stiff neck

STIFF NECK

Outcomes Be familiar with the clinical presentation

of an acute cervical locking and a discogenic locked neck.

Be familiar with the most widely used physiotherapy treatment protocol for a patient with a typical acute cervical locking and a discogenic locked neck.

Types Postural

Atlanto-axial rotation fixation

Spasmodic torticollis

Hysterical torticollis

Stiff neck as a result of muscles

History Painless contracture of one of the

sternocleidomastoïd muscles

Gives rise to the neck fixating in side flexion towards the affected side and rotation away from it

Lack of treatment may lead to permanent deformity

Acute cervical locking Sudden onset A snapping sound is heard Sudden uncontrolled movement Most common between C2/C3 Synovial pinching Localised to the mid-cervical area Severe, sharp pain with proximal referral

the patient should try to move out of the position

Acute cervical locking (cont)

Noticeable lateral flexion, slight flexion/rotation away from the pain

During PAIVMS’s any movements which decreases the articular space would evoke the familiar pain

Treatment Try to unlock the joint as soon as possible Longitudinal in position of deformity Rotation and lateral flexion Grade IV- Joint MUST be unlocked on day 1 Further treatment must be directed

towards pain relief, muscle spasm and gaining full joint mobility

Traumatic onset History of trauma eg. bump against head

If not unlocked on day 1: Manipulation

Strengthening Muscle

spasm

Discogenic locked neck Gradual onset No specific movement May awake with locked neck Any level between C2-C7 Disc Neck pain Worst pain is over medial scapula area

(Cloward area’s) Deep pain

Dicskogenic locked neck (cont)

Noticeable flexion, lateral flexion away from the pain

Extension, lateral flexion and rotation towards the painful side is stiff but not blocked

Treatment Intermittent constant cervical traction

Transverse movement

Unilateral PA

Rotation and lateral flexion

Longitudinal cephalad Grade I, II and IV-

Treatment (cont)

With distal symptoms the treatment must be of a longer duration

Slower recovery if other structure eg. dura and nerve roots also show symptoms

Restriction of extension is often one of the remaining signs after treatment

Central PA Grade IV often clears this sign