVE MOVEMENTS
Supine position
Seated: head relaxed on arms
See if ROM is greater than active
Side flexion: 75-80°
SPECIAL TESTS
Spurling’s Test
Nerve root symptoms reproduced +ve: neurological symptoms
Distraction Test
Alleviate radicular symptoms
Upper Limb Tension Tests reproduced +ve: neurological symptoms
Shoulder Depression test
Brachial plexus lesions +ve: neurological symptoms reproduce
Valsalva Test
Effect of increased pressure on spinal cord
+ve: neurological symptoms reproduced
Brachial Plexus Compression Test
+ve: neurological symptoms reproduced
FUNCTIONAL ASSESSMENT
Breathing
Looking up at ceiling: 40°-50° neck extension needed
Looking down at belt buckle/tie shoe laces: 60°-70° neck flexion needed
Paresthesia
Functional Strength Tests
Treatment
Neck Rehabilitation
Patient education
Motor Control
Stage 1
Neck Flexors:
Very NB to maintain the correct length and strength of the deep neck flexor muscle group
Deep neck flexors NB in providing stability to neck
Longus colli, longus capitus, rectus capitus anterior, rectus capitus lateralis
Addresses any altered behaviours between the deep and superficial muscles & the low level endurance capacity of the deep neck flexors for their role in segmental support & control of posture
Commenced either in prone on elbows or quadruped position, depending on patient’s ability to control scapular/trunk posture
Neck Extensor
Stage 1 training: Axio-scapular muscles
*SCAPULAR STABILIZATION NB
improving activation and endurance capacity of the trapezius & serratus anterior muscles, as well as re-educating the axio-scapular muscles functionally to provide adequate scapular stability in a) posture and b) during arm movements
Lying Dumbbell Presses.
2.Push-Up Plus (Angry cat)
3.Rhomboids Stretch. (Arm across chest)
4.Shoulder Circumference with a Ball.
Band Pull-Aparts
Face Pulls/rows from low
Bent-over pendulum Swings
Shoulder blade squeeze
Shrugs
SCAPULA STABILIZATION
Scapula stabilizing exercises:
Scapula pinch: scapulae retracted toward midline
Scapula clock
Lawn mower (*Progressive)
Low row (& inferior glide)
ROM
Aim: move the cervical spine, thoracic spine, and upper extremities through functional planes of movement
Assist pain control
Provide assurance to the patient that it is safe to move
Prevent loss of ROM secondary to disuse
Improve joint mobility
Maintain gains in ROM achieved with manual therapy
Performed within pain free ranges, and should not increase pain levels
ACTIVE MOVEMENTS
Differences in ROM
Patients willingness to perform movement
Assess quality of movement
↑ in symptoms?
Does the patient close their eyes?
Is the pain only at end of range or is it painful throughout the movement?
Is movement ceased before the onset of pain/symptoms?
Note location of the symptoms during specific movements
Flexion:
Normal: 80-90°
Chin on chest with mouth closed/within 2 fingers
Extension: 70°
Side flexion: 20-45°
Rotation: 70-90°
Combined movements
Apley’s test
