SOFT TISSUE

ASSESSMENT AND TREATMENT OF INTRINSIC SOFT TISSUE DYSFUNCTION

OF THE CERVICAL SPINE

By Robert Granter BSocSci, AssDipAppSci (Myotherapy)

WHAT IS THE DISTINCTION BETWEEN EXTRINSIC AND INTRINSIC SOFT TISSUE? ■ Extrinsic soft tissue will be defined as that which is more

superficial and provides gross or global stabilisation and move- ment. For example trapezius, splenius capitus and cervicus.

■ Intrinsic soft tissue will be defined as that which is deeper and provides stabilisation and movement at a spinal segmental (or local) level. For example multifidus, rotatores (which lie under multifidus) and the upper cervical musculature.

WHY FOCUS ON THE INTRINSIC SOFT TISSUE? 1. It forms an integral part in a thorough cervical examination 2. It gives you a clearer picture of the true function of each vertebral component of the cervical spine 3. A significant proportion of patients who present with cervical restriction, pain and other symptoms such as headache, have intrinsic joint dysfunction 4. Intrinsic joint dysfunction can lead to extrinsic dysfunction.

Some of these intrinsic, 4th tier (deep), muscles are also substantial structures capable of significant contribution to movement when they are functional (for example obliquus capitis inferior producing rotation at C 1/2). However they are also very capable of causing pain and stiffness when dysfunctional. Is it also possible and very common for extrinsic dysfunction to cause intrinsic dysfunction, so it is vital to assess and treat the extrinsic soft tissues first. The scope of this article is to focus on the segmental levels.

BIOMECHANICS OF THE CERVICAL SEGMENTS The range of motion (ROM) for the joints of the cervical spine are shown in Table 1.

ROM figures are for a person of average flexibility, expect less for hypomobile individuals and more for the hypermobile.

www.sportex.net

ASSESSMENT OF THE INTRINSIC SOFT TISSUE Subjective examination While taking the patient history (subjective examination) it is vital to establish: 1) Level of irritability – irritability is considered high if symptoms are severe, and easily aggravated and when aggravated take a long time to settle. You would obviously treat this patient more conservatively that a patient with very low irritability. 2) Past and current treatment and results – this might include: ■ What treatment have they had for this condition? ■ What was the practitioner's 'running diagnosis'?

TABLE 1: RANGE OF MOTION FOR JOINTS OF THE CERVICAL SPINE (NEUMANN 2002)

Segment Primary movement C 0/1 5% flexion 10% extension C 1/2 45% rotation

C 2–7 35% flexion 70% extension 35% lateral flexion 45% rotation Lateral flexion and rotation occur as a coupled movement

17

Secondary movement

5% lateral flexion 0% Rotation

5% flexion

50% of total cervical rotation 10% extension 0% lateral flexion

The focus of this article will be on the biomechanics of the cervical spine segments and the techniques used to assess their function and treat their dysfunction from a soft tissue perspective. Specific direct soft tissue techniques, muscle energy technique and patient self-mobilising exercises will be discussed.