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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
• IS PATIENT APPROPRIATE FOR PT?
• PAIN 'STORY'?
• DIFFERENTIAL DIAGNOSIS?
• KEY TESTS?
• TREATMENT FOCUS?
• 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
• IS PATIENT APPROPRIATE FOR PT?
• PAIN 'STORY'?
• DIFFERENTIAL DIAGNOSIS?
• KEY TESTS?
• TREATMENT FOCUS?
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
References: OPTA MVA 3/11/2017 course
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Sterling M. Physiotherapy Management of whiplash-associated disorders (WAD). Journal of
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Yoganandan N, Stemper BD, Rao RD. Patient Mechanisms of Injury in Whiplash-Associated
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activation of the semispinalis cervicis relative to the splenius capitis at specific spinal levels?
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