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MSK > Cspine Intervention > Flashcards

Cspine Intervention Flashcards

1
Q

What should you think about when intervention planning?

A
  1. Think stability vs mobility
  2. Educate (prognosis, management plan)
  3. Reduce Pain (manual therapy, exercise, improve stability)
  4. Address impairments
  5. Improve functional activity performance and participation (patient’s desired goals)
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2
Q

In phase 1 of improving stability/mobility what should you do?

A
  1. Activation/ Coordination exercises
  2. Mobility Exercises (AROM, stretching at end ranges)
  3. Inhibitory Exercises (Posture stabilizers)
  4. Soft Tissue Mobilization (guarding musculature)
  5. Joint mobs (sustained hold vs. oscillations), manipulations
    - Guarding and pain – oscillations
    - Stretch a tight capsule – sustained hold
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3
Q

In phase 2 of improving stability/mobility what should you do?

A

Progression to strength/ endurance training of stabilizers

- Retrain/ strengthen motion within newly improved range

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4
Q

In phase 3 of improving stability/mobility what should you do?

A

Increase challenge of exercises (progress toward activity limitations) -> functional goals

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5
Q

If there is muscle guarding, what type of exercise and stretch can you do to decrease?

A

i. Low intensity high rep exercise to improve motion

ii. Target antagonist with AROM to improve ROM

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6
Q

What cervical muscle is important to activate to increase ROM?

A

Longus colli

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7
Q

What muscle doesn’t activate very well in functional activity for patients with chronic neck pain?

A

Longus capitus

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8
Q

What are 2 deep neck flexor exercises?

A
  1. Craniocervical flexion exercise (CCFEx)

2. Endurance Training (Chin-tuck/ Head lift)

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9
Q

How can you make Craniocervical flexion exercise (CCFEx) more difficult/functional?

A
  1. alter positions (quadruped vs. sitting), add resistance,

2. Avoid SCM & anterior scalene activation

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10
Q

How can you make neck endurance training more difficult?

A

Increase hold times & resistance

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11
Q

Describe gentle stretching for nerve entrapments

A

stretching CT surrounding the nerve and get better movement of nerve

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12
Q

Difference between gliders and tensioner nerve entrapment mobilizations.

A

Gliders” (“Sliders”) – take up slack on one end and give slack on the other
“Tensioners” take up slack on both sides

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13
Q

What are the proposed 3 mechanisms for nerve entrapment mobilizations?

A
  1. decrease adhesions and allow improved movement of peripheral nerves
  2. increase neural vascularity, allowing increased oxygenation of the nerve and a resultant decrease in ischemic pain
  3. Dispersion of noxious fluids
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14
Q

What are 5 adverse responses to nerve mobilizations?

A
  1. flare up
  2. pain increases with intensity
  3. pain begins to peripheralize
  4. tingling increases
  5. symptoms do not go away afterwards
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15
Q

When would you use oscillation Mobilizations at mid-range or a manipulation to get neuro inhibitory effect?

A

For guarding/pain

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16
Q

When would you use static stretch mobilizations with joint held in full range of motion with over pressure?

A
  1. Address CT shortening
  2. Take up slack and put extra force to get plastic deformation (capsule tissue to stretch)
  3. 30 second holds 3-5x
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17
Q

T/F When using manual therapy for an injury, address the limiting impairment first. (ex)

A

True, Hypomobility of zygapophyseal joints but maybe muscle guarding – oscillation or soft tissue mob to address guarding first to increase mobility of joints

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18
Q

What type of movement at what range for grade I oscillatory mobilizations?

A

Small amplitude movement performed at the beginning of the range.

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19
Q

What type of movement at what range for grade 2 oscillatory mobilizations?

A

Large-amplitude movement performed within the range but not reaching the limit of the range. It can occupy any part of the range that is free of any stiffness or muscle spasm.

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20
Q

What type of movement at what range for grade 3 oscillatory mobilizations?

A

Large amplitude movement performed up to the limit of the range.

21
Q

What type of movement at what range for grade 4 oscillatory mobilizations?

A

Small amplitude movement performed at the limit of the range

22
Q

What type of movement at what range for grade 5 manipulation?

A

High velocity thrust performed at the limit of the range

1. Neuro inhibitory effect

23
Q

Proposed terminology when documenting mobilizations:

A
  1. Rate of force of application (oscillation/thrust manipulation/sustained hold)
  2. Location in range of available motion (beginning/midrange/end range)
  3. Direction of force (mobilized segment relative to stabilized segment)
  4. Target of force (where is our hand contacting)
  5. Relative structural movement (what are we trying to move on what)
  6. Patient position (joint position – open pack vs. near end range of flexion)
24
Q

What are the biomechanical proposed mechanisms for joint mobs?

A
  1. Motion improvement

2. Positional improvement – more anatomical efficient position

25
Q

What are the neurophysiological proposed mechanisms for joint mobs?

A
  1. Spinal Cord
  2. Central Mediated
  3. Peripheral Inflammatory
26
Q

What are the other proposed mechanisms for joint mobs?

A
  1. Placebo

2. Pt Expectation

27
Q

What are the 6 absolute contraindications for manual therapy (Mobilizations, Stretching, and Manually Assisted Movements)?

A
  1. Malignancy of targeted region – weakened bone tissue and can cause fractures
  2. Cauda Equina Syndrome
  3. Red flags including indicators of neoplasm, fracture, or systemic disturbance
  4. Rheumatoid collagen necrosis
  5. Upper c-spine instability
  6. Concern for Cervical Arterial Dysfunction (CAD)
28
Q

What are the relative contraindications of manual therapy?

A
  1. Neurological deterioration
  2. Osteoporosis
  3. Radiculopathy
  4. Immediately postpartum (noncervical)
  5. Blood clotting disorder
  6. Active, acute inflammatory conditions
  7. Long term oral corticosteroid use
29
Q

T/F Thrust manual therapy demonstrated better short term results than mobs

A

True

30
Q

Common symptoms of neck pain with mobility deficits:

A
  1. Central or unilateral neck pain

2. Symptomatic ROM limitations

31
Q

Common physical exam findings of neck pain with mobility deficits:

A
  1. ROM impairments (symptomatic at end-range)
  2. Cervical & thoracic joint hypomobility
  3. Symptomatic provocation testing for involved structures
  4. Motor control impairments (subacute & chronic)
32
Q

For acute neck pain with mobility deficits, clinicians should provide what?

A
  1. Thoracic manipulation
  2. Program of neck ROM exercises
  3. Scapulothoracic and UE strengthening to enhance program adherence
  4. Cervical manipulation and or mobilizations
33
Q

For subacute neck pain with mobility deficits, clinicians should provide what?

A
  1. Neck and shoulder girdle endurance exercises

2. Thoracic manipulation and cervical manipulation and/or mobilizations

34
Q

For chronic neck pain with mobility deficits, clinicians should provide what?

A
  1. Thoracic manipulation and cervical manipulation/mobilization
  2. Exercises for cervical/scapulothoracic regions: neuromuscular (coordination, proprioception. and postural training), stretching, strengthening, endurance training, aerobic)
  3. Dry needling, laser, or intermittent mechanical/manual traction
35
Q

Common symptoms of neck pain with movement coordination impairments (WAD):

A
  1. Hx related Trauma/ Whiplash
  2. Associated shoulder girdle/ UE pain referral
  3. Concussive SxS
  4. Dizziness/ nausea; HA; confusion; concentration impairments; hypersensitivity to stimuli; distress
36
Q

Common physical exam findings of neck pain with movement coordination impairments (WAD):

A
  1. Strength/ endurance/ coordination/ sensory impairments
  2. Neck pain worsens with mid- & end-range ROM
  3. Tenderness to palpation
  4. Painful with provocation testing
37
Q

For acute neck pain with movement coordination impairments (WAD), clinicians should provide what?

A
  1. Education (return to normal activites as soon as normal, minimize use of cervical collar, postural/mobility exercises to decrease pain and increase ROM)
  2. Reassurance to pt that recovery expected 2-3 months
  3. Manual mobilizations tech plus exercises
  4. TENS
38
Q

T/F cervical collar not used for patients with neck pain with movement coordination impairments (WAD) if cervical instability is ruled out.

A

True

39
Q

For chronic neck pain with movement coordination impairments (WAD), clinicians should provide what?

A
  1. Patient education
  2. Mobilization combined with submaximal exercises of strengthening, endurance, flexibility, and coordination
  3. TENS
40
Q

Common symptoms of NECK PAIN WITH HEADACHE (CERVICOGENIC):

A
  1. Non-continuous neck pain with referred headache

2. Pain provoked with neck movement/ sustained positions

41
Q

Common physical exam findings of NECK PAIN WITH HEADACHE (CERVICOGENIC):

A
    • cervical flexion rotation test
  2. HA reproduction with provocation testing of upper c-spine segments
  3. Impaired cervical spine ROM & joint mobility
  4. C-Spine strength/ endurance/ coordination impairments
42
Q

For acute NECK PAIN WITH HEADACHE (CERVICOGENIC), clinicians should provide what?

A
  1. Supervised instruction in active mobility exercise

2. C1-C2 natural apophyseal glide

43
Q

For subacute NECK PAIN WITH HEADACHE (CERVICOGENIC), clinicians should provide what?

A
  1. Cervical manipulation and mobs

2. C1-C2 natural apophyseal glide

44
Q

For chronic NECK PAIN WITH HEADACHE (CERVICOGENIC), clinicians should provide what?

A
  1. Manipulation/mobs combined with shoulder girdle and neck stretching, strengthening, and endurance exercises
45
Q

Common symptoms of NECK PAIN WITH RADIATING PAIN (RADICULAR)

A
  1. Neck pain with band-like pain in UE

2. UE dermatomal paresthesia/ anesthesia & myotomal weakness

46
Q

Common physical exam findings of NECK PAIN WITH RADIATING PAIN (RADICULAR)

A
  1. Concordant UE symptoms reproduced/ alleviated with radiculopathy testing procedures
  2. LMN (sensory/motor) impairments with neurologic testing
47
Q

T/F LMN with radiculopathy but not necessarily with radicular pain

A

True

48
Q

For acute NECK PAIN WITH RADIATING PAIN (RADICULAR), clinicians should provide what?

A
  1. Mobilizing and stabilizing exercises, laser, and short term cervical collar use
49
Q

For chronic NECK PAIN WITH RADIATING PAIN (RADICULAR), clinicians should provide what?

A
  1. Mechanical intermittent cervical traction combined with stretching, stretching, mobs/manipulation
  2. Education - participate in occupational and exercise activities

MSK (18 decks)

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