c-spine mobility

neck pain w/ mobility deficits - common sxs

- neck pain (central or unilateral)

- ROM and mobility restrictions

- shoulder girdle or UE pain may be present

neck pain w/ cervicogenic headache - common sxs

- Non-continuous unilateral neck pain and associated headache

- headache increased by neck movements or sustained positions

for OA and AA joints, SBing and rotation are coupled [ipsilateral/contralateral]

contralateral

primary motions of OA joint

nodding - flexion/extension (keep eyes level during rotation)

primary motions of AA joint

rotation (attempts to keep head facing forward during sidebending)

OA convex/concave

convex condyles on concave C1 (roll and glide opposite)

R SB at OA & couple movement

roll right, glide left

AND

coupled L rotation R ant, L post

AA convex/concave

convex atlas on convex axis

AA movement during R rotation

- R C1 rolls and glides posterior, inferior

- L C1 rolls and glides anterior, inferior

mid/lower cervical spine includes

C2-7

during flexion, facets are moving

superior, anterior (upglide/opening)

during extension, facets are moving

posterior, inferior (downglide/closing)

in mid/lower cervical spine, sidebending and rotation are coupled [ipsilateral/contralateral]

ipsilateral

in mid/lower c-spine, R rotation = R SBing. what's happening at the facets?

Right: inferior, medial, posterior (IMP)

Left: superior, anterior, lateral (SAL)

what's happening in upper c-spine during retraction?

flexion (roll ant, glide post)

observation - anterior

- head orientation relative to trunk and shoulders

- facial asymmetry

- bruising, swelling

- abnormal skin color

- incisions

- pupil size differences (CNS lesion)

- ptosis

observation - posterior

- head orientation relative to trunk and shoulders

- incisions

- muscle tone/symettry

- scapula position

observation - lateral

- assess cervical and thoracic curve

- CT junction

- FHP

- head on neck

- neck on thorax

- sitting posture

hypothesis with gross loss of rotation vs sidebending

- rotation = upper c-spine

- side bending = lower c-spine

if you have gross rotation ROM loss then what should you text next?

- protraction (ext)

- retraction (flex)

if there is no significant change in ROM when you do protraction and retraction then what should you suspect?

AA dysfunction

if retraction is more limited suspect

ipsilateral posterior OA joint

if protraction is more limited suspecr

contralateral anterior OA joint

if they have an opening restriction they will have painful and/or restricted...

flexion, contralateral SBing rotation

If they have a closing restriction they will have painful and/or restricted...

extension, ipsilateral side bending and rotation

c-spine capsular pattern

- equal limitation of rotation and SBing

- limited extension

- full flexion

upper trap ML

- flexion

- contralateral side bending

- ipsilateral rotation

levator scap ML

- flexion

- contralateral SB & rotation

SCM ML

- contralateral SBing

- extension

- ipsilateral rotation

scalenes muscle length

- contralateral SB

- extension

OA jt assessment - left side tilt and right translation tests

- anterior glide of left OA jt

- posterior glide of right OA jt

OA jt assesment - right side tilt and left translation tests

- anterior glide of right OA jt

- posterior glide of left OA jt

OA jt assesment PPIVM

- pt supine

- put them into either flexion or extension and sidebend and translate

OA jt assessment PAIVM

- pt prone

- PT thumb on lateral mass of C1

- apply anterior force toward patient's ipsilateral eye

AA PPIVM - CFRT

- pt SUPINE

- full cervical flexion, palpate posterior arches of C1, then introduce cervical rotation

- feel for when C1 stops rotating on the contralateral side of the rotation

AA PAIVM

- pt prone with head and neck rotated 30 degrees TOWARD SIDE BEING TESTED

- PT thumb contact at TP of C2

- apply anterior force toward pts mouth

*check anterior: push contralateral C1 anterosuperior

mid/lower c-spine PPIVM

- pt supine

- perform lateral glides to one side first, then the other

- lateral glide induces relative sidebending to the opposite side of the translation force

(L lateral glide = R SBing)

mid/lower c-spine - flexion hypomobility testing

- pt supine

- head and neck flexed w/o allowing a chin tuck

- maintain flexion while producing segmental lateral glide, allowing the head and neck to sidebend

with flexion hypomobility testing, if there's restricted L SBing in flexion, that indicates...

loss of flexion on the right side of the segment (R opening restriction)

mid/lower c-spine - extension hypomobility testing

- pt supine, occiput cupped by PT

- maintain extension by pushing the superior vertebra anteriorly while producing segmental lateral glide

with extension hypomobility testing, if there is restricted L SBing in extension, that indicates

loss of L side extension (L closing restriction)

if resistance occurs before pain then what grades of mobs are indicated?

3 and 4

mid/lower cervical PAIVM

- pt prone

- PT standing at head of bed

- central: both thumbs on TP or SP of same vertebra and apply anterior force

- unilateral: thumb over thumb at TP

Pt has left side suboccipital pain and HA. The pt has a gross loss of L rotation. What are 4 possible joint dysfunctions?

1. L posterior OA

2. R anterior OA

3. L posterior & inferior AA

4. R anterior & inferior AA

Pt has left side suboccipital pain and HA. The pt has a gross loss of L rotation. If L rotation improves with protraction and worsens with retraction what is your hypothesis?

L posterior OA

if a pt has a L posterior OA what PPIVM and PAIVM would you do?

- PPIVM: flexion and R SBing

- PAIVM: C1 L TP (C0 goes posterior)

what should you do for pts with acute neck pain w/ mobility deficits?

- neck ROM

- scapulothoracic and UE strengthening

- cervical mobs

- SNAGs

what should you do for pts with subacute neck pain w/ mobility deficits?

- neck and shoulder girdle endurance exercises

- cervical mobs

- SNAGs

what should you do for pts with chronic neck pain w/ mobility deficits?

- cervical mob

- stretching & strengthening for cervical/scapulothoracic regions

- neck, shoulder girdle, and trunk endurance exercises

OA flexion mob

- PT standing at head of pt with hands around ears and thumb over zygomatic arch

- apply posterior force through pts zygomatic arch or jaw

ex: posterior problem on R --> side tilt L, translate R, rotate R

AA mob

- PT applies full cervical flexion to lock out lower c-spine then adds in rotation

- mobilizing hand at posterior arches of C1

- push anterior towards pts mouth

cervical upglide mob

- restriction in opening (flexion, contralateral SBing & rotation)

- pt supine, translate lateral

- apply anterosuperior force toward the pts contralateral eye

ex: opening problem on the R --> flex and translate R then push anterosuperior on R

cervical downglide mob

- restriction in closing (extension, ipsilateral SBing and rotation)

- pt supine, translate medial

- apply posteroinferior force toward the pts contralateral hip

ex: closing problem on the R --> ext segment and translate L then push posteroinferior on R

SNAGs

sustained nautral apophyseal glides