Quiz
Case study
A 55-year old female patient presents with neck pain of 10 years duration, which has recently been aggravated by a new job as a receptionist. She originally experienced a ‘catching’ pain for two days but this subsided to a considerable ache. She says she is afraid to move her head in case the catching returns. The examination revealed a forward head carriage and an elevated right shoulder. There were no red flags and x-rays demonstrate mild osteoarthritis.
Using information from the exercise prescriptions and practitioner notes please answer the following questions related to the above case:
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Question 1 of 7
1. Question
Which exercises would you initially prescribe and what would you say to reduce the patients fear of movement?
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This response will be reviewed and graded after submission.
Grading can be reviewed and adjusted.Grading can be reviewed and adjusted.Hint
Range of motion
Moving your neck in comfortable positions can suppress pain. Important parts of your brain send signals to reduce pain and movement also block pain messages from reaching your brain. When you realise that are certain movements you can do without pain this also reduces pain messages in your brain.
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Question 2 of 7
2. Question
Describe a useful test you will perform to determine if the patient has appropriate muscle function
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This response will be reviewed and graded after submission.
Grading can be reviewed and adjusted.Grading can be reviewed and adjusted.Hint
Cranio-cervical flexion test
- Place a pressure biofeedback unit under the suboccipital region.
- Pump the cuff to 22mmHg ensuring that the pressure is stable in the start position.
- Hold the dial in front of the patient (or place the dial in their hand) so that they can see the pressure.
- Have the patient perform cranio-cervical flexion to increase the pressure to 24mmHg. Observe for faults such as retraction.
- If they perform well allow them to continue increasing the pressure to 26mmHg then 28mmHg until they reach 30mmHg.
- Once the patient has achieved the correct technique they can then hold the neck flexion position for 10 seconds, 10 times.
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Question 3 of 7
3. Question
How would you address the elevated right shoulder and why is this important?
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This response will be reviewed and graded after submission.
Grading can be reviewed and adjusted.Grading can be reviewed and adjusted.Hint
Prescribe single shoulder blade squeeze.
The scapula plays an important role in the mobility and stability of the neck and shoulder region.
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Question 4 of 7
4. Question
If you were prescribing basic neck flexion, what would you be looking for that indicates faulty technique?
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Question 5 of 7
5. Question
Describe two reasons why retraining the deep neck flexor muscles
important?
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This response will be awarded full points automatically, but it can be reviewed and adjusted after submission.
Grading can be reviewed and adjusted.Grading can be reviewed and adjusted.Hint
Answer can involve any of the following:
- The cervical spine has a high density of muscle spindles that provides essential feedback to the brain regarding balance, posture and head and eye movement.
- Due to Inflammatory mediators such as bradykinin, pain alters the stretch sensitivity of muscle spindles which has implications for motor coordination and proprioception.
- Compared to healthy subjects those with neck pain have less precise joint position sense, drift more easily into a forward head posture, display altered postural balance and reduced proprioceptive acuity in the shoulder and elbow joints.
- Retraining the deep neck flexors not only reduces neck pain but multi-joint position sense as well.
- Patients who suffer from neck pain and/or headaches display reduced deep neck flexor endurance.
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Question 6 of 7
6. Question
List five key technique tips to effectively prescribe intermediate neck flexion.
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This response will be reviewed and graded after submission.
Grading can be reviewed and adjusted.Grading can be reviewed and adjusted.Hint
- The patient should start the exercise with craniocervical flexion.
- Perform a nodding action until the head is lifted slightly.
- Observe for a forward thrust of the chin which indicates cranio-cervical Extension.
- Be careful not to overcorrect the patient into retraction.
- While sternocleidomastoid will be active in this position it should not be excessively contracted.
- Start the patient at a small angle and increase if they are performing well.
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Question 7 of 7
7. Question
List five contraindications for intermediate exercises for the neck.
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This response will be reviewed and graded after submission.
Grading can be reviewed and adjusted.Grading can be reviewed and adjusted.Hint
- Acute episode of neck pain
- Pain during the exercise
- Exercise provokes headache
- Current episode of vertigo
- Recent trauma – rule out fracture
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