Cervical Spine

Cervical Spine:

Movement Analysis, Sub-classification & Neuromuscular Retraining for Functional Movement Control

Course Description

Neck pain can be caused by trauma such as whiplash or it can be insidious and frequently recurrent. In a large sub-group of people this is related to their movement patterns and neuromuscular control in their cervical spine

Motor control and sensory motor deficits can be identified in association with neck pain. Following an episode of pain changes occur in the central nervous system including: a loss of proprioceptive awareness, reduced tactility, deficits in oculomotor function, altered postural stability, and changes in movement patterns. As well, the deep stabilising muscles have been shown to exhibit motor control deficits and the superficial muscles become more active at low threshold compared with non-neck pain subjects. The changes are more pronounced following whiplash. Tissues can be overloaded from uncontrolled segmental translation or compression due to the increased activity of the superficial muscles.

This course will provide participants with strategies to diagnose a movement pattern control deficit in the cervical spine and whether this relates to a concurrent scapular dysfunction. Motor control retraining strategies will be introduced using a comprehensive and evidence based clinical reasoning process. This involves; specific activation of the appropriate stability muscles to control segmental translation of the anterior and posterior cervical spine; the retraining of movement patterns; and the integration of these training strategies into function. This can create an environment for normal healing by reducing tissue provocation. A Clinical Prediction Rule will also be taught to predict if patients will respond to this rehabilitation. Other strategies will be introduced for other groups of clients.

Also covered are the relationship between scapular control and cervical movement control deficits and the diagnostic accuracy of cervical orthopaedic tests. Some beneficial taping techniques will also be used. The exercise progressions are described and strategies for the integration into function are discussed with participant examples and case studies to iron oit real life difficulties.

Course Objectives:
The participant will be able to:

  • Make an accurate movement pattern control diagnosis and relate this to the client’s presentation
  • Apply a clinical prediction for who will respond to motor control exercise
  • Understand the relationship of scapular dysfunction and cervical dysfunction
  • Appreciate the importance of concurrent respiratory control in the rehab of cervical muscle function.
  • Problem solve the
  • Use movement patterns as a clinical reasoning tool to help guide manual therapy and other techniques

What will you get from this course that you may not already have?

Cervical Segmental Stability - Posterior
Translation control is more than the deep neck flexors. The posterior muscles of the neck experience segmental atrophy and need to be specifically retrained. We’ll give you strategies.

Upper Trapezius is a Good Guy Muscle

Upper trapezius does not elevate the scapula – it has a local and global stability role for the neck and shoulder girdle. It has a major stability influence on the neck, shoulder and thoracic spine. It has an anticipatory timing pattern and is delayed with pain – similar to Transversus. It also experiences sudden atrophy – similar to Multifidus. It rarely loses extensibility so assessment and retaining needs to be specific. Lower trapezius does not pull the inferior angle of the scapula down and in. There are better ways to train lower trapezius for scapular stability!

The TMJ can influence the control of the cervical spine. We will show you how to test and rehab this

Sensory Motor Function
We’ll show you how to assess and rehab aspects of proprioception and tactility.

Myofascial Trigger Point Release (MTPR)
Mobilizer muscles tend to get short and/or dominate movements which contribute to faulty patterns and pain. MTPR to the mobilizer muscles can create a good window of opportunity to change movement quality and help manage symptoms.

Neurodynamic reactivity can significantly affect the way people move. We’ll show how movement can be used to treat neurodynamic reactivity.

There are some great taping techniques for the shoulder girdle, neurodynamics!

Program & Pre-course Reading

Suggested pre-course reading

Revision of the Sub-classification course (if taken)

Free articles available at: http://www.ncbi.nlm.nih.gov/sites/gquery http://pubmedcentralcanada.ca/

Altered motor control patterns in whiplash and chronic neck pain
Astrid Woodhouse and Ottar Vasseljen
BMC Musculoskelet Disord. 2008; 9: 90. Published online 2008 June 20. doi: 10.1186/1471-2474-9-90.
PMCID: PMC2446396

The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation
James Elliott, Michele Sterling, Jon Timothy Noteboom, Julia Treleaven, Graham Galloway, and Gwendolen Jull
Eur Spine J. 2009 September; 18(9): 1371–1378. Published online 2009 August 12. doi: 10.1007/s00586-009-1130-6.
PMCID: PMC2899528

Whiplash causes increased laxity of cervical capsular ligament
Paul C. Ivancic, Shigeki Ito, Yasuhiro Tominaga, Wolfgang Rubin, Marcus P. Coe, Anthony B. Ndu, Erik J. Carlson, and Manohar M. Panjabi
Clin Biomech (Bristol, Avon) Author manuscript; available in PMC 2009 June 24.
PMCID: PMC2701103

Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain: a systematic review
Chantal HP de Koning, Sylvia P van den Heuvel, J Bart Staal, Bouwien CM Smits-Engelsman, and Erik JM Hendriks
BMC Musculoskelet Disord. 2008; 9: 142. Published online 2008 October 19. doi: 10.1186/1471-2474-9-142.
PMCID: PMC2575213

Efficacy of Postural and Neck-Stabilization Exercises for Persons with Acute Whiplash-Associated Disorders: A Systematic Review
Kara Drescher, Sandra Hardy, Jill MacLean, Martine Schindler, Katrin Scott, and Susan R. Harris
Physiother Can. 2008 Summer; 60(3): 215–223. Published online 2008 October 10. doi: 10.3138/physio.60.3.215.
PMCID: PMC2792777

Head repositioning errors in normal student volunteers: a possible tool to assess the neck's neuromuscular system
Edward F Owens, Jr, Charles NR Henderson, M Ram Gudavalli, and Joel G Pickar
Chiropr Osteopat. 2006; 14: 5. Published online 2006 March 6. doi: 10.1186/1746-1340-14-5.
PMCID: PMC1450294

Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective
Toby Hall, Kathy Briffa, and Diana Hopper
J Man Manip Ther. 2008; 16(2): 73–80.
PMCID: PMC2565113

A novel method for neck coordination exercise – a pilot study on persons with chronic non-specific neck pain
Ulrik Röijezon, Martin Björklund, Mikael Bergenheim, and Mats Djupsjöbacka
J Neuroeng Rehabil. 2008; 5: 36. Published online 2008 December 23. doi: 10.1186/1743-0003-5-36.
PMCID: PMC2625342


Day 1
8:30 – 9:00 Overview of motor system changes with pain & Sub-classification
9:00 – 9:30 Review of anatomy, postural alignment and movement patterns
9:30 – 10:30 Postural alignment practical
10:30 – 10:45 Break
10:45– 11:30 Translation control: deep neck flexors
11:30– 12:00 Translation control: sub-occipital extensors
12:00 – 1:00 Lunch
1:00 – 1:45 Translation control: cervical multifidus
1:45– 2:30 Translation control: upper trapezius
2:30– 3:00 Cervical neutral: prone
3:00– 3:15 Break
3:30– 4:00 Cervical neutral: supine
Day 2
8:30 – 10:00 Cervical flexion testing & rehabilitation
10:00 – 10:15 Break
10:15– 12:00 Cervical extension testing & rehabilitation
12:00– 1:00 Lunch
1:00– 1:30 Cervical rotation testing & rehabilitation
1:30 – 2:30 Muscle imbalance rehabilitation
2:30 – 3:15 Addressing myofascial restrictions to movement
3:15– 3:30 Break
3:30– 4:00 Case studies
4:00 – 4:30 Clinical integration, Summary


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