lesson 7 mid cervical spine assessment and treatment
TRANSCRIPT
![Page 1: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/1.jpg)
Lesson 7
Mid Cervical Spine
Assessment and Treatment
![Page 2: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/2.jpg)
Arthrokinematics
Sidebend /rotation
U joints/ Z jts
ipsi inf, med, post
( IMP)
contra sup,ant, lat
( SAL)
Rotation / Side Bend
![Page 3: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/3.jpg)
Segment ROM
Mean Range
C3-4 6.5 3-10
C4-5 6.8 2-12
C5-6 6.9 0-12
C6-7 2.1 2-10
C7-T1 2.1 -2-7
Mean Values and ranges of axial rotation of cervical motion segments CT scanning Penning , Wilmink 87
![Page 4: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/4.jpg)
Normal ROM in axial rotation and coupled motion – biplanar radiography Mimura’89
Segment Axial rotation SD
Flex/ext
SD
Lateral flexion SD
C3-4 6 ( 5) -3( 5) 6( 7)
C4-5 4 (6) -2( 4) 6( 7)
C5-6 5( 4) 2(3) 4( 8)
C6-7 6(3) 3( 3) 3( 7)
![Page 5: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/5.jpg)
Objective Assessment
• Active ROM – upper vs mid cervical
• Repeated Movement
• Habitual and Combined Movements
![Page 6: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/6.jpg)
Joint Play Movements
• Central PA C3-7 – what does it tell you?
• Central Angle Caudally – what movement ?
• Unilateral PA 3-7 – incline cranially and caudally
![Page 7: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/7.jpg)
Passive Segmental Tests
PPIVMS• Used to determine the amount and quality of
passive physiological movement available at a motion segment
• Flexion, Extension, Side bending/rotation
( unilateral flexion and extension)
![Page 8: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/8.jpg)
Segmental Compliance Test
• Assess the connective tissue compliance of the arthrokinematic motions ( rocks and slides) associated with various physiological movements of the segment
• Clinician is attempting to appreciate the quality of the “ give” present in the CT when the segment is at R2
![Page 9: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/9.jpg)
NDI Measurement Properties
Coefficients• Internal consistency =.87
• Test-retest reliability (several days) .89 to .94
• Correlates with SF-36 Physical Component Score r=.53; Pain intensity r=.56; Patient Specific Functional Scale (PSFS) score r=.80
![Page 10: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/10.jpg)
NDI Measurement Properties
Scale Points• Variation in a single score value ±3 (90% CI)
• Minimal detectable change 5 points
• Minimal clinically important difference 5 points
![Page 11: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/11.jpg)
Neck Disability Index (NDI)(Vernon & Mior 1991)
10 item self-report functional status measure
Items scored on a 6 point scale (0 to 5)
Total score value 0 (high function) to 50 (low)
About 3 to 5 minutes for patient to complete
20 seconds to score without computational aids
![Page 12: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/12.jpg)
Objective Assessment
Segmental Integrity Tests
• Evaluate the ability of motion segment’s passive elements to resist uni-planar forces
• Test passive subsystem ( ligaments of knee)
![Page 13: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/13.jpg)
NZ / EZ Relationship
Boundary between R 1 and R2
NZ
EZ
![Page 14: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/14.jpg)
Stability Tests
![Page 15: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/15.jpg)
Treatment
• Mobilization – traction, IMP
• Exercise
• Education
![Page 16: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/16.jpg)
Tractionneutral and restriction
![Page 17: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/17.jpg)
Strategies for Stabilization
![Page 18: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/18.jpg)
Instability• Loss of the ability of the spine to maintain
relationships between vertebrae in such away to prevent:
» spinal cord or nerve root damage» incapacitating deformity» severe pain (Panjabi, 1990)
• Often defined as an increase in a particularmeasure (eg: ADI>3mm)
![Page 19: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/19.jpg)
Neutral Zone (Panjabi, 1989)
• That part of the ROM
which requires very little force to produce minimal resistance to the movement
![Page 20: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/20.jpg)
Stability
Control
system
Passive
system
Active system
Panjabi 1992
Psycho Social
![Page 21: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/21.jpg)
Efficient Movement = Optimal Stabilization
Requirements
Intact bones, joints, ligaments
Efficient and coordinated muscle action
Appropriate neural responses
![Page 22: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/22.jpg)
Learning to control the Deep and Postural muscles
Edgepac Queensland Aust ‘99
![Page 23: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/23.jpg)
Scapular muscle control
Poor postural position of the scapula
Balanced force couple around the scapula
![Page 24: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/24.jpg)
Muscle impairments of the axioscapular muscles
• Loss of holding capacity in any of the upper, mid, + lower portions of trapezius
• Loss of holding capacity of serratus anterior
![Page 25: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/25.jpg)
Imbalance of large posterior muscles and deep anterior muscles
![Page 26: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/26.jpg)
Muscles impairments in cervical pain syndromes
• Poor activation and holding capacity of deep neck flexors
• Overactivity of the superficial muscles that span cervical spine
![Page 27: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/27.jpg)
Deep
stabilizing
muscles of the
neck
SCMSCM
![Page 28: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/28.jpg)
Muscle impairments of the axioscapular muscles
• Overactivity of levator scapulae, pectoralis major or minor , scalenes
• Overactivity of upper traps in response to sensitive neural tissues
![Page 29: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/29.jpg)
Stabilizing Muscles of the Scapula
![Page 30: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/30.jpg)
Cervical Pain syndromes
• Superficial muscles attempt to stabilize the neck but anatomically not designed for segmental support
• Decreased capacity for co contraction of deep neck flexors and extensors to increase segmental stiffness
![Page 31: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/31.jpg)
Cervical Pain Syndromes
• Poor pattern of superficial and deep neck flexor synergy in sagittal plane movements
• Often poor postural position of neck and girdles
• Tightness suboccipital extensors
![Page 32: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/32.jpg)
Suboccipitals become tight
Stretching often contraindicated
Neural tissue must be respected
![Page 33: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/33.jpg)
![Page 34: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/34.jpg)
Head and neck in mid range neutral position, face parallel to the ceiling. May add towels
Avoid craniovertebral extension
![Page 35: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/35.jpg)
Stabilizer is placed behind the neck suboccipitally
Stabilizer is inflated to fill the suboccipital space (approx 20mmHG)
Longus colli activation
![Page 36: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/36.jpg)
Motor Control is NOT a birthright
![Page 37: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/37.jpg)
Treatment Advice
• No phasic ,erratic movement
• Emphasis on precision and control
• Discourage activity of superficial neck
flexors
![Page 38: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/38.jpg)
Treatment Advice
• Train joint position sense
• Perform exercises at least twice a day
• Exercise must be pain free
• Deep muscle function does not return automatically
![Page 39: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/39.jpg)
Components of an Effective Exercise Program
• Cardiovascular Endurance
• Muscle strength, endurance and co-ordination
• Flexibility
• Body Composition
![Page 40: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/40.jpg)
Motor Learning
• Formal motor skill training
• Perception of the specific contraction
• Understand the task, what it feels like, instructions, visual cues, different postures/positions, various facilitation and feedback
• Enhance the patients perception of the deep muscle motor skill
• Focus on one particular muscle at a time
![Page 41: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/41.jpg)
Motor Learning
Associative Stage Automatic Stage • “Got the idea” practice thousands of repetitions
• Care with fatigue
![Page 42: Lesson 7 Mid Cervical Spine Assessment and Treatment](https://reader035.vdocuments.us/reader035/viewer/2022062322/56649f005503460f94c166bf/html5/thumbnails/42.jpg)
Motor LearningExercise Progression • Commence co-activation of TA/multifidus
• Combine with short neck flexors
• Increase holding time
• Increase number of contractions
• Reduce feedback
• Add diaphragmatic breathing (abdominal wall movement while maintaining a deep muscle contraction) Intermediate steps to encourage air flow: counting, talking