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    CervicothoracicSpine Assessment

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    Kanika Sinha
    This document provides an overview of manual therapy assessment and treatment of the cervicothoracic spine. It begins with definitions of manual therapy and descriptions of cervical spine anatomy including vertebrae, ligaments, and musculature. Biomechanics of the cervical spine during various motions are explained. Assessment techniques such as range of motion, joint mobility, and special tests are outlined. Contraindications for cervical manipulation are listed. Various cervical and upper thoracic manipulation techniques are demonstrated and case studies are presented to illustrate manual therapy treatment approaches. Evidence supporting the use of manual therapy for cervical conditions is also referenced.

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    CervicothoracicSpine Assessment

    Uploaded by

    Kanika Sinha
    286 views16 pages
    This document provides an overview of manual therapy assessment and treatment of the cervicothoracic spine. It begins with definitions of manual therapy and descriptions of cervical spine anatomy including vertebrae, ligaments, and musculature. Biomechanics of the cervical spine during various motions are explained. Assessment techniques such as range of motion, joint mobility, and special tests are outlined. Contraindications for cervical manipulation are listed. Various cervical and upper thoracic manipulation techniques are demonstrated and case studies are presented to illustrate manual therapy treatment approaches. Evidence supporting the use of manual therapy for cervical conditions is also referenced.

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    This document provides an overview of manual therapy assessment and treatment of the cervicothoracic spine. It begins with definitions of manual therapy and descriptions of cervical spine anatomy including vertebrae, ligaments, and musculature. Biomechanics of the cervical spine during various motions are explained. Assessment techniques such as range of motion, joint mobility, and special tests are outlined. Contraindications for cervical manipulation are listed. Various cervical and upper thoracic manipulation techniques are demonstrated and case studies are presented to illustrate manual therapy treatment approaches. Evidence supporting the use of manual therapy for cervical conditions is also referenced.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    286 views16 pages

    CervicothoracicSpine Assessment

    Uploaded by

    Kanika Sinha
    This document provides an overview of manual therapy assessment and treatment of the cervicothoracic spine. It begins with definitions of manual therapy and descriptions of cervical spine anatomy including vertebrae, ligaments, and musculature. Biomechanics of the cervical spine during various motions are explained. Assessment techniques such as range of motion, joint mobility, and special tests are outlined. Contraindications for cervical manipulation are listed. Various cervical and upper thoracic manipulation techniques are demonstrated and case studies are presented to illustrate manual therapy treatment approaches. Evidence supporting the use of manual therapy for cervical conditions is also referenced.

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    Download as PDF, TXT or read online from Scribd
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    of 16

    Overview of Manual Therapy Assessment and Treatment of the Cervicothoracic Spine

    Megan Casey Douglas, PT, DPT, MTC, OCS

    Megan Casey Douglas, PT, DPT, MTC, OCS


    Bellingham, WA Director of Physical Therapy at Northwest Physical Therapy- Skagit Valley, Private Practice Recently moved from Cincinnati, OH DPT, MTC thru University of St. Augustine OCS thru APTA MPT Andrews University BS- Miami University Teaching Experience
    Adjunct University of Dayton College of Mt. St. Joseph Continuing Education

    WHAT IS MANUAL THERAPY?

    A clinical approach utilizing skilled, specific handson techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.1,2 (Definition from American Academy of Orthopedic Manual Physical Therapy (AAOMPT) and American Physical Therapy Association (APTA).

    Anatomy of the Cervical Spine

    Anatomy of the Cervical Spine


    Spinous Process Articular pillar formed by articular process and interarticular parts Zygapophyseal joints- 45 At T1 1st costal facet for 1st rib

    Mid-Cervical Vertebra
    Body Transverse Process Anterior tubercle Posterior tubercle Groove for spinal N. Transverse foramen Pedicle Superior articular facet Inferior articular process Vertebral foramen Spino s process
    C4Vertebra vs C7

    Anatomy of C1 and C2
    Atlas(c1)Anatomy Axis(C2)Anatomy

    Ligaments of the Cervical Spine


    Tectorial membrane becomes PLL Capsule of OA joint Capsule of AA joint Capsule of zygapophyseal joint
    Posteriorview(s.p.removed)

    Ligaments of the Cervical Spine


    Anteriorview

    Anterior Longitudinal Ligament

    Ligaments of the OA joint


    Posteriorview

    Alar ligaments Cruciate ligament Apical ligament of dens

    Cervical Spine Ligaments


    RightLateralView

    Ligamentum nuchae Ligamenta flava Spinous process of C7 vertebra Vertebral a.

    Cervical Spine Musculature

    Cervical Spine Musculature

    Cervical Spine Musculature

    Biomechanics of the Cervical Spine

    Biomechanics of the Cervical Spine

    Biomechanics of Cervical Spine


    Mid cervical forward bending
    Facets slide up, approx. 40% displacement Lateral interbody joints slide forward Vertebrae step minimally Spinal canal narrows but lengthens, volume remains the same.

    Biomechanics of Cervical Spine


    Mid Cervical Backward Bending
    Facets slide down, then fulcrum on pedicle. Lateral interbodies slide back
    Vertebrae step considerably!!

    Ligamentum flavum bulges inward Spinal canal shortens and narrows significantly Cord may be compressed in the presence of degenerative changes

    Biomechanics of Cervical Spine


    Mid Cervical Sidebending /Rotation Right
    Facets slide down and back on the right Facets slide up and forward on the left, causing right rotation

    Biomechanics of Cervical Spine


    If patient is instructed to face forward with sidebending Right, AA Rotation Left has occurred. If patient is instructed to rotate right, keeping eyes level with the horizon, SB Left occurs subcranially (OA, AA). Approx. half of cervical rotation originates from the AA joint (C1/C2).

    Anatomy/Biomechanics of the upper thoracic spine


    T1 has a unifacet for articulation of the first rib T1 through T3 generally follow lower cervical biomechanics Lower thoracic segments similar to lumbar spine

    Cervical Evaluation

    Cervical Evaluation
    Observation/ Posture
    Symmetry, resting position of head on neck Forward Head Posture (FHP) Increase/Decrease in thoracic kyphosis

    AROM testing
    Flexion, Extension, SB R/L, ROT R/L
    Veers R/L with flexion/extension SB R/L, seated, arms supported/ unsupported

    Rotation- should recruit down to approx. T3 OA nodding/SB, AA rotation

    Cervical Evaluation
    Neurovascular assessment Special Tests
    Alar Odontoid Integrity Transverse Ligament Vertebral A.??

    Precautions, trauma, diagnostic tests

    Cervical Evaluation
    PROM/joint mobility testing
    Supine, neutral to slight flexion
    OA/ AA mobility Check SB R/L, Rot R/L Cervical upglides Cervical downglides Upper thoracic joint mobility (from supine, PA) 1st rib mobility

    Muscle length, Soft tissue restrictions Palpation

    Cervical Evaluation
    Video Demonstration
    Cervical upglides Cervical downglides Upper thoracic PA mobility 1st rib mobility- depression

    Cervical and Upper Thoracic Manipulation

    Indications for Manipulation


    Restricted accessory joint motion Neurophysiological benefit and pain control.

    Contraindications/Precautions for Manipulation


    Disease states Hemarthrosis Hypermobility Muscle holding Fracture Acute inflammation Fusion/Joint replacement Anticoagulant therapy Osteoporosis

    Grades of Manipulation

    Grades of Manipulation
    Non-Thrust
    Maitland- Grade I Grade II Grade III Grade IV Traditional- stretch Paris- progressive oscillation Mulligan- mobilizes with active movement

    Thrust
    Traditional- High Velocity Low Amplitude (HVLAT)

    Distraction
    Traditional- Manual Mechanical Paris- Positional

    Cervical Manipulation TechniquesVideo Demonstration


    Cervical upglides Cervical downglides Upper thoracic PA mobility 1st rib mobility- depression Cervical Traction Suboccipital Release/Inhibitive Distraction

    Cervical DDD Cervical OA, facet arthropathy Cervical Radiculopathy


    Disc protrustion/herniation Foramenal stenosis due to OA

    Common Diagnoses that may benefit from Manual Therapy

    Cervical Sprain/Strain Cervicogenic Headache

    Forward Head Posture can contribute to...


    Muscle Imbalance/ Adaptive shortening Joint restrictions
    Areas of relative hypo/hypermobility Facet arthropathy DDD Compromise of neural foramen

    Cervicogenic Headaches Thoracic Outlet Syndrome TMJ disorders

    Key Tips to Remember


    Treatment to improve posture/ reduce FHP and optimize intended cervical spine biomechanics Treat joint restrictions with manipulation Stabilize areas of hypermobility Avoid manipulative forces thru hypermobile segments

    Key Tips to Remember


    Joint restrictions may not be where the patient complains of pain/tenderness Pain is deceiving/ referral patterns

    Key Tips to Remember


    After acute phase/palliative treatments, go to the source of the problem
    Disc protrusion- symptom Muscle sprain/strain may be guarding due to underlying problem Cervicogenic Headache
    FHP? Joint restriction of OA, AA

    Case Study 1
    Manual Therapy Cervical Radiculopathy Treatment Acute phase Patient is a 39 y/o CPA Manual traction (in April!) and has a straight pull pronounced FHP add slight SB L/ Rot L, flex Suboccipital release Pain increases Rotation Subacute R, SB R, and Ext.
    Intermittent R UE burning down to elbow, n/t in R hand Weakness in C6 myotome Tenderness over R
    Cervical upglides on R? Upper thoracic manipulation 1st rib depression Address other joint restrictions, soft tissue restrictions

    Chronic

    Case Study 2
    Manual Therapy Left Upper Trapezius Treatment Strain Patient is a 24 y/o Cervical downglides student, woke with on Left side pain on L side of neck If c/o pain with Pain and decreased L downglide, try cervical SB and L Rotation upglides on Right and Ext. ROM side. Pain and decreased Recheck joint mobility downglide C3/C4 facet Reassess L UT, may try Trigger point in L UT and pain with L UT massage/stretching if

    Case Study 3
    Cervical DDD, HAs
    Patient is a 58 y/o female, complaining of bilateral neck pain and headaches X-rays show DDD at C5/C6 and C6/C7 Patient has sedentary desk job and a significant FHP/increased thoracic kyphosis Denies radicular Sx Complains of increasing HAs as work day

    Manual Therapy Treatment


    Posture! Education/Ergonomics Manipulate joint restrictions- upper/mid thoracic, upper/mid cervical? Caution: hypermobility at C5/6, C6/7?? Suboccipital Release/ Inhibitive distraction OA, AA manipulations if restrictions present- also may decrease Has Address soft tissue t i ti l

    Evidence Supporting Manual Therapy of the Cervical Spine


    Bronfort G, Haas M, Evans R, Bouter L. 2004 Efficacy of Spinal Manipulation and Mobilization for Low Back Pain and Neck Pain: a Systematic Review and Best Evidence Synthesis. The Spine Journal, 4(3):335-56. Eldridge L, Russell J. 2005. Effectiveness of Cervical Spine manipulation and Prescribed Exercise in Reduction of Cervicogenic Headache Pain and Frequency. International J of Osteopathic Med. 8:106-113. Fernandez-de-las-Penas C, Alsonso-Blanco C, San-Roman J, MiangolarraPage JC. Methodological Quality of Randomized Controlled Trials of Spinal Manipulaiton and Mobilzation in Tension-Type Headache, Migraine, and Cervicogenic Headache. JOSPT 2006 Mar;36(3):160-9. Gross A, Hoving J, Haines T, et.al. 2004 A Cochrane Review of Manpulation and Mobilization for Mechanical Neck Disorders. Spine 29(14):1541-1548.

    Evidence Supporting Manual Therapy of the Cervical Spine


    Jull G, Trott P, Potter H. et. al. 2002. A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache. Spine 27(17)1835-1843. Lessinck M, Damen L, Verhagen A. et. al. 2004 The Effectiveness of Physiotherapy and Manipulation in Patinets with Tension-Type Headache: A Systematic Review. Pain 112:381-388. McNair PJ, Portero P, Chiquet C, Mawston G, Lavaste F. Acute Neck Pain: Cervical Spine Range of Motion and Position Sense prior to and after Joint Mobilization. Man. Ther. 2007 Nov;12(4)390-4. Zito G, Jull G, Story I. 2006. Clinical Tests of Musculoskeletal Dysfunction in the Diagnosis of Cervicogenic Headache. Man. Ther. 11(2):118-129.

    References
    Anatomy pictures
    Netter, F.H. Atlas of Human Anatomy. 2nd ed. 1997

    Paris SV. Manipulation and Management of the Spine. S1 thru S4. University of St. Augustine, St. Augsutine, FL 32086 Greenman PE. Principles of Manual Medicine. Lippincott, Williams, & Wilkins. Philadelphia, PA. 2003

    To comply with professional boards/associations standards: I declare that I or my family do not have any financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally all Planners involved do not have any financial relationship. Requirements for successful completion is attendance for the full session along with a completed session evaluation form. Cross Country Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.

    Overview of Manual Therapy Assessment and Treatment of the Cervicothoracic Spine Megan Douglas, PT, DPT, MTC, OCS

    Cross Country Education


    Leading the Way in Professional Development. www.CrossCountryEducation.com

    Thank You!

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