Assenment and management of cervical pain:

The lastest in clinical practice

29 พฤศจิกายน - 1 ธันวาคม 2549
ณ ภาควิชากายภาพบำาบัด คณะเทคนิคการแพทย์ มหาวิทยาลัยเชียงใหม่
บรรยายโดย Professor Dr.Gwendolen Jull

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The assessment of disorders of the cervical region

Previous protocols such as radiological imaging, classification
systems are not helpful for diagnosis and management in patients with
neck pain. The new models of diagnosis are to consider neck disorders
as a pain syndrome. Physiotherapy should investigate the processes
involved 1)musculoskeletal system; 2)pain (sensory) system; and
3)psychological system.
1) Impairments in the motor system
Physiotherapists should investigate the following function;
- Range of motion
- Muscle function
- Postural control system
Measurable impairments:
- Cranio-cervical flexion test
- EMG
2) Impairments in the sensory system
Sensory changes are like reflecting disturbances in central
neurobiological processing of pain. Evidence is shown that patients
with chronic whiplash had hyperalgesia which indicated the abnormal
physiology in the way the nervous system processess pain signals.
Quantitative sensory tests
- Heat&cold tests
- Pressure pain thresholds
- Brachial plexus provocation test
3) Impairments in the postural control disturbances
Neck afferents are vital for postural control. Cervical
afferents are important for knowledge of head position in relation to
the body, controlling posture, and eye-head coordination.
Quantitative postural control tests
- Cervical joint position error
- Altered smooth pursuit eye movement with nock
torsion(SPNT)
- Dynamic standing balance

The management of disorders of the cervical region

There is a need for specificity when prescribing therapeutic
exercise in the management of people with neck pain due to the
general exercise (i.e.strengthening and stretching superficial neck
muscles) showed no improvement in test performance.
The deep neck and girdle muscles are functionally more important to
provide cervical joints support and control.
The specific therapeutic exercise programme should
- Target and activate the deep neck and girdle muscles
- Retraining tonic endurance capacity of deep neck
and girdle muscles
- Retrain the patterns of activation of deep and
superficial neck and girdle muscles
- Co-contraction exercise (deep flexors and extensors)
 - Re-educate the use of muscles in posture and
functional tasks
- Address strength and endurance for functional
requirements
- Designed to focus on the muscle control aspects and
aims to improve control of the deep postural muscles
- Low load exercise is used to train the co-ordination
between the layers o the neck muscels
- Based on biomechanical, physiological and clinical
evidence of impairments in these muscles in neck
pain patients.

There are several practice sessions on the use of neck

stabilizers on cranio-cervical flexion test, which is developed by
the speaker (Professor Jull). The practical sessions are included the
assessment of lumbar and shoulder girdle dysfunctions, therapeutic
exercise for neck flexors and extensors, and balance control.