Manual Interventions for C-Spine Flashcards Preview

722 MSKT II > Manual Interventions for C-Spine > Flashcards

Flashcards in Manual Interventions for C-Spine Deck (26):

How many directions can we mobilize/manipulate spine?

side gliding- Antlantooccipital
side bending- lower cervical
rotation- predominately C1-C2
traction- all


if their is a problem CLOSING, what structure involved?

articular lesion


if problem with OPENING, what structure involved?

capsular restriction


C1 Rotary Pull

DIP of my right hand goes on the posterior aspect of the transverse process of C1 on the left

Stabilization hand (my left hand) is under the opposite cheek/zygomatic arch region

Side bend the head to the left, rotate the chin to the right.

Gently rock the head back and forth until your end feel is found

Try to time your pull or impulse as the patient exhales without making them aware

Quick pull as it you are going to pull your right elbow into your side suddenly


lower cervical opening and closing technique

opening- bias flexion, mobilize superior (toward eyes)

closing- bias extension, mobilize inferiorly (toward arm pit region)


CT jxn manipulation in prone

stabilize head by cupping ear and cheek

mobilize with key fob grip lateral to C7


Mulligan's Idea

mobilization with movement
Our example was with transverse process of C1


Maitland's Idea

Central PA mobilization


Jones Strain-Counterstrain Technique

find tender point
put that spot in lax position
Basically opposite of stretching
hold for 3 min and slowly release
"Fold and Hold"


What is a trigger point

Injury caused an energy crisis in the muscle and because calcium leaks out of the sarcoplasmic reticulum and activated actin and myosin and ultimately cause depletion of ATP. Decreased O2 eventually leads to ACh and more Ca release which reinforces contractures


Clinical Prediction Rule for C-Spine Manipulation

1. Initial scores on NDI less than 11.50
2. Presence of bilateral pattern of involvement
3. Not performing sedentary work for more than 5 hours each day
4. Report of feeling better while moving the neck
5. No report of feeling worse while extending the neck
6. The diagnosis of spondylosis without radiculopathy

Four or more 89% chance of immediate positive response to manipulation
CPI has not been validated like the low back CPI has


Alternative Clinical Prediction Rule for C-Spine Manipulation

1. Symptoms less than 38 days
2. Positive expectation that manipulation will help
3. Side to side difference in cervical rotation ROM of 10 degrees or greater
4. Pain with posterior anterior spring testing (PAIVM) of the mid cervical spine

Three out of the Four=90% likelihood they will respond to manipulation
Not validated


Clinical Prediciton Rule For Neck Pain that will Respond to THORACIC Manipulation

1. Duration of symptoms less than 30 days
2. NO symptom distal to the shoulder
3. Looking up does not aggreviate their symptoms
4. FABQ assessment score of less than 12
5. Diminished upper thoracic spine kyphosis at T3-T5
6. Cervical Extension range of motion less than 30 degrees
(excluded stensosis patients, red flags, WAD


Clinical Prediciton Rule for Cervical Radiculopathy

+ Spurlings
+ ULTT Median nerve
+Cervical Distraction Test
+Less than 60 degrees of cervical spine rotation toward the involved side
Three/Four present=94% specificity/Moderate correlation
Four/Four present =99% specificity Significant/Strong correlation


Clinical Prediction Rule for Neck Pain and CERVICAL TRACTION

1. Patient reported peripheralization with lower cervical spine (C4-C7) mobility testing
2. Positive Shoulder abduction test
3. Age >54
4. Positive ULTT A
5. Positive Cervical Distraction Test
Three out of Five 79.2% probability (moderate likelihood ratio)
Four out of Five 94.8% probability (strong/significant likelihood ratio)
Not validated


Cervical Radiculopathy S&S

numbness/tingling in pinky/ring
worse with activities


PT for cervical Radiculopathy

Thoracic Spine mobility
Postural re-educaiton
longus coli strengthening


Cervical Myelopathy S&S

bowel/bladder disturbances
wasting of intrinsic hand
Weakness of arms


Cervical Whiplash S&S

MVA, hit from behind
muscle guarding, HA
ROM decrease (pn with it)


Treatment for Cervical WHiplash?

Neuro re-education (laser on head)
Manual ther- decrease hypertonic/hyperirritable muscles
joint mobilization- pain


jefferson fracture?

obvious trauma to head
guarded neck movement


fibromyositis S&S

sedentary provokes pain
movement relieves pain
trigger points in neck/shoulder
cognitive impairment/memory
exercise intolerance
sleep disturbances


treatment for fibromyositis/fibromyalgia?

trigger point work
Mobilizations (cervical/thoraci
postural re-education


manual therapy/MOBILIZATION Contraindications

if already hypermobile/unstable
joint inflammation/effusion
hard/bony end-feel
medically unstable
acute radiculopahty
bone diseases
spinal arthropathy (spondy, DISH)
blood clotting disorder
CNS deteriorating pathology


manual therpay/MOBILIZATION Precautions

Total joint replacement
bone disease (not radiograph detectable)
CT disorders (down's, marfans, RA, SLE)
Pregnant or post-partum
Cauda equina, recent trauma
cognitive impairment
corticosteroid use


what would make PT believe it is cervicobrachial problem vs just shoulder?

if doing PAIVM, produces arm pain, C-spine involvement
or arm pain with head/neck movment
palpate for trigger points