Mentoring Minutes: Cervical Mobility Deficits

Evidence based practice for the stiff neck.  Research has provided us with many different assessments, treatments, and therapeutic exercises for patients who have neck pain and do not have sufficient ROM. Watch the video below to learn about specific strategies to improve neck pain in patients with mobility deficits.

With many different options out there, in the end, the message is simple, you just have to move it :)

The newest Mentoring Minutes with Dr. Marshall LeMoine get posted on Facebook every Monday.  If you are not on Facebook, you can find most of our videos on YouTube.  See you next week!

References:

Snodgrass SJ et al. The clinical utility of cervical range of motion in diagnosis, prognosis, and evaluating the effects of manipulation: a systematic review. Physiotherapy. 2014;100:290-304.

• A systematic review (36 papers). Restricted ROM has shown to be associated with negative outcomes, while greater ROM is shown to be associated with positive outcomes. Although there is still conflicting evidence for a prognostic values of cervical ROM.

Gross A, et al. Manipulation and mobilization for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev, 2015:CD004249.

• A systematic review (5 RCT’s) suggested T/s manipulations improved neck pain and function.

Karas S, et al. The effect of direction specific thoracic spine manipulation on the cervical spine: a randomized controlled trial. Journal of Manual and Manip Therapy. Nov, 2016. (1-8)

• A RCT that compared thoracic prone manipulation for extension vs. supine manipulation for flexion found that both groups had positive results when pain, neck disability index, and global rating of change were assessed.

Leaver AM, et al.  Conservative interventions provide short-term relief for non-specific neck pain: a systematic review. J Physiotherapy. 2010;56:73-85.

• No difference in regards to improving pain, function and disability when performing either cervical manipulations  or cervical mobilizations (PA’s).

Young JL, et al. Thoracic manipulation versus mobilization in patients with mechanical neck pain: a systematic review. J Man Manip Ther. 2014;22:141-153.

• A systematic review (14 studies) found that thoracic manipulations or mobilization improved cervical pain, range of motion, and disability.

Southerst D, et al. Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J. 2016;16:1503-1523.

• Systematic review showing that patients may either do AROM with self OP, self mobilizations using hands or towel snags to maintain and gain C/s ROM through therapeutic exercise.

What Can You Do For Neck Pain Radiating to the Arm?

Pain, numbness, burning, tingling, weakness...Cervical Radiculopathy can be a scary diagnosis for your patients.

How can you incorporate better education into their treatment?

Remember, they haven't been through PT school, they don't know all that we do about different treatments and outcomes...

For them, in addition to pain, this numbness, tingling, and weakness is uncomfortable, unknown, and unsettling...all of which can illicit a fear response, which we know can perpetuate the condition. 

Here is a post all about What Cervical Radiculopathy is and the best treatment options that yield the best results....

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Whiplash Treatment: Exercise & Advice

Whiplash injuries are the most common injury following a car accident.

Many Whiplash patients get better with time – usually within 2 to 3 weeks of the injury. Current research, however, is showing that about 50% of people still complain of neck pain even one year after the injury. One study even found that 58% of patients report having symptoms 30 months after.

Although there are a plethora of different treatment options we can offer patients with Whiplash Associated Disorders, the evidence suggests that prescribing basic exercise and giving simple advice early on yields the best outcomes...

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Relief For Chronic Neck Pain

For patients with chronic neck pain, key impairments we will likely find are weakness and a lack of coordination and endurance in the Deep Neck Flexor Muscles.

In fact, people with chronic neck pain have significantly poorer performance when compared to people without neck pain on the craniocervical flexion test.

In addition to strength and endurance issues, people with chronic neck pain also have altered proprioception, balance disturbances, altered eye movement control, and altered postural activity of cervical muscles.

Here's a post all about Chronic Neck Pain for your patients with Movement Coordination Impairments - that educates about the importance of improving strength, endurance, and coordination of the Deep Neck Flexors + Exercise Videos...

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What To Do For a Stiff Neck

It should go without saying, but I’ll say it anyways – evidence shows the treatment that targets a specific classification of neck pain (mobility deficits, headaches, sprain, etc.) has better outcomes than just general treatment for neck pain.

So what does a typical person who has a stiff neck (neck pain with mobility deficits) look like?-

• Younger than 50 years old
• Acute neck pain lasting less than 12 weeks
• Symptoms are only in the neck (referred pain may or may not be present)
• Restricted neck range of motion
• Limited mobility of the cervical (neck) and thoracic (mid-upper back) spine

For patient's who match this criteria for neck pain with mobility deficits, we should match our treatment accordingly... 

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