Cervical Spine

Question 1

Causes of neck pain

Answer 1

OA
trauma
RA
tumors, infection
cardiac involvement
cranial nerve dysfunction
fracture

Question 2

Bottom line of neck pain

Answer 2

the exact tissue that is causing a pt’s neck pain is most often unknown

use self-report questionnaires for pts to identify the baseline status and monitor changes

Question 3

RF for neck pain

Answer 3

previous neck pain
female

Lower levels of evidence: age >40, LBP, low social/work support, worrisome attitude, high job demands, ex-smoker

Question 4

RF that are not useful for determining neck pain

Answer 4

details of the accident
angular deformity of neck

Question 5

What determines prognosis?

Answer 5

pain intensity
level of self-rated disability
pain related catastrophizing
PTSD

Question 6

Trajectories of recovery

Answer 6

Mild = rapid recovery, about 45%
moderate = some incomplete recovery, 40%
severe = w/no recovery 15%

usually about 6 to 12 weeks post-injury

Question 7

Categories of Neck pain injries

Answer 7

1. Neck pain w/mobility deficits
2. neck pain w/movement coordination impairments
3. Neck pain w/headaches
4. Neck pain w/radiating pain

Question 8

Neck pain w/mobility deficits symptoms

Answer 8

central/unilateral neck pain
limitation in neck motion that reproduces symptoms
referred pain to shoulder girdle or UE

Question 9

Neck pain w/mobility deficits expected exam findings

Answer 9

limited ROM
neck pain reproduced at end ROM
restricted mobility
deficits in strength and motor control

Question 10

Neck pain w/movement coordination impairments (WAD) Symptoms

Answer 10

onset from trauma
referred shoulder girdle or UE pain
concussion symptoms
active level of distress

Question 11

Neck pain w/movement coordination impairments (WAD) expected exam findings

Answer 11

positive neck flexor muscle endurance test
strength/endurance deficits
neck pain with mid-range motion
point tenderness
sensoriomeotor impairment

Question 12

Irritability

Answer 12

the tissue’s ability to handle physical stress related to the physical status of tissues and the extent of inflammatory activity that is present

Question 13

Acute interventions for neck pain w/mobility deficits

Answer 13

cervical ROM, stretching, isometrics
stay active
strengthening that is supervised

Question 14

Subacute interventions for neck pain w/mobility deficits

Answer 14

endurance exercises

Question 15

Chronic interventions for neck pain w/mobility deficits

Answer 15

mixed exercises
neuromuscular exercises
stretching, strengthening, endurance, aerobic, cognitive
stay ACTIVE

Question 16

acute interventions neck pain with movement coordination impairments

Answer 16

education–stay active and keep doing daily routine
home exercise–postural and pain free ROM
minimize collar use

support during sleep, build self-efficacy
assure pt that recovery happens within 2-3 months

Question 17

subacute interventions neck pain with movement coordination impairments

Answer 17

education: active and counseling
combined exercises: cervical ROM, isometrics, strengthening, manual therapy
supervised exercise–neuromuscular, endurance, stabilization, ROM, strengthening

Question 18

chronic interventions neck pain with movement coordination impairments

Answer 18

education: prognosis, encouragement, reassurance, pain management

cervical mobilization
coordination, vestibular training, endurance, flexibility

Question 19

Whiplash injury mechanisms

Answer 19

Extension: mandible is pulled open and jaw elevators strained

Flexion: mandible forced posteriorly, possible injury to TMJ disc

Question 20

Clinical presentation of WAD

Answer 20

pain during contraction/elongation of muscles
localized swelling
tenderness to palpation
muscle guarding or spasms
decreased AROM in c-spine and UE

Question 21

Impairments associated with WAD

Answer 21

acute: rolling over, turning over, sitting, checking rearview mirror

subacute/chronic: push/pull, lift, carry, limited ROM, sleep disturbed

Question 22

What are some improvements that need to be made to lower levels of disabilities?

Answer 22

self-efficacy
psychological distress
fear

Question 23

TMJ and WAD

Answer 23

you need to educate pt to stop chewing gum, start eating soft foods, utilize open packed resting position

opening mouth in neutral and diaphragmatic breathing can help to decrease pain

Question 24

Closed packed position of TMJ

Answer 24

teeth touching and tightly clenched

Question 25

Open packed position of TMJ

Answer 25

mouth slightly open, lips together, teeth not touching, tongue on hard palate

Question 26

Neck flexor muscle endurance test norms

Answer 26

men: 38.9 s women 29.4 s stop test when head touches hand or when chin tuck is lost

Question 27

Exercises for segmental activation of deep neck flexors

Answer 27

active and control muscles that control retraction/axial extension requires capital flexion, flattening of cervical lordosis test is done by doing chin to throat. Can increase difficulty by lifting arms

Question 28

Proprioceptive training

Answer 28

relocating head back into neutral head alignment can do with eyes open, eyes closed, and in all positions of the neck. Try to focus on a target while keeping neck aligned

Question 29

T/F Female sex is one of the two strongest predictors for new neck pain

Answer 29

TRUE the other is previous episodes of neck pain

Question 30

T/F Direction of impact at the time of a motor vehicle accident is significant for determining a prognosis

Answer 30

FALSE it has no bearing on prognosis, along with all details of the car crash

Question 31

T/F The Neck Disability Index is a patient reported measure that includes items on self-efficacy and fatigue

Answer 31

FALSE there are no items on the NDI that address SE or fatigue. PROMIS has measures specific to these areas

Question 32

T/F The literature supports the use of supervised therapeutic exercise as part of a treatment plan for persons with non-traumatic neck pain as gains will be made up to 18 weeks after symptoms begin

Answer 32

FALSE improvements slow and are insignificant after 12 weeks. While TE is absolutely indicated, the duration of time in this statement is false.

Question 33

Acute phase--Acuity and Irritability

Answer 33

the condition and related tissues are most irritable during the acute phase. Tissues are less able to handle stress without increasing negative symptoms such as pain, swelling, decreased muscle performance. Inflammation is present and easily increased

Question 34

Subacute phase--acuity and irritability

Answer 34

the condition and related tissues are more tolerant of stress and irritability of tissues is referred to as “moderate”. This implies tissues can take some stress before becoming irritable, indicating the inflammatory process is easy triggered but less so than during the acute phase

Question 35

Chronic phase--acuity and irritability

Answer 35

conditions and tissues demonstrate a lower degree of irritability, meaning more stress can be applied than in the previous stages before initiating symptoms. An inflammatory response is less likely to occur

Question 36

What if your pt is showing abnormal actuity/irritability?

Answer 36

Consider all parts of the ICF and biophysical model fatigue, social support, level of self-efficacy, co-morbidities

Question 37

If self-efficacy, psychological distress, and fear are mediators for pain and disability, how will you proceed with treatment for a pt with WAD?

Answer 37

1. Use pt reported measures that specifically address areas of biopsychosocial model 2. Use the reported measures over time to see improvements 3. Tailor treatment towards low reported measures 4. Use feedback to increase measures

Question 38

What is recommended interventions for pts with neck pain with WAD?

Answer 38

Chronic phase = functional training and CBT Acute = little to no cervical collar, home exercises Subacute = utilize therapy if recovery is going longer than normal

Question 39

Explain the MOI for a whiplash injury and how it affects both anterior and posterior structures along with TMJ

Answer 39

Extension or flexion component the mandible is either forced one posteriorly or forced open

Question 40

Interventions for whiplash?

Answer 40

-Deep neck flexor strength: provide OA nods to engage rectus capitus anterior, rectus capitus lateralis, longus capitus, longus colli. -Teach axial extension to bring injured structures into a more neutral length instead of being held at end range. -Proprioceptive training for joint position sense deficits. -Strength and endurance training using isometrics, body weight. Stretching of scalenes, upper trap, levator. * Tongue rest position for TMJ. * Relaxation training with diaphragmatic breathing. * Support neck in neutral while sleeping using neck roll or buckwheat pillow.