Cervical Spine Hypomobility

Question 1

What are chronic neck pain factors

Answer 1

• age 40 and up
• coexisting LBP
• Bicycling (drop bars) as a regular activity
• a worrisome attitude
• poor quality of life
• less vitatlity
• loss of strength in the hands

Question 2

Mid and lower C/S and Upper Thoracic spine arhtrokinematics

Answer 2

• facets oriented at 45ºangle
• FB: facets slide up and forward
• BB: facets slide down and backward
• SB & rotation: coupled motion and always occur together - ipsilateral facets glide down and back while contralateral facets glide up and forward

Question 3

OA joint

Answer 3

• motions here: FB, BB, SB
• Convex occiptial condyles on concave atlas facets
• occiptial condyles - roll and glide opposite
• atlas always glides in direction the occiput moves

Question 4

Arthrokinematics of OA

Answer 4

• FB: occiput rolls anterior glide posterior; atlas pressed anterior
• BB: occiput rolls posterior, glides anterior, atlas pressed posterior
• SB: occiput rolls to SB side and glides in; atlas pressed to SB side

Question 5

AA joint

Answer 5

• atlas on Axis convex on convex
• AA motion is only rotation
• normal = 45º

Question 6

Arthrokinematics of

AA joint

Answer 6

• Axis always rotates in same direction occiput is moving
• during right Rotation: L alar ligament tightens and takes axis into Right rotation
• during SC RSB: L alar ligament tightens and takes axis into RR (alar ligament test)

Question 7

OA joint during rotation

Answer 7

• OA joint attempts to keep eyes level
• example: during head right rotation your eyes stay level
• so at OA subcranial Sb opposite SBL occurs to keep eyes level

Question 8

Functional side bending

Answer 8

• SB and rotation coupled - occur together ispilaterally go down and back on side rotating to
• ex: functional SB to right = couple motions down and back ipsilaterally (right)
• head/eyes drift a bit downward to right

Question 9

CS non-functional SB

Answer 9

• non-functional RSB is strictly in frontal plane
• head does not drift and stay looking forward
• this is due to AA rotation L opposite occurs allowing head/eyes to remain facing forward
• for every degree of functional SB in MC/LC have same degree of AA rotation opposite to keep head/eyes facing forward

Question 10

C/S protraction mechanics

Answer 10

• extension of upper cervical
• flexion of mid and lower cervical

Question 11

C/S retraction mechanics

Answer 11

• flexes upper cervical
• extends mid and lower cervical

Question 12

hypomobility causes

Answer 12

• some people are inherently tight
• post injury/surgery from protection/disuse

Question 13

Hypomobility can lead to

Answer 13

• adapative shortening - adhesions ‘loss of segmental motion
• degeneration of synovium
• nutrition of the disc reduced
• disuse atrophy of musculature
• liability to further injury
• developement of DDD, DJD (start DD=> DJD)

Question 14

Hypomobility

Presentation

Answer 14

• Limited CS A&PROM
• stiffness, tightness
• increased resistance at end range
• hard to turn/requiring more effort as approach end range
• pain at end range
• CS joint play & PPIVM restricted
• habitual FWD head posture leads to Hypomobility UC

Question 15

Hypomobility

Forward head, rounded shoulder posutre consequences

Answer 15

• tight suboccipital muscles cervicogenic headache
• flexion MC/LC stresses to posterior annuls disc = HNP
• DDD => cervical stenosis (spondylosis)
• Stiff U/T spine with dowagers hump kyphosis
• jaw drops/retracts = TMJ pain
• tight pecs; scalenes => elevation of 1st rib => Thoracic outlet syndrome
• shoulder impingement syndrome

Question 16

Hypomobility

CS exam: UQS

Answer 16

• UQS
• additional movements can be added: FB nod, BB nod, SB nod
• cervical repetitive movements; OP if not too acute/painful - protraction & retractions, FB/flexion, extnesion, SB rotation

Question 17

What to assess with motion for the C/S

Answer 17

• Quantity: normal vs limited C/S ROM or hypermobile
• quality: normal smooth segment recruitment without aberrant movemtns, compenstations

Question 18

Hypomobility

Facet capsular pattern M/S, LC and UT

Answer 18

with left facet restriction

• FB see deviation toward tight side (left)
• SBR: is restricted - left facet cant upglide
• Right rotation: restricted as left facet cannot upglide

SBL = relatively free
RL relatively free

Question 19

C/S joint play

Answer 19

• if motion limitied perform mobility testing
• joint play and PPVIM: to asses segmental motion
• normal = a firm stop with an element of creep
• hypomobilty = hard end feel before the expected range

Question 20

Hypomobility exam

palpation assessment

Answer 20

• C/S facets joints and musculature
• observe and palpate for position and alignment
• palpate for tissue condition - tender facets, swelling/pain, increased muscle tone, guarding, spasm, trigger points, taut bands in musculature
• muscle length/tightness: subocciptials, Upper traps/leator, SCM, Scalenes

Question 21

Hypomobility

treatment

Answer 21

• STM
• inhibitive distraction
• CS joint mobs
• Upper thoracic joint mobs
• TS thrust for mechanical neck pain
• CS roms, MM stretching
• neuromuscular control
• education.- posture

Question 22

Clinical prediction rule for neck pain and success with T/S thrust

Answer 22

1. no Symptoms distal to shoulder
2. symptoms less than 30 days
3. looking up down not aggravate symptoms
4. score of < 12 on the FABQPA
5. decreased Upper T/S kyphosis
6. cervical extension < 30º

4/6 = 93% sucess; 3/6 = 86% sucess