C-Spine Therex

Question 1

Therex for: Pain w/mobility deficit, Pain w/ headache, and Pain w/movement coordination impairments

Answer 1

-strengthening, coordination, stretching, endurance

Question 2

Therex for Pain w/ radiating pain

Answer 2

• nerve mobilization

- traction

Question 3

Therex for hypomobile/hypermobile

Answer 3

• hypomobile: ROM, flexibility, nerve glide

- hypermobile: stabilization

Question 4

Therapeutic exercise considerations (5)

Answer 4

• postural ed (correct FHP)
• ROM exercises in restricted planes (consider gravity)
• exercise localized segment according to mobility test
• stretch shortened muscles
• strengthen lengthened muscles

Question 5

Therex for Impaired Muscle Performance

Answer 5

• DNF ted to weaken, teach patient to perform present nod to active deep stabilizing muscles (cervical core) prior to any motion of the head
• chin tuck against wall, on plinth
• discourage use of SCM
• progress to active motion (no hand assist) to towel roll to resisted motion (sandbag or BP cuff)

Question 6

Cervical Extensors therex

Answer 6

• NME can be effective in initial stages of training
• teach pt to apply resistance to contraction of specific muscle determined to be weak
• return to neutral in sitting– start in FHP, extend from Tspine –> Cspine
• self-resist right superior oblique by resisting OA lat flexion/extension to same side (can do on foam roll/towel)

Question 7

Strengthening functional movement patterns

Answer 7

-once pt able to perform movements without hypertranslation, graduate to multiplanar motions

Question 8

Side Flexor and Rotator Activation

Answer 8

• lie on back on foam wedge so head is resting off to one side of wedge slope
• have to use muscles on side closest to peak to hold neck in place
• perform slight nod to activate DNF, hold nod throughout
• slowly lower head down slope to end of range, pause, and bring back up slope til end of range. Relax from nod and repeat. Do both sides

Question 9

Causes of hypomobility (6)

Answer 9

• segmentral articular mobility restriction
• capsular thickening and contracture
• degenerative bony changes
• segmental muscle spasm
• myofascial extensibility
• adverse neruromeningeal tension

Question 10

Therex – ROM

Answer 10

• Maximal downslope: use quadrant position, with and without overpressure from ipsalateral hand
• Maximal upslope: Flex, contralateral SB/R, with and without overpressure from contralateral hand
• beware tendency to overtstretch hypermobile segments above and below
• may need to improvise to focus exercise at desired level – position to lock above/below, add hand positions to stabilize

Question 11

Flexibility – Levator and Splenius cervicis

Answer 11

• for R side, grasp chair with R hand, flex and L R/SB neck
• lean trunk forward and to left using L hand to guide into more flex/SB/rot until stretch felt
• can increase stretch by contracting lower R trap

Question 12

Flexibility – Upper Trap and SCM

Answer 12

• for R side, grasp chair with R hand, place head in flexion and L SB/R
• lean trunk forward and to L, use L hand to guide into more flex/SB/R
• to increase stretch nod chin

Question 13

Flexibility – Middle and Anterior Scalenes

Answer 13

• For R side, place L hand over medial clavicle and first rib
• retract chin slightly and move neck into extension, L SB, R rot

Question 14

Flexibility – suboccipitals

Answer 14

• grab chin and occiput, flex upper Cspine and apply gentle distraction toward ceiling
• focus to one side by rotating 30 degrees to same side
• can also do craniovertebral flexion head-nod against wall

Question 15

Hypermobility treatment (4)

Answer 15

• postural correction
• consider taping scap to reduce pull on segment
• manually stabilize hypermobile segment or perform co-contractions at involved levels
• gradually challenge cervical musculature while preventing excessive motion at involved segment

Question 16

Stabilization – alternating isometrics

Answer 16

• do all directions, random directions, in/out of neutral, eyes/open closed
• resistance at head (craniovertebral) vs intersegmental

Question 17

Stage 1 Stabilization (4)

Answer 17

• isolated control CNF, extensors, lat flexors, rotators
• AROM–>RROM of chin tuck in variety of positions
• AROM–>RROM of intersegmental extensors in variety of positions
• supine roll up/down on foam wedge
• begin co-activation with quadriped chin tuck w lower Cspine extension, gradually increase duration (more for endurance, will lose chin tuck w activation of extensors)

Question 18

Stage 2 Stabilization

Answer 18

• coactivation to control Cspine position during arm movements
• supine, quadriped, upright, unstable surface
• bilat arm movements, <90 shoulder flexion less challenging
• progress to handheld weights

Question 19

Stage 3 Stabilization

Answer 19

• increase intensity, duration
• intersegmental control during neck movements and functional tasks
• straight plane–>diagonal, single plane –> multiplane, whole body movement (without neck movement –> with neck movement)

Question 20

Nerve Glides

Answer 20

• flosses nerve, freeing up tethering points
• obtain position then move: wrist to pull from distal, neck lateral flexion to pull from proximal, or at other jts to focus stretch at specific place`

Question 21

FHP – muscle imalance

Answer 21

lengthen short, strengthen weak

Question 22

FHP – neuromeningeal extensibility

Answer 22

-side flexion, scapular elevation

Question 23

FHP – articular hypomobility

Answer 23

-manual therapy and mobility exercises

Question 24

FHP – proprioception

Answer 24

-postural correction