Neck pain with mobility deficits

what are the diagnoses we may encounter here?

• spondylosis: degenerative disc disease, often referred to as OA of the neck that is seen in >85% of individuals >60

• facet syndrome: in conjunction with DDD and the source of nociceptive pain

• neck stiffness: potential source of symptoms for stiffness are acute facet dysfunction (sleeping funny) or a muscle strain

what are the subjective exam findings here?

• F>M

• age <50

• often result of awkard position or movement

• isolated to the neck with referred pain to the shoulder or scapula

what are common symptoms here?

• central or unilateral neck pain

• limitations in CROM that reproduce comparable symptoms

• associated shoulder girdle or UE pain (referred NOT radiating)

what are the patient reported outcome measures we can use here?

• neck disability index: looks like the oswestry but for the neck

• NPRS

• VAS

• PROMIS

• OSPRO-YF

what are the expected ojective exam findings?

• limited CROM

• pain at end ranges of A/PROM

• restricted cervical and thoracic UPAs/CPAs that fits the subjective complaints

• neck and referred pain reproduced with palpation of muscles or CPAs/UPAs

• weakness scapulothoracic muscles

• poor scapulothoracic motor control

what are some of the ways that thoracic mobility matters here?

• relates to the patients symptoms or functional limitations, specifically turning while driving and shoulder pain with overhead activity

• influences cervical or shoulder movement, specifically limiting cervical rotation or extension

• changes the comparable signs with test-retest, specifically symptoms that change with postural correction and a forward heas posture that effects movement

• helps the patient tolerate exercise or functional movement

discuss the prognosis for neck pain with mobility deficits.

negative factors include older age and prior hs of neck pain

course of care is 6-12 visits over 6 weeks

in general, discuss the CPR for cervical manipulation

if they have stiffnes, ROM differences side to side, are more acute, and think itll work, then you should manip. however, cervical manipulations dont hold as much sway over mobilization as compared to the lumbar spine where evidence shows manipulation has better improvements

in general, discuss the CPR for thoracic manipulation

again, if the pt is more acute, if symptoms stay local, have limited CROM

what are patient perspectives?

• short summaries designed to help patients understand research findings

• they can help clinicians explain treatment options in plain language, support shared decision making, discuss expected benefits and limitations, encourage active patient participation, and connect evidence to the patients goals

what does the 2012 manipulation of the neck and upper back patient perspective say?

• manual therapy may help some patients recover more quickly

• treatment should be selected based on examination findings

• not every patient is appropriate for manipulation

what doest the 2013 manual therapy plus exercise patient perspective say?

• combining manual therapy with exercise may lead to quicker pain reduction

• exercise helps patients continue improve outside the clinic

• active participation is an important part of recovery

what is moderate vs weak evidence for acute treatment?

• moderate: thoracic manipulation, ROM exercises, scapulothoracic and UE strengthening

• weak: cervical manipulation/mobilization

what is moderate vs weak evidence for subacute treatment?

• moderate: neck and shoulder endurance exercises

• weak: thoracic manipulation/mobilization

what is moderate vs weak evidence for chronic treatment?

• moderate: thoracic manipulation and cervical manipulation/mobilization + mixed exercise for cervical/scapulothoracic region with neuromuscular exercise, postural training, stretching, strengthening, endurance training + modalities

• weak: neck, shoulder, trunk endurance exercises + patient education