CERVICAL SPINE

■ Exactly what was done to what structures? ■ What depth of work was done? ■ What were the results? 3) It is also vital to identify, assess and address causative factors such as postural stress and inappropriate behaviours.

The answers to these questions should give you a much clearer idea of how the patient reacts to treatment and it allows you to start from an informed position. Of course certain flags will go up if anything in the history needs clarification. If in doubt – have it medically checked out.

Objective examination In relation to the assessment of intrinsic cervical segmental function we will utilise two processes: A. Active joint movement B. Passive joint movement

A. Active joint movement In relation to active assessment it may be useful to repeat the range of motion (ROM) tests, eg. cervical rotation and lateral flexion, with the scapula passively elevated. This takes out the influence of the posterior cervico-scapula extrinsic tissue (upper trapezius/levator scapulae).

■ If ROM is increased and/or pain is decreased then this implicates posterior cervico-scapula extrinsic tissue dysfunction

■ If ROM and/or pain is unchanged this excludes posterior extrinsic tissue dysfunction and implicates intrinsic soft tissue or joint dysfunction.

B. Passive joint movement Before assessing passive joint movement, ensure that the patient is relaxed and confident. This can be assisted by ensuring that you are focused and have a confident support of the head and neck and by being predictable and purposeful in your movements.

It may also be useful to use a preparatory massage to reduce tension and excessive tone in muscles that are being 'held'. Using small range, simultaneous passive rotation and lateral flexion of the head and neck will increase effectiveness.

As with any passive movement test ask the patient to ‘Please stop me the moment you feel any pain or stretch’.

PASSIVE JOINT MOVEMENT BY SEGMENT C0/1 The primary movement at C0/1 (ie. the skull and the first cervical vertebra) is flexion and extension – it is more difficult to use flexion and extension to isolate C 0/1 function as C 1/2 moves similarly. This motion is still important to assess, however lateral flexion is easier to quantify as that motion is greater at C0/1 than C1/2. Around 5-8o around 0o

lateral flexion is available at C0/1 whereas lateral flexion is available at C1/2 (1).

Laterally flex the head on a ‘still’ neck (to minimise motion from the segments C2-C7) to the first onset of practitioner-perceived resistance (R1). Assess both quantity (ROM) and quality of movement.

18 Figure 1: Lateral flexion of C0/1

C1/2 The primary movement at C1/2 is rotation.

rotation expected, for an average flexibility type is 85o that total occurs at C1/2 (3), so expect approximately 45o

The total cervical (2), 50o

of to each

side from C1/2. 1. Place mid-cervical spine into flexion to R1 to place sufficient tension on intrinsic soft tissue of joints C3-7 and thus minimise their involvement in rotation. 2. Passively rotate left and right to R1 – assess both quantity (ROM) and quality of movement.

Figure 2: Assessment of C1/2

C2/3 to C6/7 There are several ways to assess C2 to C7 function. This includes passive movement with lateral flexion or oblique glides and visual assessment of joint position. In this article only the former will be discussed.

INTERPRETATION OF FINDINGS For example if passive LEFT lateral flexion at C3/4 is restricted – the most simplistic conclusion is the intrinsic muscles (or fascia) at level of C3/4 on the RIGHT are restricted and are not allowing the joint to OPEN. But what if instead the intrinsic tissue at level of C3/4 on the LEFT was thickened and not allowing the joint to CLOSE.

In relation to soft tissue dysfunction which side is the intrinsic dysfunction on at C3/4? Which side should we work on? To clarify this, one more layer of assessment will be added. Lateral flexion at C 3/4 in NEUTRAL is assessed to be restricted to LEFT.

sportEX dynamics 2007:14(Oct):17-20