3

Cervical spine

Neil Tucker

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

Introduction
The application of the biopsychosocial and evidencebased models directs the assessment and management of cervical spine disorders. In physiotherapy,
the biopsychosocial model recognizes the presence
2009
2010 Elsevier Ltd.
DOI: 10.1016/B978-0-443-06782-2.00003-7

of injury, pathology, and pain, and integrates them

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

Assessment
Comprehensive history
Subjective history taking should attempt to identify 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 cervical artery insufficiency, and interaction with upper
limb activity. Clinicians must gain enough information 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 musculoskeletal physical impairment related to the patients pain.