Neck Flashcards
Neck Pain with mobility deficits
Presentation/diagnosis
- Pain or stiffness isolated to the neck
- Restricted or painful ROM
- Restricted or painful PAIVMS
- Typically compressive movement impairment pattern (cervical clearing test)
- TOP
- Muscle length tests
Treatment:
- PAIVMS
- PPIVMS
- Neck ROM exercises
- Scapulothoracic and upper extremity strengthening
- Neck extensor and flexor muscle endurance exercises
- SNAGS and self snags
- Transverse glides for LR and rotation or if PAIVMs are too painful
Acute wry neck
Presentation/diagnosis:
- Head rotated or tilted away from the painful side
- Ipsilateral movement restriction (compressive pattern)
- Restricted ROM
- Pain++
Treatment:
- Heat, gentle massage
- Manual traction
- PPIVMS and ROM from the side of pain initially (rotation is a good place to start, NWB)
- Progress into WBing PAIVMS and SNAGS
- NSAIDS
Neck pain with radiating pain
Presentation/Diagnosis:
- Neural signs: P&Ns, numbness, burning, weakness
- Limited cervical rotation towards site of pain
- ULNDT
- Dermatomes and Myotomes
- DTR
Treatment:
- Lateral glides (L problem - glide to right)
- Lateral flexion or rotation away from restriction
- Posture correction
- treat non-neural structures if they cause the issue (tight muscles etc.)
- Transverse glides
Neck pain with movement coordination impairment
Presentation/Diagnosis:
- Coordination, strength and upper deficits of neck and upper quarter muscles
- Flexibility deficits of upper neck muscles
- CFFT
- Deep neck extensor endurance
- Sensorimotor impairments, balance and proprioceptive deficit
- VOMS
- JPE
Treatment
- Posture correct
- Increase ROM
- Education
- JPE exercises with target
- CFFT as a treatment
- Deep neck extensor endurance exercises
Neck pain with headache
Presentation/Diagnosis:
- Posture
- Restricted cervical ROM
- Upper cervical PAIVMs and PPIVMs
- Upper cervical flexion rotation test
- Muscle length tests
Treatment:
- Posture correct
- Muscle length exercises
- Upper cervical PAIVMs and PPIVMs
- SNAGS
- CFFT and deep neck extensor training
Degenerative arthritis
Presentation/Diagnosis
- Swelling
- Stiffness
- Age
- Relief with distraction
- Relief in NWB
- X-ray
Treatment:
- Manual traction
- Lateral glides
- SNAGs
- ROM exercises
VOMS
Record baseline symptoms: headache, nausea, and fogginess
- Smooth pursuits
- Saccades (horizontal and vertical)
- Convergence
- VOR (horizontal and vertical)
- Visual motion sensitivity test
VBI
Presentation
- Light headedness, unsteadiness, giddiness
- Generally not vertigo
- Triggered by neck rotation and extension
- 5 D’s and 3 N’s
Concussion
Originates from:
- Cervical spine injury
- Vestibular dysfunction
- Ocular motor impairments
Management:
- Aerobic exercise decreases symptoms in acutely concussed individuals and those with persistent symptoms
- Subthreshold exercise should start 2 days post concussion as long as symptoms are not increased
- Neck treatment, eye exercises
WAD
0 = no complaint about the neck and no physical signs 1 = complaint of neck pain, stiffness or tenderness only, no physical signs 2 = neck complain and musculoskeletal signs (decreased ROM and TOP) 3 = Neck complaint and neurological signs (decreased or absent tendon reflexes, weakness, sensory deficits 4 = neck complaint and fracture/dislocation
Diagnosis
- NDI
- Palpation
- Observation
- ROM
- Neurological testing
Treatment
- Low load isometric
- Gentle ROM
- Postural endurance exercises
- Refer onto senior clinician
Sustained postural disorders
- Eased with movement and activity
- No movement restriction
- Diffuse ache and tenderness in cervicothoracic region
- Postural cervicogenic headache
Treatment
-Education
-Posture correction in unsupported sitting (or standing if indicated)
o Ensure can move in and out of postures
o Initiate with lumbo-pelvic position then check cervicothoracic and craniocervical position as required
o Neutral orientation of scapula
o See if change in posture changes symptoms
- Retrain proprioception and kinaesthetic awareness
- Integrate into functional
- Advice on study/work set up
Neck disability index
- Scale of 0-5
- Pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, recreation
- Total score out of 50 – want less than 30%
- Used to identify at risk patients of non-recovery
Classification of headaches
Classification of Headaches:
• Primary
• Secondary, or
• Cranial neuralgias, central and primary facial pain
• May be mixed headache types or combination concurrently
PRIMARY HEADACHE • Migraine • Tension type headache & trigeminal autonomic, cephalagias • Cluster headache • Stabbing type headache • Cough headache • Headache assoc’d with sexual activity • Exertional headache • Thunderclap headache • New daily persistent headache
SECONDARY HEADACHE H/A due to: • head/neck trauma • Cervical spine dysfunction • cranial or cervical vascular disorder • Non-vascular intracranial disorder • Substance abuse /withdrawal • Infection • Disorder homeostasis • Disorder cranium, neck, ears, nose, sinuses, mouth • Psychiatric disorder
