Active care final

What are the normal range of motion's of the cervical spine?

Flexion = ___ degrees

Extension = ___ degrees

Rotation = ___ degrees

Lateral Flexion = ___ degrees

60

80

80

45

T/f: subluxation typically involves all 3 planes of motion

T

How many degrees of rotation occurs in the upper vs lower cervical spine?

50% upper cervical C1/C2= ___ degrees

50% rest of cervical spine C3/C7=__ degrees

40

40

MOST rotation from upper cervical spine come from where?

C1-C2 (mobile)

*40 degrees of 80*

MOST lateral flexion from lower cervical spine comes from where?

lower (stable)

*35 degrees of 45*

How many degrees of motion occurs in the LOWER cervical spine? (TQ)3

35

What is know as the coupled motion of the cervical spine?

Rotation and lateral flexion

Upper C-Spine = lateral flexion with rotation in transverse plane to the _____ side

Lower C-Spine = lateral flexion with rotation in transverse plane to the _______ side

SAME

OPPOSITE

With cervical flexion facets will ____, while with cervical extension they will _____.

Open

Close

What motion of the cervical Spine would result in the anterior compression, posterior displacement?

Cervical flexion

What motion of the cervical Spine would result in the posterior compression, anterior displacement?

Cervical extension

T/f with cervical extension there is MORE space in the foramen/canal.

F (cervical flexion)

What motion of the cervical spine will increase tension of the spinal cord?

What will decrease?

Cervical Flexion

Cervical Extension

What happens to the foramen size with rotation?

Contralateral = ____ in size

Ipsilateral = _______ in size

INCREASES

DECREASES

Lateral flexion has a tensioning effect on _______ nerve roots + dura

contralateral

What happens to the nerve roots and dura with contralateral flexion?

Contralateral= tensioning

Ipsilateral= lengthening

What is stronger: cervical flexor muscles or cervical extensor muscles?

EXTENSORS are stronger because gravity helps flexors

Cervical flexors are __% as strong as extensors

60%

T/f: Reduced neck strength is strongly correlated with neck paint

T

What muscle Act as dynamic ALL, prevents hyperextension?

Longus colli (Initiates and produces stabilization of C-Spine)

What muscle can count act a cervical lordosis?

Longus colli

1. Control → nervous system

2. Active → muscles

3. Passive → spinal column

All make up what?

Stability subsystems

What is the goal on an examination?

rule out red flags and develop working diagnosis

What is the Mc diagnosis after an examination of the cervical spines?

postural dysfunctions

:

1. Anterior Head Carriage

2. Head Extension

3. Founded forward shoulders/hyperkyphosis

4. Elevation of shoulders

5. Winging scapula

Are all examples of what?

Postural dysfunction

What gender is mc affected by neck pain?

What age?

Females

Middle Aged

Sleep disorders, smoking, sedentary lifestyle, stress are all risk factors for what?

C-spine pain

Non-specific neck pain with radiating symptoms into 1 arm... what is your initial hypothesis?

Cervical radiculopathy

Neck pain, bilateral UE symptoms with occasional balance disturbance or coordination deficits... What is your initial hypothesis?

Cervical myelopathy

TQ: What is the MC diagnosis of neck pain?

NON-specific neck pain or mechanical neck pain (non-traumatic)

T/f The majority of neck pain can be categorized as benign spinal problems with NO neurological deficit (90%)

T

Know this:

What method do you "do the opposite of what you find"?

George Costabza Method (lack of motion? → improve motion)

What are the MC muscles to find cervical trigger points?

Trap and SCM

Where are trigger points located?

Brain

What is the timing for posture-based exercises? (TQ)

- Isometric hold 3-5 seconds

- 5-10 reps

- Every 15-20 minutes

Which directional preference is most common in the cervical spine?

Extension / Lower Cervical Retraction

What is used to Increase upper cervical joint motion in flexion/extension and strengthen deep neck flexors?

Cervical nodding

What exercise is best for Peripheralize symptoms?

Repeated Loading (retraction + extension)

What exercise is specifically used to improve mobility?

CARs

What is used to Increase upper cervical joint motion in rotation?

SNAGs

What is used to Strengthen deep neck flexors?

Neck planks and positioning isometrics

What is used to Strengthen deep neck flexors and reduce neck pain?

Resistance Band Neck strengthening

What is used for FUNCTIONAL management, phase 2/3?

Wall angels

What is used for FUNCTIONAL strength?

YTWL Scapular Retractions

What is used to Strengthen deep neck flexors and scapular retractors/depressors?

Wall slides

Prone stability ball pull-apart

Sphinx with band

What is used for cervical spine stability and strengthening

Prone swimmers

DNS positions

What type of dysfunction is MC in the thoracic spine: mobility or stability?

Mobility

1. Mobility 1st!!! TQ

2. Motor Control

3. Functional Patterning

These steps describe what?

Movement Hierachy

- Sit at edge of chair, turn feet out slightly, wider than hip width

- Retract chin and elongate head toward ceiling

- Drive feet into ground and reach palm of hands towards the ground

- Deep breath with abdomen, rotate arms outward, spread fingers wide

- 8-10 reps, 2x day

These steps describe what exercise?

Burgers posture break

- Restoring balance of tonic (deep stabilizers) and phasic (global) muscles

- Reposition spine, pelvis and rib cage

- Deep breathing

- Perform consistently with intention

What the main focus of what exercises?

Postural exercise

What are the primary muscles for breathing?

What focuses on inhalation?

What focuses on exhalation?

Diaphragm and elastic recoil

Diaphragm

Elastic recoil

- Activates parasympathetic nervous system

- Affects head posture

- Filters, warms and humidifies air

- Brings more oxygen to cells

- Improve memory and cognitive awareness

What has the ability to do all these things?

Nasal breathing

What type of breathing increases HR?

What decreases?

Inhalation

Exhalation

Which is not a primary muscles in the core container?

A. Transverse AB

B. Pelvic floor

C. Multifidi

D. Diaphragm

E. QL

QL

- Inhalation draws diaphragm down toward pelvic floor

- Abdominal walls expand equally in a cylindrical manner

- Sternum moves up, intercostal spaces expand minimally at the end of inhalation

- "BUCKET HANDLE"

All describe what?

Normal, Diaphragmatic Breathing

What are the 2 types of faulty breathing pattern?

Apical/chest

Paradoxical

What faulty breathing is described as excessive upward movement of sternum/shoulders?

Apical/chest

What faulty breathing is described as opposite, abdomen draws in during inhalation?

Paradoxical

Look for shallow breathing, rapid/uneven inhale/exhale, tension in face/jaw, frequent yawns**

Are ways to identify what?

Faulty breathing

Retraining breathing focuses on what 2 factors?

IAP and spinal stability

- Cat/cow

- Spinal segmentation

- Prayer stretch

- Thoracic roll-outs

- Elbows supported extension w/ dowel or T-Spine extensions

- Foam roller extensions

- Vertical foam roller with arms overhead

These are all good workouts for what?

Thoracic mobility

T/f: 90% of back pain is considered non-specific low back pain

T

Be familiar with the 10 facts of low back pain.

1. Persistent back pain can be scary but it's rarely dangerous

2. Getting older is not a cause of back pain

3. Persistent back pain is rarely associated with serious tissue damage

4. Imaging rarely shows the cause of back pain

5. Pain with exercise and movement does not mean you are doing harm

6. Back pain is NOT caused by "bad posture"

7. It is NOT caused by a "weak core"

8. Backs do not "wear out" with everyday loading and bending

9. Pain flare-ups do not mean you are damaging yourself

10. Injections, surgery and strong drugs usually are not a cure

!!

What is cause by OVERACTIVE erector spinae + hip flexors and Inhibited abdominals?

Lumbar hyperlordosis

What is cause by OVERACTIVE hip flexors and Inhibited glutes + abdominals?

Anterior pelvic tilt

What is caused by OVERACTIVE glutes + hamstrings and Inhibited hip flexors + low back?

Posterior pelvic tilt

What is caused by OVERACTIVE external hip rotators and Inhibited internal hip rotators?

Foot flare

What is caused by OVERACTIVE hip adductors and Inhibited hip abductors?

Knee vagus

What motion occurs in the lumbar spine during sitting?l

Lumbar spine flexion

What timeframe does tissue deformation begin to occur with sustained posture?

Temporary deformation occurs after ~20 minutes of sitting with sustained posture

Does sitting tend to be an aggravating or relieving factor for those with LBP?

Yes because flexion can place increased stress on lumbar spine

(Variable posture is the best)

What happens to the lumbar extensors during full spinal flexion?

Silence of lumbar extensors, passive tissues take over

Is spinal flexion avoidable? Can we even really maintain a "neutral" spine?

Spinal flexion is unavoidable (Spinal flexion is highly functional)

(MOST of our time is spent in flexion and MOST activities require flexion)

Does flexing the spine tend to be an aggravating or relieving factor for those with LBP?

Aggravating factor**

Do people without LBP spend more time in flexion or extension throughout the day?

Still flexion but they spend more time in extension

Do people with LBP spend more time in flexion or extension throughout the day?

Flexion, 0 hours in extension

Is flexion during lifting a risk factor for developing LBP?

No evidence that supports this

(Avoid flexion only IF flexion is an aggravating factor in the acute stage)

What time of day is the injury most likely to occur?

Early morning and after prolonged sitting

functionally incorporate the lumbar spine with the surrounding regions is a goal of what?

Active care

What is the idea of developing skills of independent contraction?

Segmental stabilization

When is segmental stability action best?

Early rehab

1. Core instability

2. Breathing dysfunction

3. Hip mobility dysfunction

4. Thoracic Spine Dysfunction

5. Poor control of posterior pelvic tilt

All make up what?

Primary Dysfunctions of LPH Region

What is front bridge planks for?

Anterior chain stability

a. Elbows stacked beneath shoulders with both feet dorsiflexed and hip width

b. Spine neutral

What exercise is being described?

Front bridge and curl up

What makes up the McGill Big 4 + Deadbug?

1. Anterior bridge

2. Side bridge

3. Curl up

4. Bird dog

5. Dead bug

What exercise is best for lateral chain stability?

Side bridge

a. Feet scissor or stacked position

b. Spine neutral

What exercise is being described?

Side bridge

a. Hands under lumbar lordosis to maintain neutral position, 1 leg bent

b. Pull your head, shoulders and chest off the floor as though they were locked together

c. Cervical spine remains in retracted position

What exercise is being described?

Curl up (anterior chain stability)

What exercise is best for posterior chain?

Bird dog

a. Start in neutral position on all 4's

B. Move alternate limbs from midline (R arm, L leg)

This is describes what exercise?

Bird dog

a. Supine with arms up toward ceiling and hip/knees bent to 90 degrees

b. Move alternate limbs from midline

c. Keep lumbar spine contraction

This describes what exercise?

Dead bug

rectus abdominis, transversus abdominis, obliques

These muscle make up what chain?

Anterior

paraspinals, extensors, glutes, hamstrings

These muscles are apart of what chain?

Posterior

obliques, QL, gluteus medius

All make up what chain?

Lateral

TQ: Is it best to work on pelvic tilt or hip hinge first?

Pelvic tilt

Supine → prone → quadruped → stacked → standing

This is the steps of what?

Pelvic tilt

Quadruped rockbacks → half-kneeling → tall-kneeling → standing

This is the steps of what?

Hip hinge

TQ: The 90/90 shinbox exercise is best for addressing which LPH dysfunction?

Hip mobility dysfunction

(Other hip: glute bridges, marches, clam with band, fire hydrants)

Squat, Lunge, Push/Pull, Carry, Hang, Roll/Crawl

Are all good for what?

Higher Level LPH Rehab - Foundational Movements (Phase 2/3)