Cervical Spine

• characteristics of articular dysfunction:

  • asymmetry of motion
  • alteration of mobility
  • modification of muscular activity
  • alterations of tissue texture
  • presence of symptoms
• the state of the health of the IVD is a determining factor in the stability + physiological mobility of the vertebral segment
• asymmetry in the morphology of a joint can cause asymmetrical mobility without implying the existence of an articular dysfunction
• a positional alteration occurs in a vertebral segment when its resting position is altered even when ROM is full
• positional alteration is primarily adaptive + the limitation to movement does not apply the existance of a restrictive barrier even when it is painful
• joint pain leads to changes in the activity of the muscles that regulate the mobility of the joint
• inhibition of deep stability muscles is associated with a compensatory increase of activity of superficial muscles which increases muscular imbalances
• muscular inhibition usually occurs in the deep muscles local to the involved joint that performs a synergistic function to control joint stability
• upper + deep cervical flexor muscles lose their endurance capacity in subjects with neck pain or headaches
• criteria of joint dysfunction:

  • altered mobility
  • abnormal quality of resistance perceived during articular mobilization
  • provocation of local +/or referred pain
• factors to be considered in the diagnosis of joint dysfunction:

  • mobility
  • muscle control
  • tissue changes
  • symptom provocation
• primary hypermobility occurs as a consequence of an acute trauma or overuse of the vertebral segment
• compensatory hypermobility occurs secondary to neighboring hypomobile joints
• frequent causes of cervical compensatory hypermobility are hypomobility of the cervicothoracic region or a rigid thoracic kyphosis
• convergence joint dysfunction:

  • pain + restriction of movement follow regular closure or compressing pattern
  • unilateral regular closure pattern with a restriction of extension + ipsilateral side-bending + rotation
  • improved with segmental distraction

  
• joint dysfunctions are often the result of pathological conditions in the facet joint or disc
• the state of health of the IVD is the determining factor in the stability + physiologic mobility of the vertebral segment
• divergence joint dysfunction pattern:

  • pain + movement restrictions follow regular opening or stretching pattern
  • seen in subacute or chronic conditions - capsule has lost extensibility
  • unilateral regular opening pattern with restriction of flexion + contralateral side bending + rotation
• identify the facet joint referral patterns:

  A) C3-4

  B) C2-3

  C) C4-5

  D) C6-7

  E) C5-6

  
• identify the facet joint referral patterns:

  A) C2-3

  B) C3-4

  C) C0-3

  D) C2-4

  E) C6-7

  F) C7-T1

  G) C4-5

  H) C4-6

  I) C4-6

  
• cervical facet dysfunction most commonly involves a pain-generating source located toward posterior elements of spine behind intervertebral foramen + associated nerve roots
• C7 is the longest spinous process known as vertebra prominens
• C7 seems to become very prominent with flexion + disappears with extension; T1 does not change much with movement
• all segmental dysfunctions of typical cervical joints must have either a flexion or extension component
• lateral glide PIVM:

  • tests passive lateral glide of C2-T1
  • pt in supine with neck brought into slight flexion
  • lateral force applied to articular pillars
  • general mobility assessment of uncovertebral joints, facet joints, + neural tissues

  
• a unilateral PA glide on the transverse process causes contralateral opening + ipsilateral closing
• figure 8 test:

  • series of scouring motions performed in sequence
  • head + neck are taken through figure 8 in both directions
  • + = consistent crepitation produced in same motion, consistent block, or inconsistent block
• when the deep neck flexors or lower segmental extensors are weak, the pt will demonstrate occipital extension upon attempting to flex the head/neck region - suggests SCM is taking place
• a deficiency in endurance of deep neck flexors is associated with:

  • neck pain
  • forward head posture
  • cervicogenic + tension type HA
• anterior neck flexor endurance test:

  • pt in supine + asked to retract the chin
  • pt instructed to hold position
  • normal: 46.9 sec
• posterior neck extensor endurance test:

  • pt in prone + asked to retract chin
  • stabilized at T2-4 with a belt
  • pt instructed to hold position
  • normal: 151 sec
• neck stabilizing program should include an emphasis on strengthening the deep segmental muscles:

  • longus capitis + colli
  • suboccipitals
• whiplash: acceleration-deceleration mechanism of energy transfer to the neck
• WAD clinical findings:

  • UMN signs + symptoms
  • periodic loss of consciousness
  • loss of concentration + short term memory
  • difficulty swallowing
  • pt unwilling to move neck
  • painful weakness of neck muscles
  • gentile traction + compression of neck painful
  • severe muscle spasm
  • complaints of dizziness
  • insomnia + depression
• WAD source of symptoms:

  • soft tissue
  • joint capsule + ligaments
  • facet joints
  • central or peripheral neurologic systems
  • IVD
  • dorsal root ganglia
  • vascular or visceral structures