2009 Elsevier Ltd.DOI: 10.1016/B978-0-443-06782-2.00003-7

2010

of injury, pathology, and pain, and integrates them with psychological and social issues to manage cer-vical spine dysfunction and pain syndromes (Jones et al 2002). Rehabilitation of the cervical spine involves pain management, physical therapies, assur-ance, explanation, education, self-help strategies, ergonomics, and most importantly, exercise.

Assessment

Comprehensive history

Subjective history taking should attempt to iden-tify the problem and its cause. Special questions of individuals with cervical spine injuries may focus on symptoms of headache and dizziness, the mechanism and intensity of trauma, symptoms suggesting cervi-cal artery insufficiency, and interaction with upper limb activity. Clinicians must gain enough informa-tion so that they can develop an effective hypothesis that allows them to apply their own knowledge of pathobiology and effectively manage their patient. Consideration should be given to potential red flags (e.g. serious life-threatening pathology) and yellow flags (e.g. psychosocial indicators).

Objective assessment

The aim of manual assessment of the cervical spine is to identify the presence of any organic musculoskele- tal physical impairment related to the patients pain.

CHAPTER CONTENTS

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Comprehensive history . . . . . . . . . . . . . . . . . . . . . 35

Objective assessment . . . . . . . . . . . . . . . . . . . . . . 35

Cervical artery insufficiency and manipulative therapy . . . . . . . . . . . . . . . . . . . . . . . 36

Craniocervical ligament instability testing . . . . . . . . 36

Neurological examination . . . . . . . . . . . . . . . . . . . . 36

Adverse neural dynamics . . . . . . . . . . . . . . . . . . . . 36

Observation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Active range of movement . . . . . . . . . . . . . . . . . . . 37

Manual assessment . . . . . . . . . . . . . . . . . . . . . . . . 37

Motor and sensory assessment . . . . . . . . . . . . . . . 38

Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

Spinal manual and manipulative therapy . . . . . . . . 39

Therapeutic exercise program . . . . . . . . . . . . . . . . 40

Research background . . . . . . . . . . . . . . . . . . .44

References . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

3Cervical spine

Neil Tucker

Introduction

The application of the biopsychosocial and evidence-based models directs the assessment and manage-ment of cervical spine disorders. In physiotherapy, the biopsychosocial model recognizes the presence