Suspected vascular pathology, malignancy, inflammatory or infective arthritis, advanced diabetes, haemophilia, connective tissue disease such as Ehlers-Danlos, anticoagulant medication or long-term use of corticosteroids, cranio-vertebral anomalies (e.g., congenital absence of odontoid), deteriorating neurological status, recent trauma, joint or fracture instability, marked muscle spasm, osteoporosis, pregnancy.
Because manual therapy could exacerbate the condition and lead to serious complications.
Large amplitude into resistance.
It slopes down backwards.
It risks damage to the carotid and vertebral arteries.
Acute neck pain, stiffness, and muscle spasm
Headaches resulting from irritation or dysfunction of the facet joints in the cervical spine.
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Torticollis
Rotation (approximately 45 degrees).
Unhelpful beliefs, emotions, and pain behaviors.
Cardiac pathology.
A small amount of other movements.
Serious pathology such as history of cancer, constant unrelenting night pain, unexplained weight loss.
Localized pain in the neck with referral to the back of the head and temples, stiffness in the neck with limited movement, and headache triggered or worsened by specific neck movements.
High velocity thrust (HVT).
Strenuous exercise or weightlifting.
It is benign and usually resolves within a few days
Predicted full recovery.
Rest, heat, medications, and manual therapy (DO NO HARM).
The sensory neuron directly synapses with a motor neuron in the spinal cord.
A small click (cavitation).
A receptor detects a stimulus, such as muscle stretch, in muscle spindles.
To predict the risk of ongoing moderate/severe disability and guide treatment strategies for whiplash patients.
Small amplitude short of resistance.
Small amplitude into resistance.
Blood pressure measurement and Cervical Artery Sustained Rotation Test.
The supportive hand supports the head and adds counter pressure to the motive hand.
The knee-jerk (patellar tendon) reflex.
Vascular pathology.
Narrowing of the space within the spine, such as the spinal canal or intervertebral foramina.
Congenital absence of odontoid.
Prolonged poor posture, stress, anxiety, mental fatigue, and overuse of neck and shoulder muscles.
The motive hand creates the motion.
Trauma, congenital abnormalities, inflammatory disease, generalized hypermobility syndromes.
Short lever movements generate accessory movement in the joint and can be useful for testing, acute, or elderly spines.
Double vision.
In the posterior horn.
Involuntary eye movement.
Lower Motor Neuron (LMN) presentations.
Because the impacted signals are from a single defined nerve or spinal segment.
Posterior to the sternoclavicular joints, in the carotid sheath posterior to the sternocleidomastoid muscle.
A monosynaptic reflex arc is an involuntary, fast reflex involving a single synapse between a sensory neuron and a motor neuron.
Degeneration or injury to the cervical facet joints, joint stiffness or misalignment often linked to poor posture, and muscle guarding around the cervical joints.
Cauda equina.
Disc, facet, instability/ligament, muscle, postural.
Recent trauma can lead to instability or incomplete healing, making manual therapy potentially harmful.
Transverse, alar, tectorial membrane.
Speech difficulty.
Because signals between the muscle and the spine (alpha motor neurons) remain intact, so muscle activity is present but not normal.
Movement at the OC1 (AO joint).
Often upon waking from sleep
Nociceptive sources in the cervical spine.
Ehlers-Danlos syndrome.
Tension-type headache.
Light headedness, blurred vision, postural hypotension, tinnitus.
Headaches that arise from trigger points or muscle knots in the head, neck, or shoulders.
The chin hold is an alternative grip of the head where the therapist's non-contact arm is placed along the side of the face with either a small amount of contact with the chin or none.
Ringing in the ears.
No complaints about the neck and no physical signs.
Neck complaint and neurological signs such as decreased ROM and point tenderness.
Flexion/Extension (F/E) approximately 20 degrees.
Sudden onset of throbbing pain during or after exercise, pain may affect both sides of the head (bilateral) or be localized, and may last from minutes to hours.
NDI (Neck Disability Index) score, age, and hyper-arousal status.
Large amplitude short of resistance.
To screen for cervical spine issues and obtain consent for assessment and potential treatment.
Diplopia, Dysarthria, Dysphagia, Dizziness, Drop attacks, Nausea, Nystagmus, Numbness.
It ensures that the patient understands the assessment, potential benefits and risks, and has the opportunity to ask questions and select alternate management.
Upper cervical spine dysfunction (O/C1-C1/2) and positive cervical flexion rotation test (C1/2 rotation).
Dysfunction in the jaw joint (TMJ) and surrounding muscles.
Bruxism (teeth grinding or clenching), jaw misalignment or injury, and arthritis affecting the TMJ.
Cervicogenic headache (CGH).
Widespread symptoms, hypertonia or spasticity, hyperreflexia and clonus, pathological reflexes (Babinski), paresis rather than paralysis, and rare atrophy.
Because descending regulatory/inhibitory pathways are interrupted, allowing local peripheral pathways to fire 'unchecked', causing heightened tone and reflexes.
The Babinski reflex is a pathological reflex seen in upper motor neuron (UMN) lesions, where the big toe extends upward when the sole of the foot is stimulated.
Rotation and side bend to the same side.
Accurate advice and education, relative rest, simple medications, exercise appropriate to patient condition, manual therapy, specific dizziness assessment and management, referral (imaging, medical, psychological).
Vertebral artery and carotid artery (internal and external).
Negative or Positive.
Convergence of sensory input from the upper cervical spine into the trigeminal spinal nucleus, including upper cervical facets and muscles, C2-3 IVD, vertebral and internal carotid arteries, dura mater of the upper spinal cord, and posterior cranial fossa.
Approximately 47% of the global population suffers from headaches, and 15-20% of those headaches are cervicogenic.
Downslope movements are movements of the facet joints in the mid to lower cervical spine that occur during ipsilateral side-bending, rotation, and extension.
Pain in the distribution of a nerve root, felt in the dermatomal distribution of a nerve root.
Emergency Department (ED)
Tension type headache.
5 cm tumor or fibrosis, abnormal development of the cervical vertebrae, cervical spine articular disruption, intracranial pathology, inflammation or infection in the neck.
Neurovascular compromise including 5Ds 3Ns, headaches/dizziness/facial symptoms, widespread neurological changes, lump in throat, fatigue with prolonged postures.
It involves only one synapse, providing a quick protective response.
PPIVM stands for Passive Physiological Intervertebral Movement, where the therapist passively moves a joint through its physiological range.
Classifying whiplash-associated disorders (WAD).
Neck complaint of pain, stiffness, or tenderness only with no physical signs.
Adolescents and young adults
Work-related perceptions.
Manual therapy could potentially spread malignant cells or worsen the condition.
Muscle spasm, facet sprain or synovial fold, disc material.
Diplopia, Dysarthria, Dysphagia, Drop attacks, Nausea, Nystagmus, Numbness.
Sudden falls without loss of consciousness.
Motion in one plane will reduce motion in the other two planes.
Only 1/3 fully resolved within one year.
Predicted ongoing moderate/severe disability.
Bilateral head pain described as a tight band around the head, dull pressing or tightening sensation, and mild to moderate intensity without nausea or vomiting.
Carries the signal to the spinal cord.
Oedema, haemorrhage, and inflammation.
Cluster and migraine headaches (vascular origin), tension-type headaches (muscular origin).
Upslope movements are movements of facet joints in the mid to lower cervical spine that occur during contralateral rotation or side bending.
Neck complaint and musculoskeletal signs such as decreased ROM and point tenderness.
Advanced diabetes can lead to complications such as poor wound healing and increased risk of infection, making manual therapy risky.
Anticoagulant medication increases the risk of bleeding, which can be exacerbated by manual therapy.
Manual therapy and exercise.
Osteoporosis weakens bones, increasing the risk of fractures during manual therapy.
Migraine and tension-type headaches.
Pain localized to specific muscles with referred pain patterns, muscle tenderness with palpable trigger points, and restricted range of motion in the neck.
Neck pain, stiffness, dizziness, paraesthesia/anaesthesia in the upper quadrant, headache, arm pain, concentration and sleep deficits, psychological changes, disability, decreased quality of life, and psychological distress.
The cradle hold involves both hands cradling the head using the hypothenar eminence, allowing fingertips to palpate or create other movements.
The C8 nerve root is located between the C7 and T1 vertebrae.
In the anterior horn.
Mobilization involves movements generated by the therapist that put the joint through a range of motion up to and including the end of the available range, which are controlled, rhythmical, and do not exceed the physiological joint range.
Hyporeflexia is a condition where there is a reduced reflex response.
Poor recovery.
Weakness, reduced coordination, and sensory change.
Regulatory, medico-legal, and insurance-related factors.
Fractures, infections, inflammatory disorders, malignancy, vascular pathology, neurological pathology.
Information about headaches or migraines, neck pain, medical history, and general medical problems.
Overuse of muscles, poor posture or repetitive activities causing muscle imbalance, and muscle trauma or injury.
Pain in the temples, jaw, or ear region.
Difficulty swallowing.
Because signals between the muscle and the spine (alpha motor neurons) remain intact, maintaining some muscle activity.
The sensing hand is in direct contact with the joint to be tested.
Sudden acceleration-deceleration associated with motor vehicle accidents (MVA).
Long lever movements lock 2+ cervical segments to create a lever, assessing physiological and/or accessory movements, making the movement more specific to a particular level.
Motor information.
Because tracts in the spinal cord transmit signals from multiple spinal levels and areas of the cerebral cortex represent body regions.
Because descending regulatory/inhibitory pathways are interrupted, allowing local peripheral pathways to fire 'unchecked', causing heightened reflexes.
Hypotonia is a condition characterized by reduced muscle tone.
Associated with neck pain and stiffness, unilateral, starts from one side of the posterior head and neck, can migrate to the front, associated with ipsilateral arm discomfort, aggravated by neck positions and specific occupations.
The contact hand is in direct contact with the joint being mobilized.
The muscle that responds by contracting.
Sensory information.
Fasciculations are muscle twitching caused by damaged alpha motor units producing spontaneous action potentials.
The nerve roots below the C8 nerve root come from under their respective vertebrae.
Localized symptoms such as affecting a single myotome, dermatome, or nerve.
Hyporeflexia is caused by damage to the motor nerve directly supplying the muscle, preventing the signal from reaching the muscle.
Sends a signal from the spinal cord to the muscle.
The signal does not get to the muscle, causing weakness and muscle atrophy.
The nerve roots for C1-7 are positioned above their respective vertebrae.
Hypotonia is caused by damage to the motor nerve directly supplying the muscle, preventing the signal from reaching the muscle.
Education, manual therapy, motor control and strength training, referral if required.
Headaches that result from another source such as inflammation or head and neck injuries.
PAIVM stands for Passive Accessory Intervertebral Movement, where the therapist creates an accessory glide at the joint.
The peripheral nervous system.
HVT stands for High Velocity Thrust Manipulation.
Neck complaint and fracture or dislocation.
Chemical, physical (compression/stretch/cut), hypoxia, and disease.
Sensory loss, weakness, and reduced coordination.
Neuropraxis (myelin disruption), Axonotmesis (varying axon disruption), and Neurotmesis (complete transection).
Quite good recovery.
Some recovery.
Numbness/sensory change, weakness, reflex changes, and pain.
Compression or disruption of the function of a nerve root.
Coordination problems (ataxia) and gait and balance disturbance.
A dermatome is supplied by a single nerve root, whereas a named peripheral nerve may supply multiple areas.
Forward head posture, slouching or sitting for long periods without movement, and muscle fatigue and tightness in the neck and shoulder region.
Cranial nerves.
A type of headache caused by irritation or compression of the occipital nerves at the back of the head.
Knee extension.
The spinal cord ends at L1-2, and the cauda equina consists of the L2-5 and sacral nerve roots.
Headaches triggered by physical exertion, particularly involving neck or back muscles.
Elbow flexion.
An area of skin supplied by a single nerve root.
Somatic referred pain comes from noxious stimulation of somatic (musculoskeletal) tissue, such as a disc or ligament.
Headaches caused by prolonged poor posture, especially of the neck and upper back.
It increases tension in the body and changes flow in pathways.
Bilateral lower limb neurological changes, reduced perineal sensation, altered bladder function, reduced anal tone, loss of sexual function, and pain.
Motor, sensory, or mixed fibers.
Thumb extension and long finger flexors.
Dermatomes, myotomes, and reflexes.
Power loss, sensory alteration/loss, and reflex changes.
Sharp, shooting pain starting at the base of the skull and radiating to the scalp, forehead, or behind the eyes; tenderness over the occipital area; and sensitivity to light (photophobia).
The suprascapular nerve.
Ankle plantarflexion.
An example is pain in the arm during a heart attack, caused by the convergence of nerves from the heart and shoulder to the same point in the spinal cord, leading to confusion in the brain.
Shoulder abduction.
Clench teeth.
Tightness or spasms in the neck muscles compressing the occipital nerves, trauma to the neck or head, and chronic tension or overuse of neck muscles.
The myelin sheath, made up of Schwann cells, increases the speed at which action potentials travel down nerves.
Ankle dorsiflexion.
Jaw clicking or popping, and difficulty opening or closing the mouth.
C fibers are unmyelinated and are associated with pain.
Hip flexion.
Pull arms apart.
Lumbar disc pathology.
Increased muscle tension during physical activities.
Elbow extension.
The reaction is stronger and produces a larger reflex.
Incontinence and sexual dysfunction.
Alpha, beta, delta fibers, and C fibers (pain).
Finger abduction/adduction.
Because it involves wide areas and the brain cannot distinguish between the neurons from the irritated tissue and neurons from elsewhere.
Dull, aching pain that develops gradually, pain typically starts in the neck and radiates to the back of the head or temples, and symptoms worsen as the day progresses or with prolonged static positions.
Schwann cells catapult action potentials across the cells at a fast pace, increasing the speed of nerve conduction.
Big toe extension.
The saphenous nerve and the lateral cutaneous nerve of the thigh.
Knee flexion.
