evidencebasedpracticecervical-12875411637788-phpapp01

8/13/2019 evidencebasedpracticecervical-12875411637788-phpapp01

1/16

Evidence Based PracticeExamination and Intervention

for theCervical Spine

Condensed from Josh Hayes PT, DPT, OCSBy Chris Keating PT, DPT


2/16


3/16

Examination

Acuity

Benefit from PT/RedFlags

Comparable Sign

Direction ofTreatment

Canadian C-SpineRule

Neck Disability Index Clinical Significance >10%

0-8% No Disability

10-28% Mild

30-48% Moderate

50-68% Severe 70-100% Complete


4/16

Examination

Cervical Myelopathy B&B, Atrophy and Gait

Neoplastic Conditions >50yo , Constant Pain and Night pain

Upper Cervical Ligamentous Instability Limited AROM (CROM/Inclinometer), Occipital HA and CM Signs

VA Insufficiency Ds (Dysphasia, Dysarthria and Diplopia)

Inflammatory or Systemic Disease Temp > 37, Resting Pulse >100, Resp Rate >25 and Fatigue


5/16

Special Tests

ULNTT

Spurlings

DistractionVA

Sharp Purser

Transverse LigamentAlar Ligament Test


6/16

Diagnosis

Mobility

Centralization

Conditioning Pain Control (poor candidate)

Headache


7/16

1 - Mobility

< 3 Months

No Radicular/Referred Symptoms in UQ

Limited Lateral Flexion and Rotation

No Nerve Root Compression

Rx: C-s and T-s Mobs/Manips andAROM


8/16

2 - Centralization

UQ Symptoms

Peripheralization or Centralization

Nerve Root Compression

Rx: Traction, Repeated Motion inDirectional Preference


9/16

3 - Conditioning

Low Pain and NDI

> 3 Months

No Nerve Root Compression

No Directional Preference

Rx: Strengthening or Deep andGlobal Stabilizers throughout UQ


10/16

4 - Pain Control

High Pain and NDI

Very Recent Onset

Trauma

Radiating UQ pain

Very Poor Tolerance to Exam and Rx

Rx: Gentle AROM, Modalities andActivity Modification


11/16

5 - Headache

HA Preceded by Neck Pain

HA Triggered with Neck Movement

HA Elicited by Posterior Pressure

Rx: C-s manips/mobs, Strengtheningand Posture


12/16

Cervical Radiculopathy

ULTTA

Involved Rotation < 60

Distraction Spurlings

3+ 6.1 LR 4+ 30.3 LR


13/16

Cervical Radiculopathy

Predictors of Success

< 54 yo

Non-Dominent Extermity

Looking Down Doesnt Worsen Symptoms

Manual Therapy, Traction and FlexorStrengthening


14/16

Manual Therapy & Exercises

Downglide Mob/Manip

Upglide Mob/Manip

Cervical Lateral Glide in ND Position Supine DOG

Thoracic Screw

Extension Progression See Handout for Exercises


15/16

Questions?


16/16

References

Proposal of a Classification System forPatients with Neck Pain. Childs et al,JOSPT 34:11 2004

Predictors of Short-Term Outcome inPeople With a Clinical Diagnosis of CervicalRadiculopathy. Cleland et al, PTJ 87:12

evidencebasedpracticecervical-12875411637788-phpapp01

Documents