cervical interventions: techniques and clinical reasoning

key findings w/ mobility deficits

- recent onset of sx

- unilateral/local neck sx w/ possible referral into UQ

- no peripheralization w/ repeated movements

- limited c/s ROM

- pain at EOR

- restricted c/s and t/s segmental mobility

- sx provoked w/ PAIVM or PPIVM

- no sign of n. root compression

interventions for pain w/ mobility deficits

- t/s or c/s mobilization/manipulation

- AROM/PROM to augment mob/manip

- muscle performance, coordination, strengthening

- neural mobilization if altered neurodynamic present

- address functional/regional issues

key findings for pain w/ movement coordination deficits

- neck pain w/ possible referred UQ pain

- sx may be linked to or precipitated by trauma/whiplash

- no central/peripheralization

- no sign of n. root compression

- neck pain w/ midrange movements that worsen at EOR

- DNF and UE strength, endurance, MC deficits

- difficulty w/ repetitive activities

- somatosensory dysfunction

interventions for pain w/ movement coordination deficits

- specific motor control exercises

- general exercises for UQ strength and endurance

- spinal posture education

- muscle lengthening exercises

- task-specific training

- sensorimotor control exercises

key findings for neck pain w/ headaches

- unilateral HA associated w/ neck sx aggravated by neck movements or position

- HA produced/aggravated w/ provocation of ipsilateral soft tissue or joint segments

- restricted c/s ROM

- (+) CFRT

- weak DNF

- active trigger points

interventions for neck pain w/ headaches

- cervical mob/manip

- specific motor control exercises

- general strengthening of UQ muscles

- spine posture education

- muscle/soft tissue lengthening

- MET

- trigger point therapy

key findings for neck pain w/ radicular sx

- neck pain w/ associated radiating pain

- possible UE paresthesia, numbness and weakness

- central/peripheralization w/ repeated movements

- (+) Spurling and ULNDT

- sx possibly provoked w/ PAIVM or PPIVM

- possible regional impairments of mobility or muscle performance

interventions for neck pain w/ radicular sx

- t/s or c/s mob/manip

- intermittent traction

- repeated movements to centralize

- AROM/PROM to augment SMT

- neural mobilizations

- address muscle performance deficits and regional limitations

positional release

find shortened/relaxed position and maintain light pressure for 60-90 seconds

- better if other techniques can't be tolerated

active release

find trigger point and maintain firmer pressure as patient actively lengthens the muscle for 5-8 reps

manual stretch

held for 30-90 sec

when should a cervical closing technique occur?

pain or difficulty rotating or lateral flexing to the ipsilateral side

when should a cervical opening technique occur?

pain or difficulty w/ rotation or lateral flexing to contralateral side