Evidence Based Practice Examination and Intervention  for the  Cervical Spine Condensed from Josh Hayes PT, DPT, OCS By Ch...
Objectives <ul><li>Review and Normalize Exam Techniques </li></ul><ul><li>Diagnosis with Validated Tools </li></ul><ul><li...
Examination <ul><li>Acuity </li></ul><ul><li>Benefit from PT/Red Flags </li></ul><ul><li>Comparable Sign </li></ul><ul><li...
Examination <ul><li>Cervical Myelopathy </li></ul><ul><ul><li>B&B, Atrophy and Gait </li></ul></ul><ul><li>Neoplastic Cond...
Special Tests <ul><li>ULNTT </li></ul><ul><li>Spurling’s </li></ul><ul><li>Distraction </li></ul><ul><li>VA </li></ul><ul>...
Diagnosis <ul><li>Mobility </li></ul><ul><li>Centralization </li></ul><ul><li>Conditioning </li></ul><ul><li>Pain Control ...
1 - Mobility <ul><li>< 3 Months </li></ul><ul><li>No Radicular/Referred Symptoms in UQ </li></ul><ul><li>Limited Lateral F...
2 - Centralization <ul><li>UQ Symptoms </li></ul><ul><li>Peripheralization or Centralization </li></ul><ul><li>Nerve Root ...
3 - Conditioning <ul><li>Low Pain and NDI </li></ul><ul><li>> 3 Months </li></ul><ul><li>No Nerve Root Compression </li></...
4 - Pain Control <ul><li>High Pain and NDI </li></ul><ul><li>Very Recent Onset </li></ul><ul><li>Trauma </li></ul><ul><li>...
5 - Headache <ul><li>HA Preceded by Neck Pain </li></ul><ul><li>HA Triggered with Neck Movement </li></ul><ul><li>HA Elici...
Cervical Radiculopathy <ul><li>ULTTA </li></ul><ul><li>Involved Rotation < 60 ° </li></ul><ul><li>Distraction </li></ul><u...
Cervical Radiculopathy <ul><li>Predictors of Success </li></ul><ul><ul><li>< 54 yo </li></ul></ul><ul><ul><li>Non-Dominent...
Manual Therapy & Exercises <ul><li>Downglide Mob/Manip </li></ul><ul><li>Upglide Mob/Manip </li></ul><ul><li>Cervical Late...
Questions?
References <ul><li>Proposal of a Classification System for Patients with Neck Pain. Childs et al, JOSPT 34:11 2004 </li></...
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Evidence Based Practice Cervical Spine

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Evidence Based Practice Cervical Spine

  1. 1. Evidence Based Practice Examination and Intervention for the Cervical Spine Condensed from Josh Hayes PT, DPT, OCS By Chris Keating PT, DPT
  2. 2. Objectives <ul><li>Review and Normalize Exam Techniques </li></ul><ul><li>Diagnosis with Validated Tools </li></ul><ul><li>CPR use to Guide Treatments </li></ul><ul><li>Use the Same Lingo </li></ul><ul><li>Greater Consistency of Care </li></ul><ul><li>Practice Manual Skills </li></ul>
  3. 3. Examination <ul><li>Acuity </li></ul><ul><li>Benefit from PT/Red Flags </li></ul><ul><li>Comparable Sign </li></ul><ul><li>Direction of Treatment </li></ul><ul><li>Canadian C-Spine Rule </li></ul><ul><li>Neck Disability Index </li></ul><ul><li>Clinical Significance >10% </li></ul><ul><ul><li>0-8% No Disability </li></ul></ul><ul><ul><li>10-28% Mild </li></ul></ul><ul><ul><li>30-48% Moderate </li></ul></ul><ul><ul><li>50-68% Severe </li></ul></ul><ul><ul><li>70-100% Complete </li></ul></ul>
  4. 4. Examination <ul><li>Cervical Myelopathy </li></ul><ul><ul><li>B&B, Atrophy and Gait </li></ul></ul><ul><li>Neoplastic Conditions </li></ul><ul><ul><li>>50yo , Constant Pain and Night pain </li></ul></ul><ul><li>Upper Cervical Ligamentous Instability </li></ul><ul><ul><li>Limited AROM (CROM/Inclinometer), Occipital HA and CM Signs </li></ul></ul><ul><li>VA Insufficiency </li></ul><ul><ul><li>D’s (Dysphasia, Dysarthria and Diplopia) </li></ul></ul><ul><li>Inflammatory or Systemic Disease </li></ul><ul><ul><li>Temp > 37, Resting Pulse >100, Resp Rate >25 and Fatigue </li></ul></ul>
  5. 5. Special Tests <ul><li>ULNTT </li></ul><ul><li>Spurling’s </li></ul><ul><li>Distraction </li></ul><ul><li>VA </li></ul><ul><li>Sharp Purser </li></ul><ul><ul><li>Transverse Ligament </li></ul></ul><ul><li>Alar Ligament Test </li></ul>
  6. 6. Diagnosis <ul><li>Mobility </li></ul><ul><li>Centralization </li></ul><ul><li>Conditioning </li></ul><ul><li>Pain Control (poor candidate) </li></ul><ul><li>Headache </li></ul>
  7. 7. 1 - Mobility <ul><li>< 3 Months </li></ul><ul><li>No Radicular/Referred Symptoms in UQ </li></ul><ul><li>Limited Lateral Flexion and Rotation </li></ul><ul><li>No Nerve Root Compression </li></ul><ul><li>Rx: C-s and T-s Mobs/Manips and AROM </li></ul>
  8. 8. 2 - Centralization <ul><li>UQ Symptoms </li></ul><ul><li>Peripheralization or Centralization </li></ul><ul><li>Nerve Root Compression </li></ul><ul><li>Rx: Traction, Repeated Motion in Directional Preference </li></ul>
  9. 9. 3 - Conditioning <ul><li>Low Pain and NDI </li></ul><ul><li>> 3 Months </li></ul><ul><li>No Nerve Root Compression </li></ul><ul><li>No Directional Preference </li></ul><ul><li>Rx: Strengthening or Deep and Global Stabilizers throughout UQ </li></ul>
  10. 10. 4 - Pain Control <ul><li>High Pain and NDI </li></ul><ul><li>Very Recent Onset </li></ul><ul><li>Trauma </li></ul><ul><li>Radiating UQ pain </li></ul><ul><li>Very Poor Tolerance to Exam and Rx </li></ul><ul><li>Rx: Gentle AROM, Modalities and Activity Modification </li></ul>
  11. 11. 5 - Headache <ul><li>HA Preceded by Neck Pain </li></ul><ul><li>HA Triggered with Neck Movement </li></ul><ul><li>HA Elicited by Posterior Pressure </li></ul><ul><li>Rx: C-s manips/mobs, Strengthening and Posture </li></ul>
  12. 12. Cervical Radiculopathy <ul><li>ULTTA </li></ul><ul><li>Involved Rotation < 60 ° </li></ul><ul><li>Distraction </li></ul><ul><li>Spurling’s </li></ul><ul><li>3+ 6.1 LR </li></ul><ul><li>4+ 30.3 LR </li></ul>
  13. 13. Cervical Radiculopathy <ul><li>Predictors of Success </li></ul><ul><ul><li>< 54 yo </li></ul></ul><ul><ul><li>Non-Dominent Extermity </li></ul></ul><ul><ul><li>Looking Down Doesn’t Worsen Symptoms </li></ul></ul><ul><ul><li>Manual Therapy, Traction and Flexor Strengthening </li></ul></ul>
  14. 14. Manual Therapy & Exercises <ul><li>Downglide Mob/Manip </li></ul><ul><li>Upglide Mob/Manip </li></ul><ul><li>Cervical Lateral Glide in ND Position </li></ul><ul><li>Supine DOG </li></ul><ul><li>Thoracic Screw </li></ul><ul><li>Extension Progression </li></ul><ul><li>See Handout for Exercises </li></ul>
  15. 15. Questions?
  16. 16. References <ul><li>Proposal of a Classification System for Patients with Neck Pain. Childs et al, JOSPT 34:11 2004 </li></ul><ul><li>Predictors of Short-Term Outcome in People With a Clinical Diagnosis of Cervical Radiculopathy. Cleland et al, PTJ 87:12 </li></ul>

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