Cervical Spine Manipulation

Question 1

For patients with acute neck pain with mobility deficits, their is Grade [A/B/C] for thoracic manipulation, ROM exercises, and scapulothoracic and UE strengthening.

Answer 1

Grade B

Question 2

For patients with acute neck pain with mobility deficits, their is Grade [A/B/C] for cervical manipulation and/or mobilization.

Answer 2

Grade C

Question 3

For patients with subacute neck pain with mobility deficits, there is Grade [A/B/C] evidence for neck and shoulder endurance exercises.

Answer 3

Grade B

Question 4

For patients with subacute neck pain with mobility deficits, there is Grade [A/B/C] evidence for thoracic and cervical manipulation and/or mobilization.

Answer 4

Grade C

Question 5

For patient with chronic neck pain with mobility deficits, there is Grade [A/B/C] evidence for thoracic and cervical manipulation; mixed exercises including neuromuscular, stretching, strengthening, endurance, aerobic, and cognitive elements; and dry needling, laser, and intermittent traction.

Answer 5

Grade B

Question 6

For patient with chronic neck pain with mobility deficits, there is Grade [A/B/C] evidence for neck and shoulder and trunk endurance exercise and patient education to promote active lifestyle.

Answer 6

Grade C

Question 7

For patient with movement coordination impairments (i.e. whiplash), there is Grade [A/B/C] evidence for education to return to normal (i.e. minimize cervical collar use) and perform mobility exercises, reassurance that recovery is expected in 2-3 months, manual therapy plus exercise for patients expected to have a slow recovery.

Answer 7

Grade B

Question 8

For patient with neck pain with acute headaches, there is Grade [A/B/C] evidence for supervised instruction in active mobility exercises.

Answer 8

Grade B

Question 9

For patient with neck pain with acute headaches, there is Grade [A/B/C] evidence for C1-2 self-sustained SNAG exercise.

Answer 9

Grade C

Question 10

For patient with neck pain with subacute headaches, there is Grade [A/B/C] evidence for C1-2 self-sustained SNAG exercise.

Answer 10

Grade C

Question 11

For patient with neck pain with subacute headaches, there is Grade [A/B/C] evidence for cervical manipulation and mobilization.

Answer 11

Grade B

Question 12

For patient with neck pain with chronic headaches, there is Grade [A/B/C] evidence for cervical manipulation or cervicothoracic manipulation combined with neck stretching, strengthening, and endurance exercises.

Answer 12

Grade B

Question 13

For patient with acute neck pain with radiating pain, there is Grade [A/B/C] evidence for mobilizing and stabilizing exercises, laser, short term use of a cervical collar.

Answer 13

Grade C

Question 14

For patient with chronic neck pain with radiating pain, there is Grade [A/B/C] evidence for mechanical intermittent cervical traction, stretching/strengthening exercises, cervical and thoracic manipulations/mobilizations, and education to participate in exercise and activity.

Answer 14

Grade B

Question 15

When should you use cervical mobilization/manipulation? (6)

Answer 15

Neck pain without acute radiculopathy

Biomechanical pattern

Non-traumatic history

Pain & stiffness

Cervicogenic headaches

Non-acute cervical radiculopathy

Question 16

What is the clinical prediction rule for cervical manipulation for neck pain?(4)

Answer 16

symptom duration ≤38 days

positive expectation that manipulation will help

side-to-side difference in cervical rotation range of motion of ≥10°

pain with spring (PA) testing of the middle cervical spine

Question 17

Motion characteristics and restrictions in the cervical spine may be influenced/originate where?

Answer 17

The upper thoracic spine

Question 18

Cervical mobilization and manipulation both have shown benefit for what? (2)

Answer 18

(1) neck pain
(2) headaches

Question 19

What is the thoracic spine clinical prediction rule for neck pain?

Answer 19

Duration of symptoms 30 days or less

Symptoms not distal to the shoulder

Looking up does not aggravate symptoms

FABQPA < 11

Decreased upper thoracic (T3‐T5) kyphosis

Cervical extension ROM < 30

Question 20

What are some short duration adverse reactions after cervical manipulation? (7)

Answer 20

local discomfort, stiffness, headache, radiating discomfort, fatigue, dizziness, and ringing in ears

Usually begin within 4 hours and disappear within 24 hours (women>men)

Question 21

What are some mechanisms of cervical arterial dissection?

Answer 21

normal daily movements, trauma (i.e. extreme neck movement, sport, whiplash, domestic violence, medical interventions, and manual therapies), endothelial inflammatory events or disease, or upper cervical instability

Question 22

Possible associated risk factors for cervical dissection are what?

Answer 22

• Migraines
  •Hypertension
  •Oral contraceptives
  •Smoking
  •Vascular disease
  •Unilateral headaches
  •Posterior cervical pain
  •Pulsatile tinnitus

Question 23

T/F: cardiovascular risk factors are likely not associated with craniocervical dissection in younger patients.

Answer 23

True

Question 24

What symptoms do patient normally have along with a cervical arterial dissection?

Answer 24

neck pain, headaches, prior minor mechanical trauma, and/or transient ischemic signs in the last month

Question 25

What symptoms/signs will the patient present with with a vertebral artery dissection?

Answer 25

Ipsilateral posterior upper cervical pain and occipital headache, Vascular dizziness as an effect of rotation (does not improve with movement), Light headedness, Nausea, Facial numbness, Double/blurred vision, Swallowing problems, Slurred speech

Question 26

What symptoms/signs will patients present with for an internal carotid artery dissection?

Answer 26

Ipsilateral front-temporal headache and upper/mid cervical pain, Thunder-clap, different from previous headaches, Horner’s syndrome in up to 82%, CN’s affected (hypoglossal, glossopharangeal, vagus, accessory), Retinal infarction

Question 27

What are signs of cerebral anoxia?

Answer 27

anxiety, nystagmus, dizziness, vomiting, or blurred vision

Question 28

T/F: In most people, cervical positioning/manipulation effects cervical blood flow through vertebral arteries, posterior cerebrum, or cerebellar region.

Answer 28

False!!

Question 29

What are the 3 N's AND 5 D's to screen for prior to cervical manipulation?

Answer 29

nystagmus, nausea, and numbness ataxia dizziness, dysphasia, diplopia, dysarthria, and dropattacks

Question 30

What are the contraindications for cervical manual therapy? (GO!)

Answer 30

Question 31

What are the precautions to cervical manual therapy? (GO!)

Answer 31