Colleen Scordato, DPT, Cert. MDT
Orlando Health
Better understand physical therapy cervical
terminology
Understand cervical anatomy and implications
of poor posture
Importance of a good history or subjective to
determine diagnosis and treatment
Be familiar with cervical special tests and
measures
Treatment is constantly evolving and changing
Importance of home exercise program and
education
7 vertebral bodies
8 spinal nerves
Disc
Nucleus Pulposus
Annular fibrosus
Muscular strain
Spondylosis
Degenerative disc disease
Radiculopathy
Disc herniation
Surgeries
ACDF- anterior cervical discectomy and fusion
Discectomy
Laminectomy
Work positions
80% sitting 20% standing and walking
Physical activity prior to injury
Pain rating
Mechanism of injury
Where are symptoms
Cervical, scapular, arm, headaches
When did symptoms begin
Improving, worsening or unchanging
Initial symptoms
Constant or Intermittent
What makes symptoms better or worse?
Positions
Bending
Sitting
Turning
Lying/Rising
Time of day
Am, as the day progresses, Pm
When still or on the move
Previous episodes
Previous or current other treatments
Medications, Chiropractor, Acupuncture, Injections
Red flags
Dizziness, nausea, swallowing, tinnitus
Rapid weight loss
Gait/upper limbs: normal/abnormal
medications
Recent surgeries
Recent trauma
Other medical issues
Night pain
Good, fair, poor
Correction of posture
Lumbar roll
Back, stomach or side
Number of pillows
Arm under or curl pillow
Cervical roll
Lateral shift
Relevant
Yes/no
If unable to self correct lateral forces frontal
plane treated first
Protrusion
Retraction
Flexion
Extension
Rotation
Lateral Flexion
0/5- no contraction
1/5- muscle flicker, but no movement
2/5- muscle moved through anti-gravity
position only
3/5- muscle moves through gravity position, but
no resistance
4/5- muscle moves through gravity with some
resistance; functional
5/5- normal strength
0- absent reflex
1⁺- trace
2⁺- normal
3⁺- brisk
4⁺- nonsustained clonus
5⁺- sustained clonus
Vertibral artery test
Supine extension, right rotation and right lateral
flexion hold for 10 seconds
Positive nystagmus, nausea, dizziness
Spurling’s test
Lateral flexion with clinician overpressure
Positive causes radiculopathy
Distraction test
Compression test
Quadrant test
Right Facet compression
Extension, right rotation and right lateral flexion
Positive right sided pain
Deep neck flexor endurance test
Supine retraction and elevation
2 trials for 30 seconds
Stop if painful or unable
Grip strength
Dominant hand 10% stronger than nondominant
Sitting
Protrusion
Retraction
Retraction Extension
Lying
Retraction
Retraction Extension
Sitting
Lateral Flexion- R/L
Rotation- R/L
Flexion
Protrusion
Retraction
Flexion
Extension
Sitting
Prone
Supine
Posture- mechanical deformation of normal soft
tissues
Prolonged end range loading
Dysfunction- mechanical deformation of
structurally impaired tissues
Scarring, adaptive shortening, or degenerative
Postures will have no effect or pain at end range no
worse or no better
Derangement- internal derangement causes
disturbance in normal resting position of
affected joint
Postures will either: Worsen or peripheralize
symptoms; Improve or centralize symptoms
Static postures respond better
Retraction
Flexion
Retraction Extension
Research proves it is not an effective form of
treatment
Ultrasound, Electrical stimulation, ice, heat,
laser, traction
May prep tissue for other effective treatment
Increase patient confidence by providing
temporary relief
Cross friction massage
Scar adhesions
Graston technique
Instrument assisted soft tissue mobilization
Detect and treat fascial restricitons
cervical retraction
https://www.youtube.com/watch?v=oIHH3Km
myu8
Repetitions, Frequency, Dynamic or Static, with or
without overpressure
Scapular retraction and depression
Lower trapezius strengthening
Cervical retraction
Cervical retraction with patient overpressure
Cervical retraction with clinician overpressure
Cervical retraction mobilization
Cervical retraction manipulation
Grade I- small amplitude rhythmic oscillations in
early range of movement
Grade II- large amplitude rhythmic oscillations
in midrange of movement
Grade III- large amplitude rhythmic oscillations
to end range of movement
Grade IV- small amplitude rhythmic oscillations
at end range of movement
Grade V (thrust manipulation)- small amplitude
quick thrust at end range of movement
Proper posture
Sleeping
Sitting
Standing
Lifting
Housecleaning
Computer work
Push/pull
Treatment
Repetitions, Frequency, Dynamic or Static, with or
without overpressure
Prophylactic care
Cervical Stabilization
Isometric
Proprioception
Isotonic
Thoracic mobility
Scapular strengthening