neck

neural provocation

  • what is radicular pain

    referred pain from the neck to the upper limb

  • what is a radiculopathy

    compression of the nerve causing neurological signs

  • what is a peripheral neuropathy

    damage to the secondary nerves located at the periphery of the body

  • peripheral neuropathy symptoms

    . Numbness or tingling in feet or hands . Sharp or shooting pain . Loss of coordination . Balance . Muscle weakness, excessive sweating . Bowel, bladder or digestive issues

  • neck RED FLAGS

    • cervical myelopathy

      • hand clumsiness and handwriting deterioration

      • altered sensation hands and feet

      • walking imbalance

    • motor neuron disease

    • multiple sclerosis

  • cervical radiculopathy treatment

    • intermediate phase

      • aqua rehab

      • neural mobilisation

    • strength and condition

    • later

      • swimming

cervical spine disorders

  • cervical myelopathy signs and symptoms

    • hand clumsiness and handwriting deterioration

    • altered sensation hands and feet

    • walking imbalance

    • hyperreflexia, positive babinski and hoffmans

  • cervical spine-related impairments

    • muscles

      • change in activation of deep muscles compared to superficial

      • decreased submaximal strength and endurance

    • cervical sensorimotor system

      • joint position sense disturbance

      • postural stability disturbance

      • altered oculomotor control

  • physio management

    • cervical and thoracic mobilisation

    • dry needling

    • neural mobilisation

    • strength exercises

  • physio exercise prescription

    • stage 1

      • motor learning, small muscles

    • stage 2

      • strengthening and endurance

  • physio intervention for mobility deficits

    . Acute: Provide thoracic manipulation, neck ROM exercises, scapulothoracic and upper extremity strengthening. May Provide - CxV +/- mob . Subacute: Cx and shoulder girdle endurance exercises, May provide Tx/Cx manipulation /mobilization . Chronic: Multimodal - Thoracic manipulation and cervical manipulation or mobilization

Clinical implications of anterior and posterior osteophytes (3 marks)

  • Anterior osteophytes:

    • May compress oesophagus or pharynx → dysphagia, odynophagia, or globus sensation.

    • Can restrict cervical flexion.

  • Posterior osteophytes:

  • Narrow intervertebral foramina → nerve root compression → radicular pain, paraesthesia, weakness.

  • May encroach on spinal canal → cervical myelopathy (gait disturbance, hand clumsiness, hyperreflexia).

  • Can contribute to mechanical restriction of extension/rotation.

Subjective & physical findings in vertebrobasilar insufficiency (6 marks)

Subjective findings:

  • Dizziness/vertigo, especially with neck rotation or extension.

  • Visual disturbances (diplopia, blurred vision).

  • Nausea, vomiting.

  • Dysarthria, dysphagia.

  • Drop attacks or syncope.

  • Tinnitus or hearing changes.

Physical examination findings:

  • Symptoms provoked by vertebral artery test (cervical extension + rotation).

  • Nystagmus, unsteadiness, loss of balance.

  • Neurological signs: dysmetria, limb weakness, sensory changes.

  • Reproduction of dizziness with sustained cervical rotation.

1.  Mr. Francis attends your clinic complaining of long standing neck pain and also headaches following a MVA 10 years ago.

a)  Discuss findings which would help you confirm a cervical origin for his symptoms

-          Assessing cervical spine ROM passively and actively with overpressures looking for reproduction of symptoms

-          Past history of a motor vehicle accident signifying possible whiplash and disareangment of cervical structures

-          assessment of muscle tightness and activation of deep muscles

-          ruling out cervical myelopathy and asking red flag questions such as altered sensation, walking imbalance

10 marks

 

b)  with reference to the literature outline the benefits of an active exercise program for his condition

Benefits include:

  1. Pain reduction

    • Strengthening and endurance training of cervical and scapular muscles reduces nociceptive input and improves pain thresholds.

    • Isometric and dynamic exercises shown to reduce headache intensity and frequency.

  2. Improved function and ROM

    • Mobility and stretching exercises restore cervical ROM, reducing stiffness.

    • Functional exercises improve ability to perform ADLs.

  3. Postural correction

    • Deep neck flexor training and scapular stabilisation correct forward head posture, reducing mechanical stress on cervical joints.

  4. Neuromuscular control

    • Proprioceptive and sensorimotor training improves cervical joint position sense, often impaired after whiplash.

  5. Reduced headache frequency and disability

    • Studies show exercise programs significantly reduce headache days per month and improve Neck Disability Index (NDI) scores.

  6. Psychological benefits

  • Active self-management reduces fear-avoidance, improves confidence, and enhances quality of life.