OPP Lect 19
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| Strains | Muscular Injury
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| Sprains | Ligamentous stretch injury
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| Flexion injuries from rapid acceleration-deceleration (Whiplash) | 1.Posterior muscle strain.
2.Interspinous lig sprain (vertical b/w spinous processes that maintain stability, prevent slipped vertebrae: spondelocentesis).
3.Anterior vertebral body compression fracture.
4.Disc Herniation.
5.Spinal Stenosis.
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| Extesion injuries from rapid acceleration-deceleration (Whiplash) | 1.Anterior muscle strain.
2.Brachial plexopathy.
3.Dens fracture (atlantoaxial subluxation due to rapid extension of occiput)
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| How do Shearing Injuries occur? | When one part is stable and another part moves
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| Types of Shearing Injuries | 1.Contusions (facet joint).
2.Sprains.
3.Fractures.
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| When do you order X-Rays? | 1.Severe pain & spasm that doesnt normalize after a few min.
2.Restriction and spasm that doesn't normalize in hrs to few days.
3.Instability is suspected even after ruling out fracture (persistant gaurding, or different movements). Order fle/ext view
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| Head and neck symptoms with Whiplash? | 1.Neck pain.
2.Neck Stiffness.
3.Loss of ROM.
4.Headache.
5.Shoulder pain.
6.Back pain.
7.Extremity pain.
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| What is the most important factor for chronic pain prognosis from whiplash? | TIME OF INJURY.
1.56% asymptomatic @ 3 months.
2.82% recovered @ 2 years.
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| What worsens the prognosis of chronic pain from whiplash? | 1.Age.
2.Female.
3.initial pain in neck.
4.higher initial pain intensity.
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| What can be used to distinguish b/w asymptomatic and chronic myofascial pain? | Cervical range of motion
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| What would a reduced cervical ROM at 3 months indicate? | chronic pain and disability for 2 years.
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| When testing the cervical spine, do you test active or passive ROM first? | ACTIVE
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| Active interventions for whiplash? | 1.Early physical activity (C-collar can make things worse if worn for too long).
2.Physical therapy and emotional therapy.
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| What is the major prognostic indicator at 3 months? | Cervical ROM.
**Manipulation reduces pain and improves ROM.
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| will exercise alone improve cervical ROM? | NO
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| What type of techniques would you use for the first 2 weeks after whiplash (Acute) | 1.INDIRECT techniques (NO DIRECT).
2.Sympathetic normalization (rib raising).
3.Lymph drainage (thoracic pump).
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| What type of techniques would you use for 2 weeks - 2 months after whiplash (Subacute) | 1.DIRECT techniques.
2.Home flexibility.
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| What type of techniques would you use for 2 months after whiplash | 1.Injections (trigger point and facet point)
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| With Cervical spine, how do you sidebend and rotate for counterstrain? | AWAY from tenderpoint.
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| C2-7, side-bending and rotation occur | in the SAME direction.
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| Starting position for Sidebending Muscle Energy C2-7 | Flex/Ext and sidebend INTO restiction, rotate AWAY from restriction (this limits other joints).
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| Starting position for rotation Muscle Energy C2-7 | Flex/ext and rotate INTO restriction, sidebend AWAY from restriction (this limits other joints).
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| 2 main differences b/w treatment of cervical spine and thoracic/Lumbar | 1.Not neutral or non-neutral (will be restricted in flex or ext).
2.only reversing 2 planes of restriction (taking the other into position of ease).
**Works best for Cervical Muscle energy, articulatory, and HVLA
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| Somatic dysfunction: FRS Right. Treat with cervical sidebending muscle energy | 1.Extend.
2.Sidebend Left.
3.Rotate Right (into position of ease)
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| Somatic dysfunction: FRS Right. Treat with cervical rotation muscle energy | 1.Extension.
2.Rotate Left.
3.Sidebend Right (into position of ease)
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| Why would you choose b/w sidebending or rotation treatment? | Sidebending could narrow the foramen of the nerve causing limb numbness, do rotation if this is the case.
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| Relative contraindications for cervical ME/LVHA/HVLA | 1.Joint inflammation.
2.Acute sprain.
3.Acute fracture.
4.Undiagnosed cervical radiculopathy.
5.Vertebral Artery insuffiency.
6.Joint hypermobility.
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| What is the difference b/w neuritis and radiculopathy? | Can treat neuritis with DIRECT techniques. Patient will have neurological symptoms but no sensory, motor, or deep tendon reflex loss.
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