Neck Pain w/ mobility deficits

Question 1

What would you expect to find during an examination in someone with neck pain w/ mobility deficits?

Answer 1

• loss of cervical AROM
• (+) CFRT
• (+) cervical & thoracic segmental mobility tests (cervical flexion lateral rotation test & multiple hypomobile joints)
• cervical & upper quarter MMT & endurance tests & flexibility testing

motion limitation is the primary finding
- absence of radiating pain/trauma
- central or unilateral neck pain

Question 2

What would exclude someone from this category?

Answer 2

• radiating pain to distal UE

Question 3

What is the presentation of neck pain w/ mobility deficits?

Answer 3

• limitations in motion are primarily joint or capsular
• general stiffness & lack of flexibility in cervicothoracic musculature
• may have segmental mobility deficits at several levels that may or may not be painful
• pt w/ OA findings w/o radiating pain

Question 4

What are interventions in the acute stage? (6 weeks)

Answer 4

• thoracic manipulation
• cervical manipulation/mobilization
• cervical ROM exercises
• scapulothoracic and UE stretching/strengthening

Question 5

What are interventions in the subacute phase? (6-12 weeks)

Answer 5

• thoracic manipulation & cervical manipulation &/or mobilization
• neck & shoulder girdle endurance exercises

Question 6

What are interventions in the chronic phase? (12 weeks+)

Answer 6

• thoracic manipulation & cervical manipulation or mobilization
• mixed exercise for cervical/scapulothoracic regions (neuromuscular exercise, stretching, strengthening, endurance, aerobic)
• dry needling, laser, or intermittent traction

Question 7

What is the difference between upper/lower cervical flexion/extension?

Answer 7

Upper:
- primarily atlanto-occipital joint
- chin tuck or head nod forward/upward

Lower:
- neck bends forward/back

Question 8

What is forward head posture a combination of?

Answer 8

• lower cervical flexion and upper cervical extension

Question 9

What is the corrective exercise for forward head posture?

Answer 9

• capital flexion and lower cervical spine extension
• OR a combined retraction (cueing shoulder blades back & down often helps w/ postural correction - helps correct rounded shoulders)

Question 10

What is special about rotation and side bending in the mid & lower cervical spine?

Answer 10

• they are coupled to the same side
• if you work on one, the other will also improve

rotation is often better tolerated than side bending

Question 11

What is special about rotation and side bending in the upper cervical spine?

Answer 11

• they are coupled in opposite directions

Question 12

What would a (+) CFRT indicate a need for?

Answer 12

• upper cervical rotation ROM and manual therapy exercises
• i.e. atlanto-axial rotation MET

Question 13

What does each of the glides in the cervical spine help with?

Answer 13

Central PA: flexion below the level, extension above the level
Unilateral PA: contralateral rotation
Transverse glide: contralateral rotation
Side glide: lateral flexion
Long axis distraction: decompression

Question 14

What are some upper quarter strength & endurance exercises?

Answer 14

• arm bike
• wall serratus push up plus
• banded rows
• serratus punches w/ DB