Overview
This lecture covers cervical spine injury management, focusing on referral and radiating pain patterns, assessment and treatment strategies, clinical prediction rules, contraindications for manipulation, and the importance of posture and muscular stabilization.
Cervical Spine Referral & Radiating Pain Patterns
- Cervical facet referral pain can travel superiorly (upper C-spine), remain local (mid), or radiate to the shoulder/traps (lower C-spine).
- Thoracic facet referral patterns remain localized.
- Radiating pain follows dermatomal (nerve root) patterns, distinct from referral pain.
Assessment of Cervical Radiculopathy
- Multiple upper extremity nerve compression sites exist; precise localization is essential.
- The Wehner cluster (AROM <60°, positive Spurling's, distraction, and median nerve tension test) is used to identify cervical radiculopathy.
- 4/4 positives ≈ 90% likelihood, 3/4 ≈ 65%, 2/4 or fewer, unlikely cervical radiculopathy.
Cervical Radiculopathy Management
- Begin treatment at the tissue injury source (facet, disc, nerve root, muscle).
- Similar concepts to lumbar spine: nerve sliders for desensitization, NMES/PNF for motor loss, sensory stimulation for sensory loss.
Flexion & Extension-Based Treatments
- Extension-based (McKenzie) exercises and traction for extension-biased patterns (e.g., disc injuries).
- Mechanical traction: 5–10 kg (15–25 lbs) with 25–30° cervical flexion for optimal safety and effectiveness.
- Flexion-based (Williams) exercises for flexion-biased patterns (e.g., facet dysfunction, stenosis).
- Avoid traction/mobilizations in cases of spondylolisthesis, fractures, or ligamentous injuries.
Cervical Manipulation: Indications & Contraindications
- Manipulation is suitable if: acute symptoms (<38 days), patient expects benefit, ≥10° rotation difference, pain on P to A spring test.
- Three or more criteria: 90% chance of benefit; less than three: much lower.
- Contraindications: positive alar ligament or Sharp-Purser test, spondylolisthesis, vertebral basilar insufficiency (positive VBI test).
- Safe manipulation minimizes rotation and avoids extension.
Posture, Neutral Spine & Muscle Control
- After acute phase, restore symmetrical segmental mobility and address adjacent thoracic/shoulder structures.
- Emphasize deep neck flexors and multifidus for stabilization; avoid overusing SCM and traps.
- Neutral spine and chin tuck exercises promote optimal alignment and reduce injury risk.
- Poor posture (forward head) increases neck loading, especially at lower cervical levels, leading to common injuries.
Upper Cross Syndrome & Postural Correction
- Upper cross syndrome involves tight anterior muscles and weak posterior muscles (common in athletes, students).
- Treatment includes deep muscle activation, thoracic mobility, and posterior chain strengthening.
Key Terms & Definitions
- Referral Pattern — Pain felt away from the actual injury source due to facets or discs.
- Dermatomal Pattern — Nerve root-related pain following specific skin segments.
- Wehner Cluster — Four-test clinical rule for diagnosing cervical radiculopathy.
- Cervical Traction — Manual/mechanical decompression of the cervical spine.
- Up Glide — Cervical mobilization technique with rotary component matching facet alignment.
- Neural Tension Test — Special test assessing nerve sensitivity and mobility.
- Upper Cross Syndrome — Postural imbalance: tight anterior/weak posterior neck/shoulder muscles.
- VBI (Vertebral Basilar Insufficiency) — Compromised blood flow in vertebral arteries, contraindication for cervical manipulation.
Action Items / Next Steps
- Review cervical nerve slider techniques for median, ulnar, and radial nerves in lab.
- Watch the demonstration videos for Wehner cluster tests and VBI assessment.
- Prepare for lab practice on cervical mobilization and stabilization exercises.
- Print and keep clinical prediction rule cheat sheets for reference.