Cervical Spinal Stability

Question 1

Spinal stability involves

Answer 1

intricate interrelationship btw muscles and the joints upon which they act w/o strain or injury to involved tissues

Question 2

Define clinical instability

Answer 2

A significant decrease in the capacity of the stabilizing system of the spine to maintain the intervertebral neutral zones w/in physio limits resulting in pain and disability

Question 3

Panjabi model - Active

Answer 3

muscles

Question 4

Panjabi model - passive

Answer 4

ligaments

bone

Question 5

Panjabi model - neural

Answer 5

ligaments can be neural from proprioception component

Question 6

Neutral zone =

Answer 6

a zone of high flexibility around the neutral position of the spinal segments
Segmental physiological motion occurs around this area

Question 7

Neutral zone - trauma can

Answer 7

increase the size of it

Question 8

Neutral zone - immobility can

Answer 8

decrease the size of it

Question 9

Control of motion in the neutral zone is related to

Answer 9

spinal stability
Nothing is stopping you in the neutral zone - muscle just have to help you actively control the motion in the neutral zone

Question 10

Neutral zone is located

Answer 10

midway btw flex and ext

Question 11

Global muscles are defined as the muscles

Answer 11

that act on the trunk and spine without being directly attached to it

Question 12

Global muscles - description

Answer 12

Large torque producing muscles
Remote from the spine - no direct segmental influence
Provide general trunk stability
Minimize effects of external loads

Question 13

Global muscles include

Answer 13

Upper Trap 
SCM
Serratus Ant
Lev Scap
Pectoralis

Question 14

Local muscle system

Answer 14

Deep anatomically linked to individual vertebrae
Privide segmental stability
Control the neutral zone

Question 15

Local muscle system - postural function

Answer 15

provide stiffness effect on spine for stability with limb movement
Dec in function –> intersegmental microtrauma

Question 16

Local Muscles - list them

Answer 16

Middle and lower trap
Deep neck flexors - Rectus cap ant and lat
- Longus colli
- Longus capitis

Question 17

Stability dysfunction

Answer 17

The failure of the movement system under low load testing

Trouble firing TA in neutral spine

Question 18

Strength dysfunction

Answer 18

the failure of the movement system under high load testing

cant do supine to sit

Question 19

Muscle Imbalance - tight or over activity

Answer 19

These muscles arent necessarily always tight - just need to relax them - so stretching wont always help - need to relax

Question 20

Imbalance - mm tight or over activity

Answer 20

Subocipital extensors
Lev Scap
Pecs
SCM
Upper trap
Scalenes

Question 21

Imbalance - inhibition or weakness

Answer 21

Sometimes it is true muscle weakness but sometimes the muscle is inhibited

Question 22

Imbalance - mm inhibition or weakness

Answer 22

Deep cervical flexors
Serratus ant
Middle trap
Lower trap

Question 23

Limited deep neck flexor muscle control in subjects with

Answer 23

chronic neck pain, cervicogenic headache, WAD

Question 24

Impaired SA, MT, LT strength in people with

Answer 24

chronic neck pain

Question 25

Subjective info

Answer 25

``` Trauma WAD Heavy head Inconsistent symptoms Clicking/clunking Chronic neck pain Cervicogenic headache RA Downs syndrome Klippel Feil ```

Question 26

Objective exam

Answer 26

``` Deep neck flexor muscle test Cervical extensor coordination/endurance Scapular muscle strength Muscle length Proprioceptive testing ```

Question 27

Cervical flexion and endurance test

Answer 27

Cover in lab?

Question 28

Impairments

Answer 28

Strength, endurance and coordination deficits of DNF muscles, SA, MT, LT Impaired flexibility of global mm Mid range pain with neck ROM that worsense at end range Neck and neck related UE pain Cervical instability may be present

Question 29

Deep neck flexors

Answer 29

Limited strength/delayed activation - WAD - Cervicogenic headaches - Chronic neck pain

Question 30

Deep neck flexors - limited strength/delayed activation - what are substitution strategies

Answer 30

SCM | Scalene

Question 31

Proprioception

Answer 31

Joint position sense Balance Eye movement control Postural control impairements with vestibular dysfunction, head injury, WAD, impaired afferent output

Question 32

Assessment and management of proprioception in cervical disroders is analogous to

Answer 32

lower limb prop training following ankle or knee injury

Question 33

Intervention

Answer 33

Coordination, strengthening, endurance exercises Proprioceptive training Stretching Patient education

Question 34

Principles of stability rehab - progression

Answer 34

Control of neutral Retrain Dynamic Control Rehab global stabilizers through range Lengthen or inhibit overactive muscles

Question 35

DNF - Pain and DNF exercises in patients with neck pain

Answer 35

Pain pressure threshold increases immediately after DNF exercises

Question 36

DNF exercises can do what for those with neck pain

Answer 36

Dec pain, inc strength, inc ROM, improve function in thsoe with neck pain, WAD, headache

Question 37

Progression for ex

Answer 37

Isolate LMS Train LMS Train LMS functionally

Question 38

Progression - Isolate LMS

Answer 38

Co activation Controlled breathing Neutral/vary positon

Question 39

Progression - train LMS control

Answer 39

postural | co-activation with limb load

Question 40

Progression - train LMS functionally

Answer 40

Balance | Resistance, weighted balls, swiss ball

Question 41

Proprioceptive exercises -

Answer 41

Head repositioning Occulomotor Eye/head coordination

Question 42

Proprioceptive exercises - Head repositioning

Answer 42

Eyes open and then eyes closed | Vary position

Question 43

Proprioceptive exercises - Occulomotor exercises

Answer 43

Eye movement wth head stationary | Progress to movement of head with visual fixation

Question 44

Proprioceptive exercises - Eye/head coordination exercises

Answer 44

Rotate head/eyes same direction Progress to find target with eyes first, then head Progress to head and eyes moving in opp directions

Question 45

Proprioceptive exercises - function

Answer 45

Inc joint position sense Dec neck pain Improve functional outcomes