Cervical and Thoracic Treatment

Question 1

Treatment goals

Answer 1

decrease pain
centralize pain
optimal healing enviornment
address ROM
increase strength and stability
inhibit overactive musculature
activate inhibited musculature
increase overall function

Question 2

Developing a treatment plan

Answer 2

General progression of treatment

1. increase treatment temperature/extensibility
2. soft tissue work (inhibit overactive musculature, decrease tone)
3. mobilization and manipulation (address alignment and joint mechanics)
4. restoration of motion
5. stabilization and strengthening
6. postural control

Question 3

pain control

Answer 3

cryotherapy
thermotherapy
electrical stimulation
pharmaceuticals/injections
manual therapy

Question 4

NSAIDS

Answer 4

ibuprofen, naproxen- most common OTC but need to be used at appropriate doses

Diclofenac, meloxicam

Acetaminophen- indirect COX inhibitor, max dose 4g/day

Question 5

Oral steroids

Answer 5

shown to be effective for post-operative pain management

methylprednisolone dose pack

Question 6

Muscle reaxants

Answer 6

flexeril (cyclobenzaprine), skelaxin (metaxalone), robaxin ( methocarbamol)

Question 7

Facet Injections

Answer 7

directly into joint space

injection of anesthetic and or steroid

Question 8

Medial branch block

Answer 8

diagnostic for facet mediated pain

anesthetic injected into medial branch nerve

Question 9

Cervical epidural steroid injection

Answer 9

transforaminal or interlaminar injection
can be diagnostic to determine which nerve root is the pain generator
decrease inflammatory mediators irritate the nerve root
goal to reduce pain enough so that pt can rehab

Question 10

Electrical stimulation

Answer 10

decrease pain

Question 11

Ultrasound

Answer 11

decrease pain, promote healing
increases blood flow, collagen formation, protein synthesis
Thermal effects; increase pain threshold, reduce muscle spasm, increase collagen elongation, increase skeletal muscle contractility

Question 12

Laser therapy

Answer 12

decrease pain, promote healing
high intensity laser: increase blood flow, promote regeneration, increase release of beta-endorphins
studies show LLLT decreases pain
LLLT may increase functional outcome measures and improve ROM

Question 13

immobilization

Answer 13

soft cervical collar: symptom relief for whiplash, facet sprain, strain
76% reported decreased pain
no support for long term benefit
potential for adverse affects (atrophy) with prolonged use over 10 days