Neck Pain triage

Question 1

Outline Cote’s ‘Classification of Neck Pain and Associated Disorders’ (NAD)

Which grades fall under idiopathic, NRC, and serious pathology in neck pain?

Answer 1

Grade 1:
No major structural pathology/no or minor interference with ADLs

Grade 2:
No major structural pathology, but major interference with ADLs

Grade 3:
No major structural pathology, but + neuro signs on SMR

Grade 4:
Major structural pathology

Grades 1+2 = NS neck pain
Grade 3 = NRC
Grade 4 = serious pathology

Question 2

When is the dx of NSNP used?

Answer 2

• ruled out serious pathology
• ruled out NRC
• ruled out a NON MSK cause of NP
• MVA not involved
• remember 90% of people have NSNP

Question 3

Red flags

Answer 3

Cancer
Vertebral infection
Osteoporotic fracture
Traumatic fracture
VBAI
Brain haemorrhage
Inflammatory arthritis

Question 4

Define motor control

Answer 4

• use of neuromuscular system to activate/coordinate muscles and limbs in order to perform a skill
• requires an integrated system:
  > sensors - to sense the body
  > control system - determine requirements for stability + plan appropriate responses
  > muscles to execute

Question 5

What is Panjabi’s model of spinal stability

Answer 5

Active (mm’s) - 80% of stability
Passive - ie. osseoligamentous - 20% of stability
Control/neural

Question 6

Define stability and instability

Answer 6

Stability:
- the mm stiffness needed for static + dynamic tasks and to dissipate unexpected load disturbances

Instability:
- loss of intergrity = loss of STIFFNESS = more unstable behaviour

Question 7

Describe the feedforward mechanism of motor control

Answer 7

• basically - before any movement, mm’s of the spine first turn on to stabilize it
• 100ms before to 50ms after the prime move turns on
• this mechanism can be inhibited by PAIN

Question 8

Describe the feedback mechanism of motor control

Answer 8

• comes from vision/proprioception

- importnat for motor learning and skill acquisition

Question 9

Isometric strength in neck pain vs controls?

Answer 9

23-29% LESS isometric strength in neck pain

Question 10

What are the changes to the mm’s in the neck with painful states?

Answer 10

• neck pain has less ROM and less activation of DCFs
• increased superficial mm activity (and reduced deep mm activity)
• fatty infiltration
• reduced x sectional area
• mm activation/timing/amplitude of mm activity

Question 11

What are principles of exercise prescription for neck pain?

Answer 11

1. Start early
2. Don’t provoke pain
3. Be precise
4. Address specific impairments in the motor system
5. Task specific/function
6. Reps!
7. Active participation by the patient

Question 12

Describe the 3 phases of cx ex rx

Answer 12

Phase 1:

• low load
• precision and endurance

Phase 2:

• muscle coordination + movement patterns of the neck
• coactivation of DNFs in posture + task specific ex

Phase 3:
- strength+endurance progressed to level required by pt’s work/sport