significantly associated with increased chances of having neck pain (Kazeminasab et al., 2022). ● Social support . Neck pain is associated with poor general so- cial support (Kazeminasab et al., 2022). Self-Assessment Quiz Question #27 Which of the following cognitive factors has NOT been associ- ated with the onset of neck pain? a. Catastrophizing. b. Active coping. Work factors and neck pain The work factor most commonly associated with neck pain is awk- ward/sustained postures. Workplace factors such as perceived high job demands, effort–reward imbalance, and lack of coworker support are all significant risk factors for the development of neck pain. Neck pain is also associated with low job control, routine work, lack of decision-making opportunities, low ability to influ- ence working conditions, low job satisfaction, and high job strain (Kazeminasab et al., 2022). Case Study: John Jackson c. Low self-efficacy. d. Passive coping. Mr. Jackson is a 50-year-old postal worker who presents to physi- cal therapy complaining of posterior and lateral neck pain. He states that his pain is minimal in the morning but gets worse throughout the day as he performs his mail sorting duties. He has noticeable tightness in the levator scapulae and upper trapezius Relevant cervical anatomy The cervical spine supports the head and contains the upper cervical spinal cord as well as the vertebral arteries that contrib- ute to circulation in the posterior brain. There are seven cervical vertebrae along with accompanying intervertebral discs, nerve roots, and blood vessels. Each vertebra in the spine typically has a body, spinous process, vertebral foramen, bilateral transverse The atlas (C1) and axis (C2) are called the upper cervical spine , and they have some distinctive anatomical features. The atlas ar - ticulates with the occiput (head) via the occipital condyles and the lateral mass of the atlas. The atlas is ring-shaped and does not have a body or spinous process. It articulates with C2 at the anterior arch of the axis at the atlantoaxial joint. The axis contains the dens or odontoid process, which is a vertical projection from the anterior aspect of C2. The odontoid process has a transverse ligament that runs posterior to the dens, prevent- ing anterior subluxation of the atlas on the axis (Rahman et al., 2021). Odontoid fractures are considered one of the most com- mon and controversial injury types in the cervical spine, with an associated high incidence of nonunion, morbidity, and mortality (Carvalho et al., 2019). Healthcare consideration: Odontoid fractures occur with low- energy falls in the elderly (as compared with high-energy trau- ma in younger patients). These fractures are the most common cervical fracture in the elderly. Unfortunately, patients older than age 80 have a high morbidity and mortality rate with this type of injury, regardless of whether it is treated operatively or nonop- Cervical spine structure and function Upper cervical spine (C1–C2)
Healthcare consideration: Since depression is both a conse- quence of and causative factor for neck pain, the presence of the diagnosis of depression accompanying neck pain may re- quire the assessing clinician to decide if action is warranted. Depression is considered an orange flag, that is, it is a diagnosis that can affect the ability to recover from neck pain. In this situ- ation, the assessing clinician must consider at least two factors: (1) In their clinical judgement, does the depression diagnosis affect the onset and/or recovery from neck pain and (2) in their clinical judgement, is a referral to the appropriate healthcare provider warranted? While physical therapists might identify de- pression, they do not treat it. Referral to a psychologist or back to the referring physician might be an important part of helping the client get better. muscles. When asked about his job duties, he reports that they have gotten much worse since he got a new boss a few months ago. He feels this boss has asked him to do more than he can handle. Question Can you name two possible different categories of factors that might explain this client’s neck pain? Discussion Mechanical factors might be influencing this client’s neck pain. He does a repetitive job (sorting mail) and has some musculoskeletal findings (levator and upper trapezius muscle tightness). In addi - tion, the client discusses some work factors that have been known to increase the probability of neck pain: Low work control, low ability to influence working conditions, low job satisfaction, and high job strain are all present, per the client’s report. processes, and pairs of superior and inferior articular facets. There are three elements that distinguish the cervical vertebrae: (1) Bifid spinous processes, (2) triangular shape of spinal cord, and (3) the presence of transverse foramen that allow for transmission of the vertebral arteries (Rahman et al., 2021). with a depressed area of the upper vertebral body (Rahman et al., 2021). The superior notch and inferior notch of corresponding vertebrae form the intervertebral foramina, which creates a tunnel for the spinal nerves to exit the spine. The cervical spinal nerves C1 to C7 exit the spinal canal through the superior notch of the cor- responding cervical vertebrae, while C8 exits through the inferior notch of the C7 vertebrae (Rahman et al., 2021). Self-Assessment Quiz Question #28 The nerve roots at levels C1 to C7 exit ______________ the cor- responding cervical vertebrae. At the C8 vertebral level, the nerve root exits __________ the corresponding cervical verte- brae.
a. Above; above. b. Below; below. c. Below; above. d. Above; below.
Self-Assessment Quiz Question #29 The dens, or odontoid process, is a vertical projection of: a. The occiput.
eratively (Moore et al., n.d.). Lower cervical spine (C3–C7)
b. C1, or the atlas. c. C2, or the axis. a. C7.
The lower cervical vertebrae are similar in structure, with a verte- bral body, uncinate process, spinous process, and superior and in- ferior articular process. The uncinate process is a projection from the anterior aspect of the cervical vertebral body that articulates
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