Unraveling the Mystery
of Cervical Pain #3:
TP7 Ligament Sprains
Instructor: Ben Benjamin, Ph.D.
Instructor: Ben Benjamin, Ph.D.
[email protected]
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Webinar Goal
Explore the assessment and
treatment of one of the most
common neck injuries.
Logistics
• Time: 1 hour
• Schedule:
• Presentation 30–40 min
• Questions 15–20 min
• Ongoing questions: Use chat box
Pretest
1. What is the function of the intertransverse
ligaments of the neck?
2. Where does the majority of neck rotation
occur?
3. What is the cause of most pain at the medial
border of the scapula?
4. Which ligament can cause pain in the neck,
scapula, upper arm, and chest?
5. What finding(s) will help you tell the
difference between a muscle injury and a
ligament injury?
6. The TP7 ligament connects C7 and C8.
True or False?
2
Anatomy
Anatomy of the Neck: TP7
Intertransverse Ligament
• Limits side-flexion
• Intersection between
neck and thorax
• Vulnerable area in
the neck
Locating the 7th Transverse Process
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Referred Pain Patterns in the Neck
Referred Pain Patterns in the Neck
Referred Pain
Definition: Pain felt at a distance from its source.
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Four Rules of Referred Pain
Rule #1. Pain refers distally.
Four Rules of Referred Pain
Rule #2. Pain does not cross the midline.
Four Rules of Referred Pain
Rule #3. Pain is referred within the dermatomes.
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Four Rules of Referred Pain
Rule #4. The distance the pain refers is directly
proportional to the severity of the injury.
Areas that refer pain
• Neck
• Thorax
• Low Back
• Shoulders
• Hip Joints
Areas that do not refer pain
• Elbows
• Wrists
• Hands
• Knees
• Lower Leg
• Feet
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Assessment
Active Rotations
(Pain & Limitation)
At least 50% of neck rotation occurs
at C1 and C2, the atlas and axis
Active Side-Flexion
(Pain & Limitation)
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Resisted Side-Flexions
(Muscle Pain)
Passive Rotations
(Pain & Limitation)
Passive Side-Flexion
(Pain & Limitation)
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Theory
Assessment Test Results
for TP7 Ligament Sprains
• Passive rotations are painful
• Side-flexion away from the
injured side is painful
Referred Pain Patterns
for the TP7 Ligaments
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Referred Pain Patterns
for the Cervical Ligaments
Causes of Pain at the
Medial Border of the Scapula
1. TP7 ligament sprain
2. Rhomboid muscle strain
3. Thoracic ligament sprain
4. Subluxated rib head
Primary Structures Injured in
Different Parts of the Body
Different parts of the body have
areas that are more vulnerable.
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Primary Structures Injured in
Different Parts of the Body
Foot and Ankle: Muscles and Ligaments
Primary Structures Injured in
Different Parts of the Body
Thigh: Muscles
Hamstring
Quadriceps
Primary Structures Injured in
Different Parts of the Body
Hip: Joint
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Primary Structures Injured in
Different Parts of the Body
Neck: Ligaments
Differentiating Scalene Muscle
Injury from a Ligament Injury
Resisted test vs. Passive test
Direct & Indirect Causes of Pain
Examples:
• Direct — ligament sprain in the neck
• Indirect — misalignment of neck, limited neck
flexibility, chronic contraction of the neck
muscles, poor movement habits, etc.
It is important to address both types of causes.
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Treatment
• Friction Therapy
• Myofascial Therapy
• Massage Therapy
• Stretching and Strengthening
Exercises
• Cranio-sacral Therapy
Friction Therapy:
The video will be shown at the end of the Webinar
Friction Therapy works on the Direct
Cause of the pain.
Massage Therapy
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The Neck Relaxer Device
Reduces occipital muscle tension
Flexibility Exercises
Aaron Mattes’ Active Isolated Stretching Method
Flexibility Exercises
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Neck Strength Exercises
Myofascial Therapy
Craniosacral Therapy
Correct Movement Patterns
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Referrals
• Alexander Technique or Feldenkrais
practitioner
• AIS practitioner to increase flexibility
and strength
Works on the Indirect Causes of the Pain
Questions
Facebook.com/DrBenBenjamin
Post-test
1. What is the function of the intertransverse ligaments of
the neck?
2. Where does the majority of neck rotation occur?
3. What is the cause of most pain at the medial border of
the scapula?
4. Which ligament can cause pain in the neck, scapula,
upper arm, and chest?
5. What finding(s) will help you tell the difference
between a muscle injury and a ligament injury?
6. The TP7 ligament connects C7 and C8.
True or False?
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