Lecture 5

Question 1

What kind of pain is OA

Answer 1

Dull and achy

Question 2

Where is cervical arthritis typically?

Answer 2

c5-c7

Question 3

Why would cervical OA lead to decreased tolerance to a compressive load?

Answer 3

Because the articulating cartilage has essentailly been worn down and it hurts when compressed because its bone on bone / also the nerve roots exiting dont have as much room

Question 4

What would OA do to spinal curvature?

Answer 4

Will change sagittal curvature (aka lordosis / kyphosis changes)

• neck loses lordoic curve and becomes more neutral w/ OA

Question 5

Will cervical OA increase or decrease ROM

Answer 5

Decrease

Question 6

Will cervical OA increase or decrease C-spine height?

Answer 6

Decrease

Question 7

Will cervical OA increase or decrease stiffness in the cervical spine?

Answer 7

Increase

Question 8

What would we do for an acute OA pt

Answer 8

Isometric (decrease pain / increase function) - think when he came in w/ a painful neck

Eduction

Manipulation (etc..)

Question 9

Know: facet joint referal pattern (its a reffered pain sensation - so deep and achy)

He’s proably going to pick on the extremes
C2-3 facet refferal = base of skull / ear
C6-7 = into the scapula

Question 10

Which facet joint area referes into the scapula?

Answer 10

C6-C7

Question 11

Which facet joint area referal refers to the shoulder?

Answer 11

C5-C6

Question 12

Which facet joint area refers to the base of the skull / ear?

Answer 12

C2-C3

Question 13

Which facet joint area refers to the upper neck?

What about lower neck?

Answer 13

C3-C4

C4-C5

Question 14

Is mobilizing cervical vertebrae super specific?

Answer 14

No, you can mobilize one and it might not be the one you think you’re mobilizing / other ones around it also have benefit

Question 15

is there specificity in manual therapy?

Answer 15

No

Question 16

as disc heigh decreases what happens to load on facets?

Answer 16

It increases (essentially pinching together)

Question 17

Does a closing down issue or an opening up issue cause facet referred pain?

Answer 17

Closing down on the facet joints is what causes the pain

Question 18

What two symptoms do facet issues cause

Answer 18

stiffness / pain

Question 19

Is facet pain unilatearl or bilatearl?

Answer 19

unilatearl

Question 20

A student heard a noise behind them and looked to see where it was (rotating their head). They felt a locking sensation and a dull aching pain in their right lower neck. What could be their issue?

Answer 20

right, c4-5 facet issue

Question 21

What is a key charcteristic of cervical facet issues after what 3 motions

Answer 21

locking after rotation, extension, or side bending (any motion that closes down those facet joints)

Question 22

Should you push into pain?

Answer 22

Yes

Question 23

A feeling of locking is common with what three movement when someone has facet issues. Why specifically do these movements cause an issue?

Answer 23

Rotation, side bending, extension

Because its closing down the facet joints

KNOW: the reason we have pain at all is because the facet joint is a synovial joint. When we close down a bit of that synovial membrane gets stuck and inflammed.

Question 24

A patient comes in reporting neck pain with extension. You figure out that its a facet joint issue. Would you want to open this patients facet joints up or push into pain? What does this depend on?

Answer 24

It all depends on how irritable the patient is

You would push into pain if it isnt that irritable in attempt to losen it up. However, if they are highly irritable you should work on opening that facet joint up by closing the contraltaeral facet joint down.

Question 25

Does imaging show facet joint issues?

Answer 25

Proably not

Question 26

KNOW: Sometimes a local steriod injection is done into the facet joint to calm it down if symptoms are lasting a long time

Question 27

A patient has shooting pain and numbness and tingling that starts in their neck and goes down their arm. Are we thinking this is a facet issue?

Answer 27

No. Facet issues are typically nociceptive only (pain) and do not have numbness or shooting (nerves not involves here)

Question 28

KNOW: facet patients respond well to mobilization (loosen it up) ROM (loosen it up) and strenthening EX (and other pain modulation techniques - isometrices etc.)

Question 29

KNOW: you are upgliding from the left - which means i am going into right rotation

Question 30

**If I want to open up the facet joint on the left between C4-C5 do i upglide on C4 or C5?**

Answer 30

C4 - you're essentially pulling the C4 up and off of C5

Question 31

If I wanted to close down C4 and C5 with an upglide what cervical verebra would I do it on?

Answer 31

I would upglide on C5 which will essentially push it up and into C4 (and will pull C5 and C6 apart) So if they're really tinder on C4 thats a way to close it down without actually touching it

Question 32

If I wanted to open the right C4-C5 facet joint what is the simplist way to do this?

Answer 32

lateral flexion to the left

Question 33

In an upglide which side opens?

Answer 33

ipsilatearl side (contralatearl side closes)

Question 34

in a cervical downglide which side closes down the vertebra

Answer 34

You're essentailly laterally flexing them so the ipsilateral side closes and the contralateral side opens

Question 35

**Patient reports pain on the right side when going into left side flexion. Is this a vertebral (facet) opening or closing issue?** (on test)

Answer 35

Right opening issue (left side = closing right = opening)

Question 36

What are two things that cause opening issues between the vertebrae (might just be talking about between facet joints)

Answer 36

Muscles not wanting to be stretched (muscle tightness) Synovial membrane not liking the stretch (I think specifically the synovial membrane around the facet joint)

Question 37

patient reports right pain when rotating right and side flexing right. Is this a opening or closing issue?

Answer 37

closing on right

Question 38

What 3 issues are associated w/ vertebral (facet) opening issues? What two theraputic things do we do for this?

Answer 38

Flexion contralteral rotation Contralateral side bending (anything that opens up) We want to do anything that will further open up this side. Ipsilatearl upglide, contralatearl downglide (both facilitate opening of the same facet joint)

Question 39

Doesnt want to close is a closing issue or opening issue?

Answer 39

Closing issue

Question 40

What 3 motions are affected by closing dysfunction of the facet joint? What two theraputic measures do we take?

Answer 40

Anything that closes it down. Extension, ipsilateral side bend, ipsilateral rotation We want to do things that close down this joint. Ipsilateral downglide, contraltaeral upglide (things that close it down) - think stuck drawer we want to close it down and maybe get it unstuck

Question 41

**A patient presents with extreme pain on the right side when right side flexing / extending / rotating to the right. We decide its a facet issue. What is the 1 and only best thing to do here and why? (test)**

Answer 41

We know that it is a closing down issue because its on the same side were bending to. However, theres pain when on that side so we would want to mess with the other side. Our two options to close it down would be an ipsilateral down glide or contralateral upglide. We choose contralatearl upglide because its on the opposing side.