Podcast
Questions and Answers
What is the medium-term effect of therapeutic exercise on pain in patients with cervical spine injury?
What is the medium-term effect of therapeutic exercise on pain in patients with cervical spine injury?
- Medium and statistically significant (correct)
- No effect
- High and statistically significant
- Medium and not statistically significant
Posterior derangements of the cervical spine can occur due to poor posture.
Posterior derangements of the cervical spine can occur due to poor posture.
True (A)
Name one special test that produces an increase in cervical spine pain.
Name one special test that produces an increase in cervical spine pain.
Cervical Compression Test
The ___ Abduction Test is positive for a decrease in cervical spine pain.
The ___ Abduction Test is positive for a decrease in cervical spine pain.
Match the therapeutic exercise interventions with their corresponding description:
Match the therapeutic exercise interventions with their corresponding description:
Which of the following findings indicates that therapeutic exercise is effective for disability at 1 month?
Which of the following findings indicates that therapeutic exercise is effective for disability at 1 month?
How many studies met the inclusion criteria in the systematic review?
How many studies met the inclusion criteria in the systematic review?
Only one study investigated the effects of therapeutic exercise beyond 6 months.
Only one study investigated the effects of therapeutic exercise beyond 6 months.
How many times should each exercise be performed per hour?
How many times should each exercise be performed per hour?
Seated retraction should be performed without overpressure.
Seated retraction should be performed without overpressure.
What position should the head be in when performing retraction exercises while lying down?
What position should the head be in when performing retraction exercises while lying down?
Cervical spine anterior derangement is primarily caused by a __________ mechanism of injury.
Cervical spine anterior derangement is primarily caused by a __________ mechanism of injury.
Match the cervical spine exercises with their descriptions:
Match the cervical spine exercises with their descriptions:
Which of the following is NOT a recommended exercise for cervical spine treatment?
Which of the following is NOT a recommended exercise for cervical spine treatment?
Anterior derangements in the cervical spine refer pain to the upper extremity.
Anterior derangements in the cervical spine refer pain to the upper extremity.
What should the clinician do while performing retraction with extension?
What should the clinician do while performing retraction with extension?
What is indicated by the finding of ^P NW ERP during retraction and extension testing?
What is indicated by the finding of ^P NW ERP during retraction and extension testing?
The Shoulder Abduction Test is expected to relieve symptoms in cervical spine ENR.
The Shoulder Abduction Test is expected to relieve symptoms in cervical spine ENR.
List two common mechanisms of injury for cervical spine facet syndrome.
List two common mechanisms of injury for cervical spine facet syndrome.
Clinicians should discontinue RROM testing upon finding symptoms of _____ in order to prevent further nerve irritation.
Clinicians should discontinue RROM testing upon finding symptoms of _____ in order to prevent further nerve irritation.
Which of the following exercises should NOT be performed at end-range like a stretching exercise?
Which of the following exercises should NOT be performed at end-range like a stretching exercise?
Match the cervical spine special tests with their respective outcomes:
Match the cervical spine special tests with their respective outcomes:
What should be included in the treatment of cervical spine ENR?
What should be included in the treatment of cervical spine ENR?
Facet dysfunction in the cervical spine is commonly associated with sudden trauma.
Facet dysfunction in the cervical spine is commonly associated with sudden trauma.
What is the baseline finding of cervical spine pain for a patient with flexion dysfunction?
What is the baseline finding of cervical spine pain for a patient with flexion dysfunction?
Cervical spine extension dysfunctions are more common than flexion dysfunctions.
Cervical spine extension dysfunctions are more common than flexion dysfunctions.
What special test is positive for an increase in neck pain in patients with flexion dysfunction?
What special test is positive for an increase in neck pain in patients with flexion dysfunction?
Patients with flexion dysfunction have a minimum range of motion in __________.
Patients with flexion dysfunction have a minimum range of motion in __________.
Match the exercises with their descriptions for treating cervical spine flexion dysfunction:
Match the exercises with their descriptions for treating cervical spine flexion dysfunction:
After waking, if flexion dysfunction is secondary to a previous posterior derangement, what should you avoid?
After waking, if flexion dysfunction is secondary to a previous posterior derangement, what should you avoid?
Protrusion and retraction show any range of motion findings in patients with flexion dysfunction.
Protrusion and retraction show any range of motion findings in patients with flexion dysfunction.
What type of dysfunction occurs following anterior derangement in the cervical spine?
What type of dysfunction occurs following anterior derangement in the cervical spine?
Which of the following cervical spine special tests is associated with an increase in pain?
Which of the following cervical spine special tests is associated with an increase in pain?
Forward head posture can lead to cervical spine postural syndrome.
Forward head posture can lead to cervical spine postural syndrome.
What is the initial recommended exercise for treating cervical spine anterior derangements?
What is the initial recommended exercise for treating cervical spine anterior derangements?
The condition described as abnormal stress on normal tissue is known as __________.
The condition described as abnormal stress on normal tissue is known as __________.
What change is observed in motion findings during repeated range of motion tests in cervical spine postural syndrome?
What change is observed in motion findings during repeated range of motion tests in cervical spine postural syndrome?
What is the only cervical spine special test that will be positive for an increase in neck pain?
What is the only cervical spine special test that will be positive for an increase in neck pain?
Correcting forward head position will often increase neck pain.
Correcting forward head position will often increase neck pain.
Retraction will always result in pain for patients with extension dysfunction.
Retraction will always result in pain for patients with extension dysfunction.
How long does sustained positioning in a forward head posture usually take to result in neck pain?
How long does sustained positioning in a forward head posture usually take to result in neck pain?
What is the prescribed duration for each of the initial exercises for patients with extension dysfunction?
What is the prescribed duration for each of the initial exercises for patients with extension dysfunction?
Match the cervical spine special tests to their outcomes regarding pain:
Match the cervical spine special tests to their outcomes regarding pain:
Patients with cervical spine adherent nerve roots often report __________ pain along the involved nerve root pattern.
Patients with cervical spine adherent nerve roots often report __________ pain along the involved nerve root pattern.
Which exercise is NOT recommended for patients with extension dysfunction?
Which exercise is NOT recommended for patients with extension dysfunction?
Match the range of motion findings with their corresponding conditions:
Match the range of motion findings with their corresponding conditions:
Patients with cervical spine ANR will demonstrate an increase in cervical flexion range of motion.
Patients with cervical spine ANR will demonstrate an increase in cervical flexion range of motion.
What may protrusion cause in patients with cervical spine ANR?
What may protrusion cause in patients with cervical spine ANR?
Flashcards
Cervical Retraction
Cervical Retraction
A movement that draws the chin towards the chest, engaging the muscles in the back of the neck.
Cervical Extension
Cervical Extension
Movement that tilts the head backward, extending the neck.
Overpressure
Overpressure
Applying additional force beyond the normal range of motion to increase stretch.
Cervical Traction
Cervical Traction
A gentle pulling force applied to the head to stretch the neck muscles.
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Cervical Retraction with Extension
Cervical Retraction with Extension
Combining cervical retraction and extension movements to create a specific therapeutic stretch.
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Cervical Anterior Derangement
Cervical Anterior Derangement
An injury of the cervical spine where structures shift forward, often from a whiplash injury.
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Repeated ROM findings for Cervical Anterior Derangement
Repeated ROM findings for Cervical Anterior Derangement
Specific movements and repeated motions that produce consistent symptoms in patients with a cervical anterior derangement. They typically don't involve upper extremity pain.
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Cervical Spine PA Mobilizations
Cervical Spine PA Mobilizations
Therapeutic manual techniques applied to the cervical spine to address joint restrictions and improve movement.
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Therapeutic exercise for cervical spine injury
Therapeutic exercise for cervical spine injury
Exercises including strength training for the cervical spine, shoulder (GHJ and STJ) musculature strengthening, postural education, and stretching.
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Effect of therapeutic exercise
Effect of therapeutic exercise
Therapeutic exercise has a medium and significant short-term (1 month) and intermediate-term (1-6 months) effect on pain and disability.
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Posterior derangement of the cervical spine
Posterior derangement of the cervical spine
A condition resulting from trauma, whiplash, or poor posture, causing limitations in neck movement.
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Findings in posterior derangement
Findings in posterior derangement
Single ROM: Protrusion/Flexion - Nil PDM, Retraction/Extension - Min/Mod ERP. Repeated ROM: Protrusion/Flexion - ^ (P) W PDM, Retraction/Extension - Initial: ^ NW ERP, Later: v AB.
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Valsalva Maneuver
Valsalva Maneuver
A special test for cervical spine derangement, where increased pain indicates a positive test.
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Cervical Compression Test
Cervical Compression Test
A special test for cervical spine derangement, where increased pain indicates a positive test.
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Shoulder Abduction Test
Shoulder Abduction Test
A special test for cervical spine derangement, where decreased pain indicates a positive test.
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Cervical Distraction Test
Cervical Distraction Test
A special test for cervical spine derangement, where decreased pain indicates a positive test.
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Cervical Spine Anterior Derangement
Cervical Spine Anterior Derangement
A condition causing pain in the neck due to a restricted movement, typically involving the cervical discs.
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Protrusion / Flexion
Protrusion / Flexion
Movement of the cervical spine forward, resulting in a decrease in pain in a patient with an anterior derangement.
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Retraction / Extension
Retraction / Extension
Movement of the cervical spine backward, resulting in an increase in pain in a patient with an anterior derangement.
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Cervical Spine Postural Syndrome
Cervical Spine Postural Syndrome
Neck pain caused by prolonged poor posture, especially forward head posture.
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Forward Head Posture
Forward Head Posture
A posture where the head is positioned forward of the body's center of gravity, straining the neck muscles.
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Sustained Positioning Test
Sustained Positioning Test
A test used to diagnose postural syndrome by assessing pain after maintaining a forward head posture for a period of time.
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PA Mobilizations
PA Mobilizations
Mobilizations that use a posterior-to-anterior (PA) force to restore proper movement in the cervical spine.
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Treatment Progression
Treatment Progression
A gradual approach to treating cervical spine problems, starting with basic exercises and progressing to more advanced techniques.
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Cervical Spine ENR
Cervical Spine ENR
A condition where a nerve in the cervical spine is being compressed or irritated.
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Red Light Finding
Red Light Finding
A finding in a physical exam that indicates a need to stop the test and potentially change treatment.
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Cervical Hyperextension Test
Cervical Hyperextension Test
A test where the patient's neck is extended backward to see if it increases symptoms.
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Cervical Spine Facet Syndrome
Cervical Spine Facet Syndrome
A common condition affecting the small joints in the neck causing pain and stiffness.
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Insidious Onset
Insidious Onset
The gradual and often unnoticed development of symptoms.
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Facet Dysfunction
Facet Dysfunction
A problem with the small joints in the neck, often causing pain, stiffness, and limited range of motion.
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Repetitive Activities
Repetitive Activities
Activities performed frequently that can contribute to neck pain and stiffness.
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Flexion Dysfunction
Flexion Dysfunction
A condition where the patient loses neck flexion range of motion, experiencing only neck pain without peripheralization. Baseline pain is 0/10.
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Flexion Dysfunction - ROM Findings
Flexion Dysfunction - ROM Findings
Protrusion and Retraction have no effect. Flexion causes minimal or moderate pain with end range (ERP) on a single ROM, increasing on repeated ROM. Extension has no effect.
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Flexion Dysfunction - Positive Test
Flexion Dysfunction - Positive Test
The Cervical Hyperflexion Test will be positive for increased neck pain.
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Flexion Dysfunction - Treatment
Flexion Dysfunction - Treatment
Exercises include flexion in sitting with and without overpressure to end range, SNAGs for cervical spine flexion, and flexion mobilizations (PA Mobilizations).
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Flexion Dysfunction - Secondary to Posterior Derangement
Flexion Dysfunction - Secondary to Posterior Derangement
Avoid flexion for the first 3 hours after waking and always follow flexion exercises with extension exercises.
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Extension Dysfunction
Extension Dysfunction
A condition where the patient loses neck extension range of motion, experiencing only neck pain without peripheralization. Baseline pain is 0/10.
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Extension Dysfunction - Cause
Extension Dysfunction - Cause
Occurs after an anterior derangement in the spine or repeated facet dysfunction, leading to the loss of extension range of motion.
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Extension Dysfunction - Prevalence
Extension Dysfunction - Prevalence
Extension dysfunction is far less common than flexion dysfunction in the cervical spine.
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Retraction Exercise
Retraction Exercise
An exercise where you gently pull your chin back towards your chest, helping improve cervical spine extension range of motion.
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SNAGs for Cervical Extension
SNAGs for Cervical Extension
Special exercises that target specific nerves and muscles in the neck to improve extension range of motion. They're often used for patients with extension dysfunction.
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Cervical Spine Adherent Nerve Root (ANR)
Cervical Spine Adherent Nerve Root (ANR)
A condition where a nerve root in the neck is stuck or compressed, often caused by previous neck surgery or trauma. This leads to pain and limited range of motion.
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ANR Symptoms
ANR Symptoms
Patients with ANR typically experience radiating pain along the affected nerve root, a loss of cervical flexion range of motion, and a baseline pain score of 0/10.
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ANR and Protrusion
ANR and Protrusion
Although protrusion in the cervical spine can cause symptoms, it's less likely to be the cause of pain in patients with ANR.
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Flexion Dysfunction vs. ANR
Flexion Dysfunction vs. ANR
Both flexion dysfunction and ANR involve limited range of motion in the cervical spine. However, ANR is a more specific condition where a nerve root is stuck, while flexion dysfunction can have various causes.
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Cervical Spine Treatment Research
- A systematic review and meta-analysis of randomized trials on therapeutic exercise following cervical spine injury examined 1,268 studies.
- Of these studies, only nine met inclusion criteria.
- Therapies included strength training for the cervical spine, shoulder strengthening, postural education/training, and stretching.
Systematic Review Results
- Author: Study authors are listed in the table.
- N: Number of subjects included in each individual study.
- Intervention: Specific treatment implemented, details included. Example: "Strength training for UE, BID, 6 days/week x 4 weeks."
- Outcomes: Clinically and / or statistically significant results, example: "Decreased Pain (SS)," or "No change in pain or disability (SS)."
Short-Term and Intermediate-Term Effects of Therapeutic Exercise
- Therapeutic exercise has a medium and significant short-term (1-month) and intermediate-term (1-6 months) effect on pain.
- A moderate, non-statistically significant effect on disability was also found.
- Only one study examined the effects beyond 6 months.
Clinical Implications
- Clinicians should include therapeutic exercises (strengthening and stretching) in treatment programs for patients with cervical spine pain and/or disability.
Cervical Spine Posterior Derangement
- Posterior derangements can result from trauma, whiplash, or poor posture.
- Common findings include single and repeated range-of-motion.
- There are specific special tests positive or negative for increasing or decreasing pain.
- Treatment involves exercises for reduction of the herniation, maintenance, recovery of function, and prophylaxis / prevention.
Cervical Spine Anterior Derangement
- Anterior derangements, while less common than posterior, result from similar injury mechanisms.
- Pain is not typically referred to in the upper extremities.
- Treatment proceeds with a similar progression of exercises as posterior, focused on flexion.
Cervical Spine Postural Syndrome
- Postural syndrome arises from prolonged poor posture.
- Patients report neck pain in a forward-head posture (but not in other positions).
- This readily corrects immediately with posture change.
- Treatment includes correct posture, lumbar and cervical rolls for sitting and sleeping, ergonomic assessment, and driving adaptations.
Computer Ergonomics
- Computer workstation modifications are crucial for both posterior derangements and postural syndrome.
- Workstations should be adjusted for proper seated posture, screen height, arm/wrist placement, and seating to prevent long-term issues.
- Take regular breaks.
Cervical Spine Flexion Dysfunction
- This condition arises from prior posterior derangements, causing a loss of flexion.
- Symptoms include reports of neck pain only, without peripheralization.
- Treatment involves exercises including flexion in sitting, with and without overpressure; SNAGs for cervical flexion; and mobilization.
Cervical Spine Extension Dysfunction
- This condition results from prior anterior derangements and impacts extension range of motion.
- Symptoms are similar to flexion: localized neck pain.
- Treatment includes exercises like retraction in sit/lie and lying extension, as well as SNAG exercises.
Cervical Spine Adherent Nerve Root
- Adherent nerve roots, often post-surgery or injury, involve pain radiating along the nerve path, with reduced flexion range.
- Symptoms include pain along the peripheral nerve and reduced flexion.
- Treatment combines neurodynamics (upper extremity exercises), targeted flexion, and contralateral side-bending and rotation exercises.
Cervical Spine Entrapped Nerve Root
- Entrapment of nerve roots can arise from whiplash or facet dysfunction, exhibiting radiating pain and limited extension ROM.
- Symptoms include pain along nerve path (dermatome), and reduced extension.
- Treatment focuses on mobilization and specific exercises in the same direction, including flexion in multiple positions.
Cervical Spine Facet Syndrome
- Cervical facet syndrome, the most common cervical spine pathology, has insidious onset due to poor posture or repeated motions.
- Pain is localized to the spine, not the extremities.
- Treatment utilizes several exercises to mobilize or manipulate the facet joints including different directions of movement and varying pressures.
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