1. Evaluating and Treating the Cervical Spine
10/20/ :42 AM
Evaluating and Treating the Cervical Spine
Colleen Scordato, DPT, Cert. MDT
Orlando Health
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

2. Objectives Better understand physical therapy cervical terminology
Understand cervical anatomy and implications of poor posture
Importance of a good history or subjective to determine diagnosis and treatment
Be familiar with cervical special tests and measures
Treatment is constantly evolving and changing
Importance of home exercise program and education

3. Cervical Spine- anatomy
7 vertebral bodies
8 spinal nerves

4. Cervical Anatomy
Disc
Nucleus Pulposus
Annular fibrosus

5. Common Cervical Diagnosis
Muscular strain
Spondylosis
Degenerative disc disease
Radiculopathy
Disc herniation
Surgeries
ACDF- anterior cervical discectomy and fusion
Discectomy
Laminectomy

6. Subjective/History Work positions Physical activity prior to injury
80% sitting 20% standing and walking
Physical activity prior to injury
Pain rating
Mechanism of injury
Where are symptoms
Cervical, scapular, arm, headaches
When did symptoms begin
Improving, worsening or unchanging
Initial symptoms
Constant or Intermittent

7. Subjective/History What makes symptoms better or worse? Positions
Bending
Sitting
Turning
Lying/Rising
Time of day
Am, as the day progresses, Pm
When still or on the move

8. Subjective/History Previous episodes
Previous or current other treatments
Medications, Chiropractor, Acupuncture, Injections
Red flags
Dizziness, nausea, swallowing, tinnitus
Rapid weight loss
Gait/upper limbs: normal/abnormal
medications
Recent surgeries
Recent trauma
Other medical issues
Night pain

9. Sitting posture
Good, fair, poor
Correction of posture
Lumbar roll

10. Sleeping posture Back, stomach or side Number of pillows Cervical roll
Arm under or curl pillow
Cervical roll

11. Wry neck/ Torticollis Lateral shift Relevant
Yes/no
If unable to self correct lateral forces frontal plane treated first

12. Range of motion Protrusion Retraction Flexion Extension Rotation
Lateral Flexion

14. Motor testing 0/5- no contraction 1/5- muscle flicker, but no movement
2/5- muscle moved through anti-gravity position only
3/5- muscle moves through gravity position, but no resistance
4/5- muscle moves through gravity with some resistance; functional
5/5- normal strength

15. Reflex testing 0- absent reflex 1⁺- trace 2⁺- normal 3⁺- brisk
4⁺- nonsustained clonus
5⁺- sustained clonus

16. Special Tests Vertibral artery test Spurling’s test Distraction test
Supine extension, right rotation and right lateral flexion hold for 10 seconds
Positive nystagmus, nausea, dizziness
Spurling’s test
Lateral flexion with clinician overpressure
Positive causes radiculopathy
Distraction test
Compression test

17. Special Tests Quadrant test Deep neck flexor endurance test
Right Facet compression
Extension, right rotation and right lateral flexion
Positive right sided pain
Deep neck flexor endurance test
Supine retraction and elevation
2 trials for 30 seconds
Stop if painful or unable
Grip strength
Dominant hand 10% stronger than nondominant

18. Repetitive movement testing
Sitting
Protrusion
Retraction
Retraction Extension
Lying
Lateral Flexion- R/L
Rotation- R/L
Flexion

19. Static cervical positions
Protrusion
Retraction
Flexion
Extension
Sitting
Prone
Supine

20. Cervical syndromes
Posture- mechanical deformation of normal soft tissues
Prolonged end range loading
Dysfunction- mechanical deformation of structurally impaired tissues
Scarring, adaptive shortening, or degenerative
Postures will have no effect or pain at end range no worse or no better
Derangement- internal derangement causes disturbance in normal resting position of affected joint
Postures will either: Worsen or peripheralize symptoms; Improve or centralize symptoms

21. Treatments Headaches- cervicogenic
Static postures respond better
Retraction
Flexion
Retraction Extension

22. Treatment Modalities
Research proves it is not an effective form of treatment
Ultrasound, Electrical stimulation, ice, heat, laser, traction
May prep tissue for other effective treatment
Increase patient confidence by providing temporary relief

23. Treatment Soft tissue techniques
Cross friction massage
Scar adhesions
Graston technique
Instrument assisted soft tissue mobilization
Detect and treat fascial restricitons

24. Treatment for posture
cervical retraction
Repetitions, Frequency, Dynamic or Static, with or without overpressure
Scapular retraction and depression
Lower trapezius strengthening

25. Progression of forces Cervical retraction
Cervical retraction with patient overpressure
Cervical retraction with clinician overpressure
Cervical retraction mobilization
Cervical retraction manipulation

26. Treatment Grading mobilizations: Pain or Stiff dominant
Grade I- small amplitude rhythmic oscillations in early range of movement
Grade II- large amplitude rhythmic oscillations in midrange of movement
Grade III- large amplitude rhythmic oscillations to end range of movement
Grade IV- small amplitude rhythmic oscillations at end range of movement
Grade V (thrust manipulation)- small amplitude quick thrust at end range of movement

27. Treatment Patient education
Proper posture
Sleeping
Sitting
Standing

28. Treatment Patient education
Lifting

29. Treatment Patient education
Housecleaning
Computer work
Push/pull

30. Treatment Treatment Prophylactic care
Repetitions, Frequency, Dynamic or Static, with or without overpressure
Prophylactic care

31. Treatment Therapeutic exercise
Cervical Stabilization
Isometric
Proprioception
Isotonic

32. Treatment Therapeutic exercise
Thoracic mobility
Scapular strengthening

33. Questions?