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CERVICOTHORACIC MVA: TIPS AND PROGRESSIONS FOR BEST OUTCOMES KAREN WALZ , PT, DPT, OCS, COMT, FAAOMPT

FREEIMAGES.COM

ACUTE MVA KINEMATICS

•  Rear End Collision Mechanics •  Stage 1- Retraction; "S"

Curve •  Stage 2-

Hyperextension •  Stage 3- Hyperflexion

•  Yoganandan 2013; www.tinnutusformula.com

CASE #1

•  55 YR OLD MALE, 3 WEEKS POST REAR-END MVA. NECK PAIN 3/10 WITH SUBOCCIPITAL HEADACHE AND CERVICOTHORACIC ACHE.

•  SYMPTOMS AGGRAVATED BY SUSTAINED NECK POSTURES, COMPUTER WORK, DRIVING. SLEEP OK. EASED SOMEWHAT WITH LYING DOWN, ICING.

•  NUMBNESS/TINGLING RT DOMINANT ARM RT 1-2ND FINGERS AND OCCASIONALLY LT THUMB

•  IS PATIENT APPROPRIATE FOR PT?

•  PAIN 'STORY'?

•  DIFFERENTIAL DIAGNOSIS?

•  KEY TESTS?

•  TREATMENT FOCUS?

•  WWW.IFOMPT.COM; Fortin et al, 2017

PAIN 'STORY'- WHAT DRIVES THEIR PAIN SYMPTOMS?

Biomechanical, MSK- tissue,

system

Psychological - coping,stress

reactions

Socioeconomic- motivational,

litigation

PAIN DRIVER EARLY INFLUENCE ON OUTCOMES •  45% show 'rapid recovery'

•  39% trend toward 'moderate recovery'

•  16% trended toward 'poor recovery' and chronic symptoms over 12 months, at 1 month post assessments

•  Sterling et al. 2010; http://www.physio-pedia.com/Neck_Disability_Index

•  HYPERSENSITIVITY •  COLD HYPERALGESIA

•  https://naiomt.me/?s=MVA (cold hyperalgesia test method)

•  PTSD •  PTSD self test

•  https://www.adaa.org/screening-posttraumatic-stress-disorder-ptsd

•  Rivest et al 2010 ; Ritchie 2013

EMERGING CLINICAL PREDICTION RULE- MVA OUTCOMES

PDS >/ 6 PTSD scale >/35 yr old >/ 40% NDI

POOR POST-MVA CLINICAL

OUTCOMES Ritchie 2013; Rivest et al

2010; PCS

CASE #2

•  39 yr old male, retail IT troubleshooter, involved in rear-end MVA 3 months ago. He complains of mild Lt neck pain 2/10, fatigue, feeling "foggy" (especially with looking up), difficulty concentrating and with some long term memory skills.

•  Imaging negative, gross neuro screen WNL. Mild Lt cerv rotation AROM loss. Past 4 chiro treatments helped neck pain somewhat




•  KEY TESTS?


•  Mucha, et al 2014

DIFFERENTIAL DIAGNOSIS

Vestibulo-Oculomotor

•  Dix-Hallpike BPPV

• VOMS

Concussion

• SCAT 3 •  Post-

concussion Symptom Scale

Sensorimotor

•  Joint position sense

• Neck movement control

Where to Start ?

CASE #3

•  23 yr old female, involved in side impact collision 2 months ago in commercial parking lot (estimated speed 8 mph). Neck pain 7/10, head feels "heavy" at times (end of work day, lifting head from lying in bed) as receptionist at busy legal office. She worries a lot about her neck "never getting better"

•  Initial imaging & neuro screen negative. PCP prescribed muscle relaxer and OTC pain meds; she feels these helped initially




•  KEY TESTS?


TREATMENT

•  Deep neck flexor activation (CCFT) •  O'Leary S, Jull G, et al. 2007

TREATMENT

•  Deep neck extensor activation •  Schomacher 2015

TREATMENT

•  Somatosensory •  Kristjannson E et al. 2009

SUMMARY

•  Consider the patient's "pain story"

•  Use appropriate screening tools and predictive analytics to help you gauge outcomes and progress of patient

•  Classify and prioritize any multi-regional or multi-system diagnoses to progress your plan of care

•  Treat acute neuro/vestibulo-ocular symptoms and MSK to allow full progression to functional activity

•  Give the patient tools 'for success' in long term management

KAREN WALZ, PT, DPT

[email protected]

References: OPTA MVA 3/11/2017 course

Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on

whiplash-associated disorders: redefining “whiplash” and its management. Spine. 1995; 20(8S):

1S-2S.

Sterling M. Physiotherapy Management of whiplash-associated disorders (WAD). Journal of

Physiotherapy. 2014; 60: 5–12.

Yoganandan N, Stemper BD, Rao RD. Patient Mechanisms of Injury in Whiplash-Associated

Disorders. Seminars in Spine Surgery. 2013;25: 67- 74.

Rushton A. et al. International framework for examination of the cervical region for potential of

Cervical Arterial Dysfunction prior to Orthopedic Manual Therapy. Manual Therapy. 2014;

(19)3: 222–228.

Fortin M, Dobrescu O, Courtemanche M, Sparrey CJ, Santaguida C, Fehlings MG, Weber MH.

Association Between Paraspinal Muscle Morphology, Clinical Symptoms, and Functional Status

in Patients With Degenerative Cervical Myelopathy. Spine. 2017 Feb 15; 42(4):232-239.

Sterling M, Hendrikz J, Kenardy J. Compensation claim lodgement and health outcome

developmental trajectories following whiplash injury: A prospective study. PAIN 150 (2010) 22–

28.

Elliott, JM. Are there implications for morphological changes in neck muscles after whiplash

injury? Spine. 2011;36(25S):S205-S210.

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both chronic moderate/severe disability and full recovery following whiplash injury. PAIN. 2013;

154: 2198–2206.

Rivest K , Cote JN , Dumas JP , et al. Relationships between pain thresholds, catastrophizing and

gender in acute whiplash injury . Man Ther 2010 ; 15 : 154 – 9.

M.J.L. Sullivan, S. Bishop, J. Pivik. The pain catastrophizing scale: development and validation.

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http://sullivan-painresearch.mcgill.ca/pdf/pcs/PCSManual_English.pdf

Mucha A, et al. A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate

concussions: preliminary findings. Am J Sports Med. 2014 Oct; 42(10):2479-86.

O'Leary S, Jull G, Kim M, Vicenzino B. Specificity in retraining craniocervical flexor muscle

performance.J Orthop Sports Phys Ther. 2007 Jan; 37(1):3-9.

Schomacher J, Erlenwein J, Dieterich A, Petzke F, Falla D. Can neck exercises enhance the

activation of the semispinalis cervicis relative to the splenius capitis at specific spinal levels?

Manual Therapy 20 (2015) 694-702.

Kristjansson E & Treleaven J. Sensorimotor Function and Dizziness in Neck Pain: Implications for

Assessment and Management. JOSPT. 2009; 39 (5): 364-377.

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