Neck pain w/ movement coordination impairments

Question 1

What are some common symptoms of those with neck pain w/ coordination impairments?

Answer 1

• MOI linked w/ trauma or whiplash
• referred shoulder girdle or UE pain
• associated varied nonspecific concussive s/s
• dizziness/nausea
• headache, concentration, or memory difficulties, confusion, hypersensitivity to thermal, sound, odor, or light

Question 2

What are some expected exam findings?

Answer 2

• (+) CCFT
• (+) deep neck flexor muscle test
• (+) pressure algometry (pain pressure threshold)
• strength & endurance deficits of neck muscles
• neck pain w/ mid-range motion that worsens w/ end-range positions
• TTP of myofascial trigger points
• neck & referred pain reproduced by provocation of the involved cervical segments
• abnormal movement during cervical ROM

Question 3

What are the 2 scores recorded during the cranial cervical flexion test? (CFFT)

Answer 3

1) activation score -> max pressure held for 10 seconds
2) performance index = max pressure achieved and held for 10 seconds x # of reps up to 10

Question 4

What are the norms for the deep neck flexor endurance test?

Answer 4

Without neck pain:
- 38.95 sec +/- 26.4 sec

With neck pain:
- 24.1 sec +/- 12.8 sec

Question 5

What is the algometric assessment of pressure pain threshold?

Answer 5

• a test of pain processing using a digital pressure algometer applied at the upper trap
• applied perpendicular to muscle in which pressure is increased at a rate of 4-5 N/s then pt will notify PT when pressure turns into pain
• repeated on opposite side

lower scores suggest a local mechanical hypersensitivity
widespread lowered scores raise the possibility of a central nociceptive processing disorder

Question 6

What are some interventions in the acute phase?

Answer 6

Education:
- return to normal, nonprovocative pre-accident activities ASAP
- minimize use of cervical collar
- perform postural and mobility exercises to decrease pain & increase ROM
- reassure pt will recovery w/in first 2-3 months

Multimodal interventions:
- manual mobilization + exercise
- strengthening
- endurance
- flexibility
- postural
- coordination
- aerobic
- functional exercises

Question 7

What are some interventions in the chronic phase?

Answer 7

Education focused on:
- reassurance, education, prognosis, and pain management

Mobilization combined w/ an individualized, progressive submaximal exercise program:
- cervicothoracic strengthening, endurance, flexibility, and coordination
- incorporate principles of cognitive behavioral therapy

TENS

Question 8

What muscles help with cervical stability & muscle control?

Answer 8

Global:
- SCM
- scalenes
- levator scapulae
- Upper/mid/lower trap
- erector spinae
- rhomboids

Deep core muscles:
- DCF (rectus capitis ant & lateralis, longus capitis & coli)
- suboccipitals

Question 9

How can you train the deep neck flexors?

Answer 9

• perform proper technique of deep neck flexor endurance test
• “nod your head or tuck your chin into a double chin”

Sets & reps:
- :10 holds for 10 reps
- :15 sec holds for 5 reps

Question 10

What is a good way to progress deep neck flexor strength?

Answer 10

Change:
- posture of your exercise (sitting, standing, kneeling, quadruped, POE)

Combine:
- combine w/ functional movements

Maintain:
- specific head postures while performing UE tasks

Question 11

What are some interventions to help train these deep cervical flexors?

Answer 11

• maintain chin tuck w/ UE movements in supine
• maintain chin tuck w/ prone I’s/Y’s/T’s
• maintain chin tuck w/ UE movements in functional positions

good to start w/ isometrics