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Cervial Arthritis
- the most common cause of neck pain in the elderly
- NO PRECAUTIONS
- body mechanics, strech, core, modalities, strengthening
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S&S of Arthritis
- Symptoms when the osteophytes impinge on a neural or vascular structure
- Local pain
- Parethesia - numbness, tingleing
- Stiffness - not using full ROM
- Joint crepitance - grinding noise with movement
- Radicularsymptoms - sharp shotting apin in the neck and arm
- Loss of Motion
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Treatment for Cervical Arthritis
- use modalities and massage for symptomacitc relief
- prescribe active fpain free neck exercises and prgoress to resistvie isometric exercises
- Teach pt to self stretch the upper trapexius, levator scapulae,and pectoral muscles
- Teahc the importance of correct head posture
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Muscle Strain
- Can occur with flexion or extension trauma
- Can occur from postural strain from prolonged sitting posture
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Symptoms of Muscle Strain / Whiplash
- Neck shoulder, and back pain
- Nech stiffness
- Concentration and memory problems
- Dizziness
- Insomnia
- Depression and anxiety
- Not always dianosed correctly,may have underlying fracture
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Whiplash from extension
- Head rapidly accelerates into extension and occiput is stopped by thorax
- posterior structures compresed and anterior structures stretched
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Whiplash from Flexion
- Head rapidly accelerates into flexion with chin stopped by sternum
- Posterior stretched anterior compressed
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Important Rehab Considerations for Whiplash
- Do no traction - may have fracture
- Avoid passive stretching of head and trunk - already overstretched
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Acute phase whiplash treatment
- 2-3weeks
- Modalities for pain
- collar for support
- AROM exercises without pain - sidebend rotation
- Educate pt about possture
- find position of comfort (shortened)
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Controlled Mobility Whiplast treatment 2-10 weeks
- Restore flexibility
- Restore optimal posture- lordosis
- AROM exercises
- Grade 2-3 joint mob without pain
- Identify position bais, choose exercises in direction of comfort
- Modalities as needed
- Do motions short of symptoms
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Return to function whiplash treatment 10 weeks to 12 months
- Emphasis is on strengthening and posture
- Increase strngthening exercises
- Posture education
- Functional activities
- Modalilies only in necessary
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Facet Joint Issues
- Will have protective posture - SB/rotation to the same side
- Canbe locked into a position and have pain and restriction with SB and rotation in opposite direction
- Pain may follow dermatomal patho
- no true neruoligical signs
- Palpation of single semgent will be painful
- Will have muscle gaurding
- Most Common site is C5
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Acute Facet Joint Treatment
- Identify position of comfort
- Passive positioning - often will have flexion bias
- Modaliaties
- Traction
- Self Traction
- Isometric Exercises
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Controlled Mobility Facet Joint Treatment
- Modablities as need
- ROM activities into prain free movement - move toard position of comfort andthen gradually work on moving in opposite direction
- Joint mobs
- Stabilization exercises
- Pt ed
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Return to Function phase for Facet Joint Treatment
- Emphasis on strenthening
- AROM to resisted ROM
- Posture ed
- Functional Activities
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Symptoms of Nerve Root Involvement
- Gradual worsening of symptoms starting with central pain at the base of the neck and spreading to shoulder and arm and may refer to upper thoracic spine
- Interscapular pain corresponding to clowards signs
- Later can have psitive neuro signs appear
- SYMPTOMS INCREASE WITH ACTIVITESI AND POSTURES THAT INCRASE FLEXION AND DECREASES WITH AXIAL EXT.
- Posture- slumped posture with forward head. Extension or correct posture can increase peripheral signs and symptoms if protrusion is too large to be reduced
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Disc Pathology Common Sites
- Less grequently in lumbar
- Most common C5-6
- Caused by DDD,DJD
- May need CT scan to diagnose
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Disc Pathology Diagnosis
- x-rays usually are noraml or how very slight narrowing - DDD, DJD, will show more changes on x-ray
- Specal Tests
- CSpine flexion with compression = + HNP
- CSpine extension with compression = nerve root problem at neural foramen
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Important Rehab Considerations for Disc Disorders
- Isometric exercises held secondary to increaseing disc pressure
- Avoid rotation exercises in early stages
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Treatment of Acute Disc
- Bed rest if severe, walking
- Passive axial extension/ cervical retraction- supine no pillow,do a midline head nod
- Pt ed - passively retract in sitting by pushing against chin, position of comfort, passive positioning
- Traction - sustained or oscillatory
- Gental Joint Mobs
- Posture Ed
- Cervial Collar/ support if needed
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Controlled Mobility treatment for Disc problems
- Correct posture
- Dynamic stabilization exercises for posture control - emphasis on shoulder and scapular muscles
- Aerobic exercise
- Environmental adaptations to decrease postural stress
- Initiate function activities
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Return to Function Treatment for Disc Problems
- Progress strengthening during this stage - empasis on upper trunk and core
- Continue postural training
- Functional Activites with safe spinal mechanics - emphasis on repetitive tasks
- Pt ed to revention of reinjury
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