C&T Active Movements

• Active movements:

  • want to look for:
  • reproduction of symptoms
  • behaviour of pain - does it occur before/during/after
  • quality of movement
  • limiting factor: pain, stiffness, weakness
  • arc of pain
• Active movement add ons:

  • repeated movements
  • sustained movements
  • rapid movements
  • combined movements
• Cervical spine active movements:

  • rotation
  • flexion
  • extension
  • lateral flexion
  • combined movements
  • compare upper CS to lower CS
• Cervical Flexion:

  • pts seated, ensure pts in a neutral position
  • instruct pts to bring their chin toward their chest
  • overpressure: place 1 hand to stabilise the cervicothoracic junction, other hand on top of the head to apply overpressure
• Cervical Extension:

  • pts seated, ensure pts in a neutral position
  • tell pts to look up at ceiling
  • overpressure: stand at pts side, place 1 hand on top of the head and the other hand supports the chin, use webspace between thumb and index finger at the chin to allow for control whilst applying the extension overpressure force
• Cervical Lateral Flexion:

  • pts seated, ensure pts in a neutral position
  • instruct pts to bring their ear to their ipsilateral shoulder, ensure theres no rotation movement occurring
  • overpressure: place 1 hand on the contralateral shoulder to stabilise, other hand on the side of pts head to provide the overpressure force
• Cervical Rotation:

  • pts seated, ensure pts in neutral position
  • stand on the side theyre rotating to, facing them, instruct pts to rotate towards you
  • overpressure: 1 hand supporting the scapula and blocking the thoracic spine, the palm of the hand is placed on the side of the face to over press the rotation movement
• Upper cervical flexion:

  • pts seated, ensure pts in neutral position
  • tell pts to perform a gentle nodding movement with the movement axis through their ears
  • overpressure: stand in front and slightly to the side of pts, 1 hand on top of the head to help stabilise, other hand applies overpressure force through the chin, use hand hold of the webspace between thumb and index finger at the chin to allow for control of the flexion overpressure
• Upper cervical extension:

  • pts seated, ensure pts in neutral position
  • instruct pts to perform a gentle nodding movement upwards, with the movement axis through their ears
  • overpressure: stand in front and slightly to the side of pts, 1 hand on top of the head to help stabilise, other hand applies overpressure force through the chin, use hand hold of the webspace between thumb and index finger at the chin to allow for control of the extension overpressure
• Thoracic spine active movements:

  • extension
  • rotation
  • lateral flexion
  • flexion
  • combined movements
• Thoracic Extension:

  • arms folded across pts chest or hands behind neck
  • tell pts to extend thoracic spine, lifting up through their chest
  • can help stabilise pts by placing hell of hand fingers pointing down the spine
  • overpressure: one hand on the back, other arm under elbows, lifting upwards, pivoting off stabilising hand
• Thoracic Rotation:

  • arms folded across pts chest, twist to the side
  • stand facing pts on the side theyre turning, can also block their knees with your leg
  • overpressure: hand on their shoulders, elbows out with both hands work to produce the rotation
• Thoracic Lateral Flexion:

  • arms folded across pts chest, tilt shoulders and chest bending sideways through the rib cage
  • easiest to monitor range from behind
  • overpressure: 1 hand on the top of each shoulder, make sure both hands work together to localise the side flexion force
• Thoracic Flexion:

  • arms folded across pts chest or hands behind neck
  • instruct pts to bend through their thoracic spine bringing their elbows to the stomach
  • overpressure: place 1 hand on the back in the mid thoracic region whilst other hand applies force through the elbows or folded arms into the stomach
• Combined movements:

  • when performing the technique, ask the pts to perform the first direction of the movement, then when theyre at the end range ask them to move into the second movement
  • once they reach the limit, this might be due to pain or available ROM, its important to ask them what their symptoms are as well as what is limiting them
  • at end range or symptoms/stiffness, you can choose to add overpressure - if pain has already been reproduced, no need to add overpressure