Exercise Interventions for the Cervical Spine Flashcards
1
Q
5 main principles that are manipulated/adapted in spinal rehab
A
1) Kinesthetic awareness: training of safe movement & postures
2) Mobility/flexibility
3) Muscle performance: stabilization, endurance, strength, & power
4) Cardiopulmonary performance: aerobic training
5) Functional activities: body mechanics & skill based training
2
Q
Impairment based intervention selection for the spine
A
- General: Stage of healing
- Non-weight bearing/traction approach
- Extension bias
- Flexion bias
- Hypermobility & instability: stabilization
- Hypomobility: mobilization & manipulation
- Postural pain syndromes: exercise & conditioning
3
Q
Stages of recovery/healing
A
- Acute with inflammation (0-4 wks): constant pain, signs of inflammation, no position or movement completely relieves symptoms
- Acute without inflammation (0-4 wks): intermittent symptoms related to mechanical deformation, may be an extension/flexion/non-weight bearing bias
- Subacute (4-12 wks): some movements, ADLs, IADLs still provocate symptoms
- Chronic (>12 wks): chronic pain syndrome (>6 months), emphasis is placed on returning to high level demand activities requiring relativity loads on a sustained basis over a prolonged period of time
4
Q
Describe non-weight bearing bias
A
- patient does not tolerate being upright for basic ADLs & IADLs
- movement testing makes symptoms worse
- traction relieves symptoms
5
Q
Describe extension bias
A
- patient usually presents with flexed posture, a lateral shift may also be present
- extension tests decrease or centralize symptoms
- diagnosis may include intervertebral disc lesions, impaired fixed posture, fluid stasis
6
Q
Describe flexion bias
A
- patient usually presents with flexed posture & is more comfortable when flexed
- extension tests exacerbate or peripheralize symptoms
- diagnosis may include spondylosis, stenosis, extension load injuries, swollen facet joints
7
Q
Describe hypermobility/functional instability
A
- stabilization/immobilization approach
- patients present with hypermobile spinal segments, poor spinal stability
- diagnosis may include trauma, ligamentous laxity, spondylosis, or spondylolisthesis
8
Q
Describe hypomobility
A
- mobilization/manipulation approach
- restricted mobility in one or more spinal segments
9
Q
Describe postural pain syndrome
A
- exercise & conditioning approach
- patient presents with faulty posture, symptoms increase with sustained position
- diagnosis may include postural strain, crevice-genic headache, thoracic outlet syndrome, poor physical condition
- movement, posture correction, & exercise decrease symptoms
10
Q
Spinal precautions following spine surgery
A
- no bending
- no twisting
- no lifting greater than 10 lbs
- follow for 2-6 weeks
- log roll to get out of bed
11
Q
Post-op exercises for spine surgery
A
- begin 4-6 wks after surgery
- isometric neck exercises
- spinal stabilization exercsies
- U active motion to tolerance
- posture education
- strengthening of associated areas
- walking program or other cardiovascular based exercise
- screen for post-op infection, DVT, ensure proper pain management, review assistive device recommendations, & home exercise program (HEP) prior to discharge from hospital
12
Q
5 classifications for neck pain
A
- Neck pain with mobility deficits
- Neck pain with movement coordination impairments (WAD)
- Neck pain with headaches
- Neck pain with radiating pain
- Neck pain
13
Q
Common symptoms of neck pain with mobility deficits
A
- central and/or unilateral neck pain
- limitation in neck motion that consistently reproduces symptoms
- associated (referred) shoulder girdle or UE pain may be present
14
Q
Expected exam findings for neck pain with mobility deficits
A
- limited cervical ROM
- neck pain at end ranges of A/PROM
- restricted cervical & thoracic segmental mobility
- intersegmental mobility testing reveals characteristic restriction
- neck & referred pain reproduced with provocation of the involved cervical or upper thoracic segments or cervical musculature
- deficits in cervicoscapulothoracic strength & motor control may be present in individuals with subacute or chronic neck pain
15
Q
Acute interventions for neck pain with mobility deficits
A
- cervical spine neck ROM exercise progressions
- Levator scapulae stretch progression
- scalene stretch progression
- T spine mobilization progression
- scapulothoracic & UE strengthening program
- cervical spine mobilizations & manipulations
- time frame <6 weeks
16
Q
Thoracic spine mobilizations
A
- extension stretch over a foam roll/towel
- seated thoracic extension over chair with or without towel
- quadruped thoracic extension stretch
- self posterior to anterior mobilization with a tennis ball
17
Q
Subacute interventions for neck pain with mobility deficits
A
- neck & shoulder girdle endurance exercises
- thoracic manipulation & cervical manipulation and/or mobilization
- time frame 6-12 weeks
18
Q
Describe the different phases for neck & shoulder girdle exercises for neck pain with mobility deficits subacute
A
- Phase 1: neck ROM and resisted shoulder extension/shrugs
- Phase 2: isometric neck exercises and chest/lats stretches
- Phase 3: resisted neck exercises and resisted dynamic hugs & reverse fly
19
Q
Chronic interventions for neck pain with mobility deficits
A
- thoracic or cervical manipulation or mobilization
- mixed exercise for the cervical & scapulothoracic region
- dry needling, laser, intermittent mechancial/manual traction
20
Q
Common symptoms for neck pain with radiating pain
A
- neck pain with radiating pain in the involved extremity
- narrow band of lancinating pain
- UE dermatomal paresthesia or numbness & myotomal muscle weakness
21
Q
Expected exam findings for neck pain with radiating pain
A
- neck & neck related radiating pain reproduced or relieved with radiculopathy testing
- Cluster: ULLT-A, Spurlings test, cervical distraction, & cervical ROM <60 degrees rotation
-may have UE sensory, strength, reflex deficits associated with the involved nerve roots
22
Q
Treatment for neck pain with radiating pain
A
- intermittent manual/mechanical traction
- repeated directional preference mobilizations (retraction/retraction with extension)
- nerve glides
- Acute: provide mobilizing & stabilizing exercises, laser, & short term use of a cervical collar
- Chronic: provide mechanical intermittent cervical traction in combination with stretching & strengthening exercises plus cervical & thoracic mobilization/manipulation, provide education & counseling to encourage participation in occupational & exercise activities
23
Q
Common symptoms for neck pain with coordination impairments
A
- mechanism of onset linked to trauma or whiplash
- referred shoulder girdle or UE pain
- referred varied nonspecific concussive signs & symptoms
- dizziness/nausea
- headache, concentration or memory difficulties, confusion, hypersensitivity to mechanical, thermal, acoustic, odor, or light stimuli
- heightened affective state
24
Q
Expected exam findings for neck pain with coordination impairments
A
- Pos. cranial cervical flexion test
- Pos. neck flexor muscle endurance test
- Pos. pressure algometry
- strength & endurance deficits of the neck muscles
- neck pain with mid-range motion that worsens with end range positions
- point tenderness may include myofascial trigger points
- sensorimotor impairment may include altered muscle firing parameters, proprioceptive deficit, postural balance & control
- neck & referred pain reproduced by provocation of the involved cervical segments
25
What are the deep neck flexors
- longus colli
- longus capitis
- rectus capitis anterior
- rectus lateralis
26
What are the deep cervical extensors
- semispinalis cevicis
- multifus
- rotators
27
What are the cranio-cervical extensors
- rectus capitis posterior minor
- rectus capitis posterior major
- obliquus capitis superior
- obliquus capitis inferior
- spinalis cervicis
28
Interventions for neck pain with coordination impairments
- education
- return to normal, non provocative pre-accident activities ASAP
- minimize the use of a cervical collar
- perform postural & mobility exercises to decrease pain & increase ROM
- reassure patient recovery is expected within the first 2-3 months
- multimodal intervention
- manual mobilization techniques plus exercise
- strength, endurance, flexibility, postural, coordination, aerobic, functional exercise for those expected to have a moderate to slow recovery
- conditioning exercises: deep neck flexor & cervical extensor strengthening progressions
29
Cervical stabilization with progressive loading for neck flexors
- gentle craniocervical flexion/axial extension hold 10 sec for 10 reps
- Max to mod protection: shoulder flexion to 90 degrees, shoulder abduction to 90 degrees, & shoulder ER with arms at sides
- Mod to min protection: shoulder flexion to end range, shoulder abduction combined with ER to end range, & diagonal patterns
- Min to no protection: reaching forward, outward, upward in functional patterns & pushing/pulling & lifting activities
- Max to min support: supine, sitting, standing with wall support, standing with no support
30
Cervical stabilization with progressive loading for neck extensors
- lift forehead off exercise mat hold 10 sec for 10 reps
- Max to mod protection: arms at side ER shoulder & adduct scapulae, arms in 90/90 position horizontally abd shoulders and add scapulae
- Mod to min protection: elevate shoulder in full flexion, arms abd to 90 degrees & ER elbows extended horizontally abd shoulder & add scapulae, UE diagonal patterns
- Min to no protection: reaching forward, outward, upward in functional patterns, and pushing/pulling/lifting activities
- Max to min support: prone forehead on treatment table, quadruped over padded stool or gym ball, standing back supported by wall, & standing no support
31
Common symptoms for neck pain with headaches
- noncontinuous, unilateral neck pain & referred headache
- headache is precipitated or aggravated by neck movements or sustained postures
32
Expected exam findings for neck pain with headaches
- Pos. cervical flexion rotation test
- headache reproduced with provocation of the involved upper cervical segments
- limited cervical ROM
- restricted upper cervical segmental mobility
- strength, endurance, & coordination deficits of the neck muscles
33
Acute interventions for neck pain with headaches
- supervised instruction in active mobility exercise
- SNAG stretch
- deep cervical flexor training
- light stretching/strengthening/AROM
- postural education & training
34
Subacute interventions for neck pain with headaches
- provide cervical manipulation & mobilization
- SNAG stretch
35
Chronic interventions for neck pain with headaches
- provide cervical or cervicothoracic manipulation or mobilizations combined with shoulder girdle & neck stretching, strengthening, & endurance exercises
36
Summary of what to do for the different neck pain classifications
- Neck pain with mobility deficits: C-spine ROM, T-spine mobilization, SNAGs, cervicothoracic strengthening
- Neck pain with radiating pain: repeated motions & nerve glides
- Neck pain with movement coordination impairments: cervical flexor & extensor conditioning exercise progressions
- Neck pain with headaches: combination of above techniques
