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Evaluations and Treatment of the Cervical Spine, 2nd Edition: Summary
○ Gentle head nod “yes” motion performed to an increase of 2 mm Hg ○ Hold for 10 seconds/rest for 30 seconds ○ Monitor for substitution of superficial neck flexors (SCM), cervical retraction, and head lift ○ Repeat at intervals 22, 24, 26, 28, and 30 mm Hg if able ○ Stop if unable to hold 10 seconds at any level or if goal of 30 mm Hg at 10 seconds is met • Cervical isometrics : ○ “Rule of 10s” is commonly prescribed: 10 seconds hold, 10 seconds rest, 10 repetitions: ■ Allows for a 2-second ramp up/down rather than an instantaneous firing/relaxing of the muscle • Functional exercise examples : ○ The mirror twist : Keep eye gaze on mirror with head still while body rotates right then left as far as able ○ Walk past—extension : Focus eyes on an object up and to the side; walk past this object until cervical end range is completed; perform bilaterally ○ Walk past—flexion : Focus eyes on an object down and to the side; walk past the object until cervical end range is completed; perform bilaterally ○ Crossing the road with a step : Walk in a straight line with consistent right and left cervical rotation with aerobic steps in the path to simulate step or curb ○ Stand and reach : Stand with eyes focused on object in front; slowly flex the hip keeping spine erect; try to reach forward with one arm while eyes keep forward focus; can be modified to sit and reach Joint Mobilizations Literature describes two main types of joint mobilizations: • Oscillation (repetition) • Steady stretch (sustained) Pain reduction via stimulating the mechanoreceptors. Mobilization grades depend on indication: • Grades I–II mobilizations are used for pain relief • Grades III–V are used for increasing mobility CPG Indications: • Neck pain with mobility deficits: Acute, subacute, and chronic • Neck pain with headache: Acute, subacute, and chronic • Neck pain with radiating pain: Chronic
Sustained Natural Apophyseal Glide (SNAG): • Current CPG recommendation: Self-SNAG exercise for the upper cervical spine for neck pain with headache for acute and subacute injury • (SNAG technique not directly specified for chronic neck pain with headache, though general joint mobilization is recommended) Soft Tissue Mobilization (STM) Common techniques: • Effleurage : Smooth and continuous sliding and gliding technique: ○ Typically starts and concludes the soft tissue mobilization portion of the treatment due to its potential to be a relaxing stroke • Petrissage : Typically deeper strokes of wringing, lifting, and squeezing tissue • Myofascial release : “Stretching” the tissue in a specific direction: ○ Feedback from client determines force, duration, and direction of technique ○ Hold until a release is felt; time will vary • Trigger point release : Ischemic compression of a trigger point or “knot”: ○ Area of hyperirritability of a muscle and/or fascia with a predictable pain referral pattern ○ Hold compression for approximately 10–30 seconds followed by series of deep strokes over the treatment area • Friction : Rhythmic movement that is parallel, cross- fiber (cross-friction), or circular: ○ Little to no lubrication necessary ○ Often performed with thumbs, though heel of hand and elbow can also be used ○ Used to break up adhesions and muscle spasms • Scar massage : Adequate pressure to improve mobility of scar tissue: ○ Multiple directions effective, including lifting the scar and skin rolling • Vibration : Low-amplitude oscillations over muscle fibers in a perpendicular direction • Tapotement : Percussive stoke with rapid alternating movements of the hand and wrist against the treatment area
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