Cervical dysfunction
Evaluation and treatment
Introduction:-
-Cervical spine is always liable to injury as it is the most movable segment …….so we note that it is few to find people with thoracic disc for example
-Injury may be in form of joint dysfunction ,,, or may be muscular dysfunction
-In cervical spine…The joint between the elements "Pedicles – laminae – transverse processes " is called Zygophyseal joint……Which is connection between inferior facet of vertebrae above and superior facet of vertebrae below called also facet joint……
-Joint dysfunction:-Discoid intrapement……..-Polapse of intervertebral disc….-Stifness of zygophyseal joint
-Muscular dysfunction:-spasm……….-Hypertonicity"spacticity and rigidity" where spacticity is due to pyramidal tract injury………While rigidity is due to extra pyramidal tract injury………-Interneuron dysfunction
-Treatment:-By joint mobilization ….to increase nourishment to joints and excitation of synovial membrane and reflex muscle relaxation
Should therefore normalize muscle tone..The best methods of that are post isometric relaxation(PIR) ,, post facilitation stretch (PFS
-PIR :- -Isometric contraction is submaximal
-Time of contraction is 5.7 sec
-PFS:--Maximum or near maximum isometric contraction when muscle is in its middle of functional excursion
-Time of contraction is 10 sec
-Isometric contraction is followed by quick stretch
-Note:- Isometric contraction activates Golgi tendon organ causes inhibition of alpha motor neurons so causing muscle inhibition
PIR
-Guide lines for application:-
-Patient position
-Fully lengthening of muscle
-Engage the resistance barrier
-Isometric contraction(5-7sec
-Eye movement should follow head movement
-Breathing : Breathe in at muscle contraction….and breathe out at muscle relaxation
-Wait until release of barrier
-Lengthening again
-Repeat 3-5 times
PFS
-Guide lines for application:-
-Patient position
-Start from mid range
-Near maximum or maximum contraction
-Hold for 10 sec
-Total relaxation
-Fast stretch and maintain from 10 to 15 sec
-Repeat from 3-5 times
Techniques of application:-
A-sub occipitalis muscle:-
PIR
___It is a small muscle extends upper cervical region….and is inserted in C2
-Patient is supine lying
-therapist left hand put the index finger on C2 spinous process to lock it by pushing for wards to make fixation during stretching…To palpate for C2 :It is the first spinous process below foramen magnum
-Other hand of therapist is on mastoid process and parietal bone of diseased side
-The muscle action is to rotate and laterally flex neck to same side….so Therapist stretch against its action by laterally flex and rotation to opposite side……then add flexion of upper cervical region( chin in ) till find the barrier
-Then to make isometric contraction resist against the patient head….By ordering him to push against your hand
-Then after about 5.7 sec. relax and take muscle in another stretch to find out if there was still barrier….So means exercise is repeated
PFS
-Same positioning
-But only when barrier is detected return patient to midposition by decreasing upper cervical flexion( chin out ) Then give resistance against patient head
-Then relax patient…but then suddenly make quick stretch to gain more length
-Repeat if another barrier is found
B-Sterno cliedo mastoid muscle:-
PIR
-Patient is supine lying with head out side the plinth
-Flex laterally head to opposite side and rotate it to same side of involved muscle then extend lower cervical spines passively
-When find the barrier so stop and begin giving resistance on fore head by thump for isometric contraction of involved muscle
-Then when therapist feel with barrier release he take the upper cervical gently in extension to wards ground
[color=magenta]معلش في تعديل عملته على الجزء بتاع الsternocliedomastoid يا ريت اللي قرأ الموضوع قبل التعديل يرجع يقرأ الجزء ده تاني[/color]
موضوع: سكشن ثرابيوتك اكسرسيزDysfunction in cervical spine 
الخميس نوفمبر 08, 2007 11:56 pm
و جزاكم الله خير
