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 physio will ask about the location and nature of the pain. Neck problems often involve other areas and the presence of shoulder and arm pains will tell the physiotherapist what kind of pain they are dealing with. Sharp, localized pain on movement could be a joint sprain, generalized neck ache a postural or segmental problem and severe arm pain could be a nerve root compression from a disc prolapse.
Because neck pain could be an indicator of various pathologies the physio will ask all the special questions such as general health, past medical history, weight loss, bladder and bowel control, quality of appetite and sleep and medication usage. The objective examination begins by getting the patient to take their upper body clothes off and looking at the posture of the trunk, neck, shoulders and arms. A humped thoracic spine with rounded shoulders and a poking chin are a common postural abnormality which can lead to pain.
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 therapists such as physiotherapists learn mobilization techniques and to assess the spinal joints manual palpation of the cervical spine is used. Using their thumbs or the heel of the hand, the physio presses down on the spinal processes or side joints of the cervical spine. This allows some specific conclusions to be drawn when the pain symptoms come on at one particular spinal level and not another. Treatment will be aimed at these levels.
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.
Typical physio treatments are exercise programmes, nerve mobilizing techniques, correction of poor posture, pacing technique, trunk segmental mobilization and strengthening of the deep flexor muscles of the cervical spine. Nerve root compression of a cervical nerve root can cause severe arm pain, loss of sleep and distress from a cervical slipped disc. Cervical traction can decrease the pressure on the affected segment and reduce pain enough t - 15438
The physio will ask about the location and nature of the pain. Neck problems often involve other areas and the presence of shoulder and arm pains will tell the physiotherapist what kind of pain they are dealing with. Sharp, localized pain on movement could be a joint sprain, generalized neck ache a postural or segmental problem and severe arm pain could be a nerve root compression from a disc prolapse.
Because neck pain could be an indicator of various pathologies the physio will ask all the special questions such as general health, past medical history, weight loss, bladder and bowel control, quality of appetite and sleep and medication usage. The objective examination begins by getting the patient to take their upper body clothes off and looking at the posture of the trunk, neck, shoulders and arms. A humped thoracic spine with rounded shoulders and a poking chin are a common postural abnormality which can lead to pain.
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 therapists such as physiotherapists learn mobilization techniques and to assess the spinal joints manual palpation of the cervical spine is used. Using their thumbs or the heel of the hand, the physio presses down on the spinal processes or side joints of the cervical spine. This allows some specific conclusions to be drawn when the pain symptoms come on at one particular spinal level and not another. Treatment will be aimed at these levels.
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.
Typical physio treatments are exercise programmes, nerve mobilizing techniques, correction of poor posture, pacing technique, trunk segmental mobilization and strengthening of the deep flexor muscles of the cervical spine. Nerve root compression of a cervical nerve root can cause severe arm pain, loss of sleep and distress from a cervical slipped disc. Cervical traction can decrease the pressure on the affected segment and reduce pain enough t - 15438
About the Author:
Jonathan Blood-Smyth is a Superintendent Physiotherapist at a large NHS training hospital in Devon. He publishes articles on injuries and accidents in journals and on his website for physiotherapists. If you are seeking local physiotherapy after an accident or injury, visit his website for physiotherapy practitioners around the United Kingdom.
