Cervical TherEx Flashcards
(54 cards)
1
Q
What 3 classification groups of the C-spine are treated with stretching, coordination, strengthening and endurance?
A
- Pain with mobility deficit
- Pain with headache
- Pain with movement coordination impairments
2
Q
What are 2 treatments for the pain with radiating pain c-spine classification?
A
- Nerve mobilization
- Traction
3
Q
What are 2 treatment for impaired muscle performance?
A
- Strength exercises
- Endurance exercises
4
Q
What are 3 treatments for hypomobility of a joint in the c-spine?
A
- ROM
- Flexibility
- Neural glide
5
Q
What is the treatment for hypermobility of a c-spine segment?
A
- Stabilization exercises
6
Q
How are lengthened muscles treated?
A
- Strengthen in shortened range
7
Q
How are shortened muscles treated?
A
- Stretching/ postural correction
8
Q
Which muscle group is most commonly impaired in the c-spine?
A
- Deep anterior cervical flexors
9
Q
What group of muscles are the DNF of the c-spine similar to in the trunk?
A
- Transverse abdominus/ core muscles
10
Q
How can a patient activate their DNF muscles prior to movement of the head?
A
- Chin tuck/ nod
11
Q
Describe the least vigorous DNF exercise.
A
- Slide back of head up wall
- Palpate SCMs and scalenes to ensure they are not activating
- Hold for 10 seconds
12
Q
Describe the self-assist DNF exercise.
A
- Pt supine
- Hand supporting head
- Hand helps patient lift head off table as well as provide a traction force
- Hand can also assist in eccentric contraction
13
Q
What are 2 ways to progress the self-assist DNF exercise?
A
- Progress to unassisted active motion
- Progress to resisted motion with a 1lb sandbag on the forehead
14
Q
What are 2 methods of deep cervical flexor with SCM and Scalene assistance exercises?
A
Towel roll:
- Pt supine with towel roll under the head
- The patient lifts their head off the mat while maintaining contact with the towel roll and a chin tuck to avoid dominance of superficial muscles
Incline:
- Pt positioned sitting on a large incline
- Patients lifts head off mat maintaining a chin tucked position
15
Q
What modality is effective in the early treatment of the cervical extensors?
A
- Nueromuscular stimulation (e-stim)
16
Q
How are cervical extensors strengthened?
A
- Pt is taught to apply resistance with a specific force vector with a direction and magnitude sufficient to cause a muscle contraction in the targeted tissue. (usually sidebending with rotation)
- Pt may be lying or sitting, and reaches up over shoulder and behind head with hand and fingers to apply gentle ipsilateral sidebending and rotation
17
Q
Describe an exercise targeting segmental activation of the cervical extensors?
A
- Start in the sitting and forward flexed position (c-spine and some T-spine)
- Begin segmental extension begining at the T-spine, then retracting the cervical region, then extending the upper C-spine and head TO NEUTRAL
18
Q
Describe manual resistance of the cervical muscles, and progression.
A
- Begin with gentle isometrics of side bending, flexion, extension, and rotation in different neck positions
- Progress to dynamic, isotonic movements
- Increase force and duration
19
Q
Describe rotation and side bending exercises.
A
- Pt hooklying with head on foam wedge, which patient rolls up and down in a controlled fashion
OR
- Pt sidelying with a towel roll used as a fulcrum for sidebending
20
Q
How are rotation and sidebending exercises progressed?
A
- Multiplanar movements are introduced
hypertranslation needs to be controlled
21
Q
What are the 6 causes of hypomobility?
A
- Segmental articular mobility restriction
- Capsular thickening and contracture
- Degenerative bony changes
- Segmental muscle spasm
- Myofascial extensibility
- Adverse neuromeningeal tension
22
Q
What neck position creates a maximal downslope of the targeted vertebra?
A
- Quadrant
23
Q
What neck position creates a maximal upslope of the targeted vertebra?
A
- Flexion, contralateral flexion, and rotation
24
Q
How can a downslope ROM exercise be aided by the patient in their HEP?
A
- Target with overpressure from the ipsilateral hand
OR
- Use a towel to assist in motion
25
How can an upslope ROM exercise be aided by the patient in their HEP?
- Target with overpressure from contralateral hand
OR
- Use towel to assist in motion
26
By what 2 methods can an overstretch of the hypermobile segments above and below the hypomobile segments be prevented?
- Position neck to lock out above and below the targeted segment
- Stabilize with hand pressure
27
What muscles are targeted by the 4 flexibility exercises/ tests of the c-spine?
- Levator and Splenius Cervicis
- Upper Trapezius and SCM
- Middle and Anterior Scalenes
- Sub Occipitals
- Bilateral
- Unilateral
28
Describe the flexibility exercise that targets the levator scapulae and splenius cervicis muscles.
- Grasp chair with ipsilateral side
- Place head and neck into flexion, and contralateral rotation and side-bending
- Lean trunk to contralateral side
- Emphasize stretch with hand
- Increase stretch by contracting ipsilateral lower trapezius
29
Describe the flexibility exercise that targets the upper trapezius and SCM.
- Grasp chair with ipsilateral hand
- Position head and neck into flexion, contralateral sidebending, and ipsilateral rotation
- Lean to contralateral side
- Emphasize stretch with hand
- Nod chin to sharpen stretch
30
Describe the flexibility exercise that targets the middle and anterior scalenes.
- Pt places contralateral hand over medial clavicle and first rib of ipsilateral side
- Retract chin slightly
- Position neck into extension, contralateral side bending, and ipsilateral rotation
31
Describe the flexibility exercise that targets the suboccipitals.
- Position one hand on the back of the head, and one on the chin
- Flex upper C-spine with gentle distraction force
- Maintain chin tuck
- To focus stretch to one side, rotate 30 degrees
32
What are the 4 basic treatments for hypermobility of the C-spine?
- Postural correction exercises
- Taping of scapula to reduce pull on segment
- Manually stabilize hypermobile segment or perform cocontractions at involved levels
- Gradually challenge c-spine musculature while preventing excessive motion at involved segment
33
Describe the alternating isometric exercise for stabilization.
- Head and neck positioned in neutral (to begin)
- Isometric contractions applied in all cardinal planes with pressure applied on cranium (Hold for 6 - 10 seconds)
- Progressed to different directions
- Progressed to head and neck positioned out of neutral
- Progressed to eyes closed
- Progress from light force to significant (but, don't break form)
34
What 3 exercises target the DNF, extensors, lateral flexors, and rotators in stage 1 of stabillization?
- AROM --> RROM of chin tuck in a variety of positions
- AROM --> RROM of intersegmental extensors in a variety of positions
- Supine head roll up/downhill on a foam wedge
35
How can is co-activation initiated in stage 1 of stabilization?
- Quadriped chin tuck with lower c-spine extension
36
How are the stage 1 exercises progressed?
- Increase in duration
37
How are stabilization exercises progressed in stage 2?
- Increase intensity and duration (while maintaining form)
| - Coactivate C-spine to control positions during arm movements
38
List the positions for co-activation of the C-spine form most to least stable.
- Supine
- Quadriped
- Upright
- Unstable surface (foam roller, wobble board, ball)
- Include arm movement
- Include hand held weights
39
Is position of the c-spine harder to control during bilateral or unilateral arm movement ?
Unilateral
40
Past what degree shoulder flexion does c-spine stability become more difficult?
- 90 degrees
41
How are stabilization exercises progressed in stage 3?
- Intensity and duration
| - Intersegmental control progressed to neck movements and functional tasks
42
How are neck movements progressed in stage 3 stability exercises?
- Straight plane --> Diagonal planes
- Single plane --> Multiplanar movements
- Whole body movements with neck not emphasized --> Neck emphasized
43
What is important for positioning of a self- nerve glide?
- Belt placed around shoulder and ipsilateral thigh in hooklying to depress shoulder
- Make sure shouder is supported so it doesn't fall into extension
44
How is the nerve pulled from the distal portion?
- Wrist movement
45
How is the nerve pulled from the proximal segment?
- Lateral flexion of the neck
46
What is the position for a median nerve bias glide?
- Shoulder depressed
- Shoulder ER
- Wrist extension
- Forearm supination
- Elbow flexion --> extension
47
What is the position for a radial nerve bias glide?
- Shoulder depressed and IR
- Forearm pronated
- Wrist flexed and ulnar deviated
- Move from elbow flexion to extension
48
What is the position for a ulnar nerve bias glide?
- Shoulder depressed and ER
- Shoulder abudcted to 90
- Forearm pronated
- Wrist and fingers extended
- Move from elbow extension to flexion
49
What is the treatment for FHP due to muscular imbalance?
- Lengthen short muscles
| - Strengthen long/ weak muscles
50
What is the treatment for FHP due to neuromeningeal extensibility impairments?
- Side flexion and elevation of the scapula
51
What is the treatment for FHP due to articular hypomobility?
- Manual therapy
| - Mobility exercises
52
What is the treatment for FHP due to proprioception impairments?
- Postural correction
53
What are the 2 types of FHP?
- Forward head position with minimal midcervical lordosis
| - Forward head position with excessive midcervical lordosis
54
How often should postural correction exercises be performed?
- As often as possible
