_________________________________________________________________________ Neck Pain in Adults
The McKenzie theory recognizes that patients may demonstrate similar signs and symptoms, but one movement (i.e., cervical extension) may help some patients and aggravate symptoms in others. In McKenzie therapy, treatment individualization plays a key role [51]. Cervicothoracic Stabilization Programs Cervicothoracic stabilization programs reduce pain, maximize function, and prevent further injury through cervical spine flexibility, postural training, and strengthening [51; 103]. Flexibility restoration prevents further repetitive microtrauma resulting from poor movement patterning. Soft tissue or joint restriction that inhibits range of motion is treated, and range of motion is restored through spine and soft-tissue mobilization, passive range of motion, self-stretching, and correct posturing. Postural training in spinal stabilization uses mirrors and therapist feedback to maintain neutral spine and correct posture during daily activities. Patients learn whole-body movements while maintaining a stabilized spine, and progress to controlled movement of the spine that approximates normal biomechanical motions without creating undue vertebral stress. Cervicothoracic stabilization requires strengthening and coordination of neck, shoulder, and scapular muscles, as well as training of the lumbar spine and lower extremities to provide a foundation for the cervicothoracic spine. Stabilization exercises proceed systematically from simple to complex. Isometric and isotonic resistive exercises employ elastic bands, weight machines, and free weights. Such conditioning distributes forces away from the cervical spine. Exercise repetition ultimately encodes an engram that commands immediate, automatic cervicothoracic stabilization during everyday activity. Proprioceptive skills are used during strengthening exercises to facilitate stable, safe, and pain-free cervical posture during strenuous activity. Neuromuscular Re-Education Neuromuscular re-education and movement training involves stabilizing and mobilizing muscles, proper sequencing, and optimal biomechanical motion patterns for daily tasks and activities. Tasks are broken down into their component single-joint movement patterns and perfected with proper alignment, breathing, and muscle stabilization in non-weight- bearing postures using manual or mechanical assistance. After single-joint patterns are mastered without symptoms, the training complexity increases, with multi-joint movement, non- linear motion (circular or diagonal), weight-bearing postures, proprioceptive challenges (e.g., eyes closed, unstable surfaces), progressive resistance, and/or variable speeds and durations. The end goal is to transition the patient from movement incompetence to a state of automatic movement competence [227]. Directional exercises are used in pain-generators that show “directional preference” to apply beneficial mechanical loads that correct the abnormality and avoid loading in the direction of vulnerability [227].
In cervical myofascial pain, the goal of physical therapy is to restore balance between muscles working as a functional unit, accomplished using cervical stretch and stabilization, myofascial release techniques, massage, and postural retraining [57]. Strengthening Exercise General exercise is defined as purposeful physical activity involving repetitive exercises that incorporate multiple muscle groups [228]. In contrast, therapeutic exercise programs should be specific to the injury and address general functional deficits as identified in the diagnosis and clinical assessment. Common specific approaches include strengthening, stretching/range of motion, and flexibility training [8]. Many patients with spine-related symptoms and functional deficits lose strength in specific muscles or muscle groups from neurologic compromise, disuse, and deconditioning. Strength training rehabilitation is used for restoring muscle loss and reversing changes, and for easing recurrent spine-related symptoms in patients with pre-episode deficits. This process can take many months of effort. In the early phases, most gains are in learning and neuromuscular adaptation, which lead to better efficiency and economy of movement [227]. Strengthening is initiated under trained supervision and is later self-directed. Strength training is performed two to five days per week, with any number of movement patterns performed 8 to 20 times over two to four sets. The loads, intensity, volume, and duration used for desired outcomes vary greatly. Equipment that can assist in strengthening includes barbells and dumbbells, exercise machines, medicine balls, and elastic cords [227]. Stretching Lack of flexibility in certain muscle groups is linked to spine- related symptoms. A causal relationship is not established, but improving the flexibility of muscle, tendon, and connective tissue elements may enhance recovery and reduce focal areas of tension and stress. Stretching involves techniques ranging from static, passive, low-load, long-duration strategies applied by a therapist, to contract-relax tactics that enhance muscle reception to stretching [227]. Patients should continue exercise and stretching therapies at home as an extension of the treatment process to maintain improvement levels. Follow-up visits to reinforce and monitor progress and proper technique are recommended. Home exercise can include exercise with or without mechanical assistance or resistance and functional activities with assistive devices [103].
59
MDKY1626
Powered by FlippingBook