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Evaluations and Treatment of the Cervical Spine, 2nd Edition: Summary
LEARNING TIP!
LOW-LEVEL LASER THERAPY (LLLT) • Current CPGs recommend its use for chronic neck pain with mobility deficits and acute neck pain with radiating pain • Low-intensity light therapy • Wavelengths can penetrate to various tissue depths • Beneficial in treating trigger points of the upper trapezius • Quick treatment durations, often in seconds depending on the setting Ultrasound • Using sound waves for treatment rather than for imaging; treatment times typically between 5 and 10 minutes, though this depends on tissue depth and surface area treated • Current CPGs: ○ Neck pain with mobility deficits (chronic) ○ Most studies from CPGs do not officially recommend its use • Parameters: ○ Thermal effects: ■ Duty cycle = continuous, 100% ○ Nonthermal effects: ■ Duty cycle = pulsed, usually 20% ■ Cavitation; altar cell membrane permeability: – Improves inflammatory/healing process ○ Superficial tissues: Higher frequency (3 MHz) ○ Deep tissues: Lower frequency (1 MHz) Cervical Collar • Not recommended for long-term use, as evidence suggests increased efficacy of increasing cervical strength and not becoming dependent on external bracing/collar • Most research indicates recommendation of cervical collar for acute cervical pain with radiating pain only • Recommend against its use for acute neck pain with movement coordination impairments
*According to the most recent CPGs, the only category where STM is recommended is chronic neck pain with headache.*
Instrument-Assisted Soft Tissue Mobilization (IASTM) • Cupping : Creates negative pressure and separates the layers of connective tissue: ○ Treatment duration: Up to 90 seconds is considered minimal effective dose ○ Shown to improve cervical ROM, improve function, and decrease pain versus no treatment for subjects with chronic neck pain • Mechanical traction : Increases intervertebral and interforamenal space, thus opposing effects of spinal compression; increases intervertebral space; allows disc herniation or bulge (if present) to centralize; and provides stretch to muscles, ligaments, and soft
tissues of the area treated: ○ CPG recommendations:
■ Pain with mobility deficits: Chronic ■ Pain with radiculopathy: Chronic
• McKenzie Method of Mechanical Diagnosis and Therapy (MDT) : Goal is to maximize self- management of symptoms: ○ Clients are categorized based on examination findings: ■ Often mistaken as an “extension-based program” ■ If radiating pain is present, centralization of pain indicates improvement while peripheralization of pain indicates worsening • Dry needling : ○ Current CPG recommendation: ■ Neck pain with mobility deficits: Chronic ○ Healthcare professionals such as PT, OT, ATC, MD, DO, PA, NP, DC; certification is required; law is dependent on each profession’s state practice act ○ Differs in philosophy: ■ Acupuncture: Eastern medicine, uses meridians on the body ■ Dry needling: Western medicine philosophy
in which needles can be placed on trigger points, muscle, and connective tissues; uses teachings of neuromusculoskeletal systems and targeting the problem areas
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