Cervical Spine Treatment Protocol Quiz

Cervical Spine Treatment Research

• A systematic review of randomized trials regarding therapeutic exercises following cervical spine injury identified 1,268 studies.
• Only nine studies met the inclusion criteria.
• Therapeutic exercises included: strength training for the cervical spine, shoulder strengthening (GHJ and STJ), postural education/training, and stretching.
• Individual study results are presented in summary tables.
• The summary tables show the number of subjects (N), interventions, and clinically and/or statistically significant findings.
• One study followed-up on patients beyond 6 months.
• Clinicians should include therapeutic exercises (including strengthening and stretching) in treatment programs for patients with cervical spine pain and/or disability.

Systematic Review Results (Details)

• Several authors (Delive et al. 2011, Hakkinen et al. 2008, etc.) conducted studies with varying participant numbers (N), interventions, and outcomes.
• Authors report decreased pain and/or decreased disability in their respective studies. (SS=Statistically significant; CS=Clinically significant) Some studies showed no change in pain or disability.
• Interventions varied, including strength training for upper extremities (UE) with different frequencies and durations, strength training and stretching for the neck and UE, postural exercises, strengthening and stretching, or high-intensity strengthening.

Cervical Spine Posterior Derangement

• Posterior derangements of the cervical spine can result from trauma, whiplash, or force-flexion mechanisms, or from poor posture.
• Posterior derangements present with single and repeated range-of-motion findings similar to the lumbar spine.
• Examples of positive special tests are the Valsalva Maneuver, Cervical Compression Test, Spurling's Compression Test, and Quadrant Test.
• Positive tests for decreased pain include the Shoulder Abduction Test and the Cervical Distraction Test.

Treatment Procedures

• Treatment for posterior derangements involves repeated retraction/extension exercises to the end-range of motion.
• These exercises should be coupled with patient education regarding proper posture and body mechanics.

Recovery of Function

• Recovery of function involves repeated protraction/flexion exercises to regain motion.
• This step should begin only after the patient has been pain-free for two weeks and should be discontinued if pain returns.
• Flexion exercises should be avoided for the first three hours after waking.
• Patients should undergo prophylactic efforts, including posture correction and avoiding secondary injuries, after the two-week period.

Cervical Spine Anterior Derangement

• Anterior derangements are less common than posterior ones.
• Symptoms often are not referred to the upper extremities.
• The process is similar to Posterior Derangements, with specific exercises and tests.

Cervical Spine Postural Syndrome

• Postural syndrome results from excessive poor posture (e.g., forward head posture during prolonged sitting).
• Symptoms are typically resolved with posture correction.
• Special tests are only positive if the patient displays sustained forward-head postures. These tests may worsen the pain, but correcting posture relives the symptoms.

Computer Ergonomics

• Modifying computer workstations is crucial for cervical spine and postural syndromes.
• Recommendations include adjusting chair features, screen position, keyboard, mouse, and work breaks.

Cervical Spine Flexion Dysfunction

• Flexion dysfunction is the loss of cervical flexion range of motion, often occurring insidiously after posterior derangement.
• Usually only reports neck pain, without peripheralization, so there is no referred upper-extremity pain.
• The Cervical Hyperflexion Test may also be positive.
• Treatment focuses on exercises to restore flexion along with general care for other conditions.

Cervical Spine Extension Dysfunction

• This occurs insidiously, following anterior derangement or facet dysfunction.
• Symptoms are similar to flexion dysfunction, but typically less common.
• Treatment utilizes specific exercises, such as retractions and extensions.

Cervical Spine Adherent Nerve Root (ANR)

• ANRs are associated with prior surgical procedures or traumatic neck injuries
• Symptoms include: radiating pain, and loss of flexion range of motion.
• Neurodynamic exercises (i.e. median nerve, radial nerve, and/or ulnar nerve) are indicated for treating ANRs.

Cervical Spine Entrapped Nerve Root (ENR)

• ENRs are insidiously associated with whiplash or facet injuries.
• Symptoms involve radiating pain along the nerve's dermatome and loss of extension range of motion.
• Special tests and specific exercises (i.e. flexion exercises, and various side-bending and spinal rotation exercises) are indicated for treating ENRs.

Cervical Spine Facet Syndrome

• Facet dysfunction is associated with insidious onset due to poor posture, poor sleeping positions, or repetitive movements (especially in the workplace).
• Treatment typically uses specific exercises and modalities depending on the type of restriction (e.g., retraction for end-range movements).

Cervical Spine Stenosis

• A less common condition than lumbar spine stenosis.

• Primarily results from repeated traumatic injuries

• Testing and stretching should be included in the treatment plans for stenosis.

• More specific testing is part of the diagnosis.