Neck pain w/ movement coordination impairments (clinical instability)

spine stability

spine’s ability, under physiologic loads, to maintain its pattern of displacement so no neuro damage/irritation/deformity development/incapacitating pain occur

passive, active, neural

3 subsystems of functional spinal stability

passive

spinal stability provided by spinal column

bone, jt, lig, disc; elongated m-t

passive subsystem: all passive structures (___) and the passive resistance from an ___

active

spinal stability provided by ms

active

spinal ms/ts that provide control of vertebral segs

neural

spinal stability provided by body’s sense of control

neural

all structures responsible for coordinating m contraction thru/o C/PNS

neutral and elastic

2 zones of the spine

neutral zone

motion around mid-position; minimal passive resistance

neutral zone; active and neural

.___: mid portion of range w/ least amount of passive resistance (similar to loose-packed position) which requires ___ subsystem to contribute most to spinal control

elastic zone

motion around end range; against passive resistance

elastic zone; passive

.___: portion of range w/ the most passive resistance; much of control here is thru ___ subsystem

neural zone; elastic zone; active and neural

clinical instability: increased size of ___; reduction of passive resistance to motion in ___; inability for the ___ subsystems to accommodate this lack of passive control

clinical instability

term to describes what occurs w/ a large neutral zone, either congenital or acquired

neutral zone, elastic zone, passive

if spine stiff, ___ decrease and ___ increase, result in an increase in ___ resistance and less reliance on active/neural subsystems for control

prolonged end-range position, stress from awkward/dysfuncal movement patterns

causes of recurrent strain to lig, m, t, and/or jt tissues

coordination/endurance, flexibility/strength

causes of m performance deficits of neck and upper quarter ms

uncoordinated, end-range, global ms

pts often report sxs related to ___ movement thru neutral zone, sustained loading of passive structures at ___, fatigue/increased resting tone of ___

C multifidi, longus coli/capitus

local muscles

coordination, endurance

local muscle impairments that cause clinical instability

C multifidi

deep neck extensors, provides control via segal attachments postly

longus coli/capitus

deep neck flexors; provides control antly

flexibility, coordination, resting tone

global muscle impairments that cause clinical instability (upper trap, levator scap, scalenes, SCM)

local m

by addressing ___ impairments, most global m performance deficits resolve

myofascial trigger points

addressing this may help w/ pain control and m performance

moskel

affected system

lig, m, t, NS

affected structures

nociceptive

pain mechanism

none

phase of healing

neck/referred UE, fatigue, instability/shaking/lack control, acute attacks, sharp

general sxs: ___ pain; hx of trauma; ___ and “inability to hold head up”; feels better w/ external support; frequent need for self-manipulation; feeling of ___ w/ head movement; frequent episodes of ___; ___ pain w/ sudden movements

dull ache across bilat; sharp/localized

pain described as ___ neck/shoulders, but may be ___ w/ sudden/uncontrolled movements

static WB (sit/stand), uncontrolled

agg factors: prolonged ___; ___ movements

sit

WB position that causes more C protraction

stand

WB position that causes more C retraction

sagittal plane

uncontrolled movement while moving thru neutral zone usually w/ ___ motions of flex/ext causing abnorm tissue loading during RoM

position change, self-manipulate, NWB positions, external support, C ARoM/stretch

easing factors

morning

24hr pattern: best time of day for clinical instability

aberrant motions

sudden de/accelerations (shake, judder, poor neurom control)

aberrant/unsmooth motions (seg hinging, pivot, fulcruming), pain in mid-range that worsens at end-range

AROM results

NWB (supine), WB (sit/stand)

ARoM is greater in ___ than in ___

hypermobile w/ loose; hypomobile at adjacent

PIVM: ___ end-feel; possible ___ segs

deep neck flexors; extensors

assess isolated ___ for neurom control and endurance; once cleared then can asses global neck flexors and deep neck ___

acute

idiopathic neck pain has variable recovery w/ slowing of progress noted at 6-12 wks from onset

chronic

non-specific, atraumatic neck pain may be stable of fluctuating w/ periods of improve/worsening

movement coordination impairments (clinical instability)

Pts w/ ___ often report worsening over time, w/ increasing frequency/duration of sxs and shorter bouts of time in btwn episodes

endurance/coordination, decrease stress, neutral zone

overall goal of treat: enhance ___ of local spinal ms; ___ on involved spinal segs; increase capacity of subsystems (active and neural) to compensate for increased ___