Cervical Lecture 3 Flashcards
What is the main goal of the acute phase?
Increase pain free ROM
How soon should we encourage return to normal ADLs after an acute injury in c spine
2-4 days
is absolute rest recommended
no
When should we initiate cervical stabilization program for cervical injury patients
At earliest opportunity (in acute phase if possible)
What is a great choice for initial cervical spine tx
walking
Should we use manual techniques on cervical patients in the acute phase
Yes, in the T-spine
What does research say about cervical collars
May delay recovery
What are the goals for the subacute phase for c-spine
postural retraining
ergonomic changes
overall strength and CV fitness
achieve significant decrease in symptoms
What stage of healing is most important for preventing longterm disability
sub-acute
T or F: Patients never change what bucket they’re in once classified
F, patients will switch between buckets and correctly categorizing and recategorizing the is vital
Pt with central or unilateral neck pain
May refer to UE or shoulder girdle
Limitation in neck ROM that CONSISTENTLY reproduces symptoms
Neck pain with mobility deficits
Neck pain is reproduced at end range of AROM and PROM,
restricted mobility throughout Cspine and Tspine
May have deficits in cervico-scapulo-thoracic strength
Neck pain with mobility deficits
What should PTs do for Neck pain w/ Mobility deficit patients in the Acute Phase
Thoracic Manip + neck ROM + shoulder strengthening- B level evidence
Cervical mob/manip - C level evidence
What should PTs do for mobility deficit patients in the subacute phase?
B level evidence- NEck and shoulder girdle ENDURANCE training
C level evidence- Cervical and thoracic manip/mob
What does PTs do for mobility deficit patients in the chronic phase?
B level evidence- Cervical/thoracic mob/manip
mixed exercises
may do modalities like dry needling and laser/ traction
C level evidence- endurance exercise
Pt with MOI linked to trauma OR general hypermobility
Referred pain to shoulder girdle and UE
Dizziness/nausea
Headache/concentration problems
Hypersensitivity
heightened affective distress
Neck pain w/ movement coordination deficit
Pt w/
Positive cranial cervical flexion text
Positive Neck Flexor Muscle Endurance test
Positive pressure algometry (motor control test w/ BP cuff)
Point tenderness
Strength and endurance deficits
Neck pain with mid-motion that worsens w/ end range positions
Neck pain w/ movement coordination impairment
What is the prognosis for a pt with movement coordination impairment
Recovery expected in 2-3 months
WITH manual therapy + exercise + Pt education
What education needs to be given to pts with a movement coordination deficit
Stay active
Early pain science education
Acute recommendations for Movement coordination deficits
B level evidence:
Return to normal activities as soon as possible
minimize use of collar
perform ROM and posture exercises
reassure pt of prognosis
Subacute recommendations for Movement coordination impairments
B level evidence: Multi-modal intervention
C level evidence: if PT perceives pt as low risk of chronicity, they can do a single session with just education and HEP
Chronic recommendations for movement coordination impairments
C level evidence: Patient education and advice focusing on assurance, encouragement, prognosis, and pain management
Mobilization + submax exercise
TENS
Pt w/ noncontinuous unilateral neck pain with headache
Headache precipitated or aggravated by neck movements
Neck pain w/ headaches
(note that these patients DO NOT have a constant headache)
Neck pain w/ headache patients will typically have what positive test
Cervical flexion and rotation test
