Cervical spine pain and disability is one of the commonest problems for which people consult a physiotherapist. The first part of the examination is to find out the cause of onset of the pain and how it has behaved since then. The cause of the pain is clear in about half of all cases but the rest can give no good idea why the pain came on. Where the pain is and how it behaves gives indications to the physio about where the underlying pathology might be found and what treatment approach might be
The type and area of the pain are very useful to the physio in determining where the likely site of the lesion is. Shoulder, scapular, thoracic and arm pains are common with neck pain and the pattern will explain what kind of pain problem the patient has. A sprained neck joint gives very sharp, defined pain in one area, a postural cause or degenerative neck changes will give more generalized pain and a nerve root impingement from a slipped disc will give severe arm pain.
Many illnesses and conditions can be associated with cervical problems so the physios review the past medical history, general health, loss of weight, normal control of the bowel and bladder, normal appetite, drugs use and quality of sleep. The physio will then ask the patient to disrobe and examine the posture of the thoracic spine, cervical spine, arms and shoulders. Poor posture is very common, with a rounded trunk, rounded shoulders and a poking chin being the most common combination.
The neck has typical ranges of motion which are disturbed in pain conditions and the abnormalities give useful evidence about the underlying joint mechanics. The physio goes through cervical flexion, cervical extension, cervical rotations, cervical retraction and cervical side flexions to check which movements are limited and which are unaffected. Nerve conduction to the arms is then tested by investigating the sensation, muscle strength and reflex response.
Manual palpation of the neck is an advanced skill shared by manual therapists and gives information about the more defined location of the neck lesion. The physio will lie the person on their front and press down gently on each spinal level from the high neck down to the upper thoracic levels. By palpating the central bony processes and the small joints at the sides the physio hopes to bring on the patient's symptoms by pressing on a specific structure, pointing to the guilty structure.
Mobilization techniques are a core manual skill for physiotherapists and abnormal joint mechanics, known as dysfunctions, can be identified by palpation of the main spinal and facet joints by the physio. Treatment can use repetitive small movements to relieve pain an encourage normal motion, to more forceful manipulations which take the joints beyond their typical ranges and restore movement. Any increases in movement gained by treatment is maintained by home exercises.
Mobilization techniques, which include manipulation, are used to restore joint movement or to reduce pain levels by repeated stimulation. Physiotherapists employ many different treatments for cervical spine pain including correction of posture, deep neck muscle strengthening, fitness exercises, loosening up the thoracic spine, nerve movements to ease nerve related pain syndromes and pacing activities to prevent overdoing in any one position. Traction of the neck, either manually by the physiotherapist or by using an autotraction kit mounted on a door, is a useful technique in cases where pain is a significant problem and other treatments would be likely to aggravate. Sciatica can occur in the arm as well as the leg and is referred to as nerve root pain. - 15437
The type and area of the pain are very useful to the physio in determining where the likely site of the lesion is. Shoulder, scapular, thoracic and arm pains are common with neck pain and the pattern will explain what kind of pain problem the patient has. A sprained neck joint gives very sharp, defined pain in one area, a postural cause or degenerative neck changes will give more generalized pain and a nerve root impingement from a slipped disc will give severe arm pain.
Many illnesses and conditions can be associated with cervical problems so the physios review the past medical history, general health, loss of weight, normal control of the bowel and bladder, normal appetite, drugs use and quality of sleep. The physio will then ask the patient to disrobe and examine the posture of the thoracic spine, cervical spine, arms and shoulders. Poor posture is very common, with a rounded trunk, rounded shoulders and a poking chin being the most common combination.
The neck has typical ranges of motion which are disturbed in pain conditions and the abnormalities give useful evidence about the underlying joint mechanics. The physio goes through cervical flexion, cervical extension, cervical rotations, cervical retraction and cervical side flexions to check which movements are limited and which are unaffected. Nerve conduction to the arms is then tested by investigating the sensation, muscle strength and reflex response.
Manual palpation of the neck is an advanced skill shared by manual therapists and gives information about the more defined location of the neck lesion. The physio will lie the person on their front and press down gently on each spinal level from the high neck down to the upper thoracic levels. By palpating the central bony processes and the small joints at the sides the physio hopes to bring on the patient's symptoms by pressing on a specific structure, pointing to the guilty structure.
Mobilization techniques are a core manual skill for physiotherapists and abnormal joint mechanics, known as dysfunctions, can be identified by palpation of the main spinal and facet joints by the physio. Treatment can use repetitive small movements to relieve pain an encourage normal motion, to more forceful manipulations which take the joints beyond their typical ranges and restore movement. Any increases in movement gained by treatment is maintained by home exercises.
Mobilization techniques, which include manipulation, are used to restore joint movement or to reduce pain levels by repeated stimulation. Physiotherapists employ many different treatments for cervical spine pain including correction of posture, deep neck muscle strengthening, fitness exercises, loosening up the thoracic spine, nerve movements to ease nerve related pain syndromes and pacing activities to prevent overdoing in any one position. Traction of the neck, either manually by the physiotherapist or by using an autotraction kit mounted on a door, is a useful technique in cases where pain is a significant problem and other treatments would be likely to aggravate. Sciatica can occur in the arm as well as the leg and is referred to as nerve root pain. - 15437
About the Author:
Jonathan Blood-Smyth is a Superintendent Physiotherapist at a prominent NHS training hospital in Devon. He publishes articles on injuries and accidents in periodicals and on his website for physiotherapists. If you are seeking local physiotherapy after an accident or trauma, visit his website for physiotherapy practitioners around the United Kingdom.
