W1-2. Interventions Neck Pain CPG

Interventions Neck Pain CPG

What are the main neck pain classifications in the 2017 Neck Pain CPG?

Neck pain with mobility deficits
Neck pain with movement coordination impairments
Neck pain with headache
Neck pain with radiating pain

What is lower cervical flexion?

Forward bending of the neck involving the lower cervical spine

What is upper cervical (capital) flexion?

Primarily motion at the OA joint, performed as a chin tuck or head nod forward

What is lower cervical extension?

Backward bending of the neck with the head looking toward the ceiling

What is upper cervical (capital) extension?

Extension occurring primarily at the OA joint with eyes moving upward

What cervical positions make up forward head posture?

Lower cervical flexion combined with upper cervical extension

What exercise corrects forward head posture?

Upper cervical flexion with lower cervical extension (cervical retraction)

Why does cueing scapular retraction help posture correction?

It reduces scapular protraction, supporting cervical alignment

How are rotation and sidebending coupled in the mid and lower cervical spine?

They are coupled to the same side (ipsilateral)

How are rotation and sidebending coupled in the upper cervical spine?

They are coupled in opposite directions (contralateral)

What does a central PA glide produce in the cervical spine?

Flexion below the segment and extension above the segment

What motion results from a unilateral PA glide?

Contralateral rotation

What is the purpose of a lateral glide in the cervical spine?

Produces lateral flexion

What is the effect of long-axis cervical distraction?

Spinal distraction and decompression

What must be screened before cervical mobilization?

Red flags, ligamentous instability, and vertebrobasilar insufficiency (VBI)

Why is rheumatoid arthritis a precaution for cervical mobilization?

Increased risk of cervical subluxation and vertebral artery compromise

How is the upper trapezius stretched?

Depress the scapula and sidebend away, adding slight flexion and rotation toward the muscle

How is the levator scapulae stretched?

Depress the scapula, rotate head away, and flex toward the opposite axilla

How are scalene muscles stretched?

Perform cervical extension, sidebending, rotation, and contralateral arm extension

What does the Craniocervical Flexion Test (CCFT) assess?

Deep neck flexor activation and endurance

How is the CCFT performed?

Patient supine with pressure cuff at cervical lordosis starting at 20 mmHg, increasing by 2 mmHg increments and holding 10 seconds without compensation

What two scores are recorded during the CCFT?

Activation score and performance index

What does the Neck Flexor Endurance Test measure?

Time a patient can maintain cranial cervical flexion while lifting the head against gravity

What is the average endurance time for patients with neck pain?

Approximately 24 seconds

What does algometric pressure pain threshold (PPT) testing assess?

Central and peripheral pain processing sensitivity

What is allodynia?

Pain response to a normally non-painful stimulus

What is hyperalgesia?

Exaggerated pain response to a painful stimulus

What does localized reduced PPT suggest?

Local mechanical hypersensitivity

What does widespread reduced PPT suggest?

Central nociceptive processing dysfunction

What are considered global cervical muscles?

SCM, scalenes, levator scapulae, upper trapezius, erector spinae, rhomboids, mid/lower trapezius

What are deep cervical stabilizing muscles?

Deep neck flexors, longus capitis, longus coli, rectus capitis muscles, suboccipitals

Who benefits from deep neck flexor training?

Patients with deficits on CCFT or neck flexor endurance testing

What cue is commonly used for deep neck flexor activation?

“Gently nod your head” or “make a double chin”

How is cervical stabilization progressed?

Changing posture, adding functional movement, maintaining posture during UE tasks

Why are unstable surfaces used in cervical stabilization?

They increase demand on cervical stabilizing musculature

What does the Cervical Flexion-Rotation Test (CFRT) assess?

Passive rotation ROM at the C1–C2 segment

What defines a positive CFRT?

Rotation less than 32° or a side-to-side difference of at least 10°

What condition commonly shows reduced CFRT ROM?

Cervicogenic headache

What tests make up the cervical radiculopathy clinical prediction rule?

Spurling test, distraction test, ipsilateral rotation <60°, ULTT

What does a negative ULTT help with clinically?

Ruling out cervical radiculopathy

What does a positive Spurling test indicate?

Reproduction of upper extremity symptoms due to foraminal compression

What does the cervical distraction test assess?

Symptom relief with traction indicating nerve root involvement

What are typical parameters for intermittent mechanical cervical traction?

10–25 lb max pull, 30:10 or 60:20 on/off ratio, 10–20 minutes duration

What is the goal of cervical traction?

Symptom reduction and centralization

What are neural gliders and sliders used for?

Moderate to highly irritable radicular symptoms

What is the goal of neural mobilization?

Decrease symptoms without increasing neural tension