Neck pain - CPG

Question 1

acute neck pain with radiating pain

Answer 1

utilize mobilization and stabilization exercise
laser
short term use of cervical collar

Question 2

chronic neck pain with radiating pain

Answer 2

mechanical intermittent cervical traction + stretching and strengthening exercises + c-spine and t-spine manip

encourage participation in occupational and exercise activities

Question 3

traction contraindications

Answer 3

vertebral fx and dislocation
hypermobility
disease/infection
vertebral artery dysfunction

Question 4

manual cervical traction benefits

Answer 4

• muscle and joint stretch
• bigger IVD spaces and foramen
• makes centropetally directed forces on disc and soft tissue
• joint mobilization
• increases joint proprioception
• ease compression forces
• improve arterial, venous and lymphatic flow

Question 5

manual cervical traction

Answer 5

Variety of head and neck positions
Hand should cradle neck contacting one mastoid process
Other hand on chin

Gentle pull
- < 20 pounds
Intermittent pull
- 3 - 10 sec
Treatment time
- 3 - 10 min

Question 6

cervical traction for cervical radiculopathy

Answer 6

towel traction:
- light pull
- begin with 5-10 min –> 20 mins

manual traction
- flex neck

Question 7

mechanical traction

Answer 7

20-30 PSI x 5-10 mins
KNOW THE AMOUNT OF PRESSURE PULL

Question 8

Mechanical cervical traction guideline

Answer 8

Supine
Neck flexed 20 - 30deg
Traction harness pulls on occiput
Intermittent pull
* > 20 pounds
* Minimum of 7 seconds
* Adequate rest time for recovery
Treatment time, 20 - 25 min

Question 9

force of increased IV separation

Answer 9

forces up to 50 pounds

Question 10

Cervical Traction Clinical Prediction Rule

Answer 10

• Peripheralization with mobility testing - C4-7
• (+) Shoulder Abduction Test
• Age greater than or equal to 55
• (+) Upper limb tension test
• (+) Cervical Distraction test

Question 11

Combination of Predictor Variables and Associated Accuracy Statistics

Answer 11

Having at least 3 out of 5 predictors appears to be the optimal threshold for choosing the cervical traction as an intervention

Question 12

mechanical txn + exercise
or
over door txn + exercise

Answer 12

Mechanical traction + exercise found to decrease disability score and pain intensity compared to only exercise in a subgroup of patients

Question 13

addition of traction to physical therapy

Answer 13

Mectxn=>decr short & intermed pain; improved disability at intermediate term

Mantxn=>decr pain in short term