Neck pain by Gwen Jull, Part II
Assessment of movement and manual examination of the cervical (neck) spine are fairly routine assessment conducted by physiotherapists. Range of cervical spine movement is a generic measure of neck impairment and lacks specificity to an explicit disorder or stage of a disorder. However, from a diagnostic sense, it has value as a measure to characterize patients with neck disorders. For example, range of movement can discriminate patients with chronic (long-standing) whiplash-associated disorders from control subjects with high sensitivity and specificity (Dall'Alba P, Sterling M, Treleaven J, et al. Cervical range of motion discriminated between asymptomatic and whiplash subjects. Spine 2001; 26:2090-4). Likewise, a reduced range of movement distinguishes cervicogenic (neck origin) headache sufferers from those with migraine and tension-type headache (Zwart JA. Neck mobility in differerent headache discorders. Headache 1997; 37:6-11) . Manual examination of the cervical segments is also a non-specific test from a pathological point of view. This method tests the responsiveness of a cervical segment to manually induced motion in qualitative terms of the nature of tissue resistance and pain provocation. This method of examination has not fared well from the perspective of inter-therapist reliability to grade hypo-or hypermobility. Nevertheless, when manual examination has been tested to answer a more general question, namely, is painful cervical segmental dysfunction present in a particular subject or subject group, its value is proven from a diagnostic perspective. Discreet provocation of pain over a cervical zygapophysial joint identifies neck pain subjects from asymptomatic control subjects and, in the case of headache, manual examination has very acceptable sensitivity and specificity to detect those with non-cervicogenic headaches (Marcus Da, Scharff L, Mercer S, et al. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache 1999: 39:21-7). Thus, the assessment of regional movement and the assessment of the presence of painful cervical segmental dysfunction are proving their value in detecting impairment in the cervical region.
From a clinical management perspective, a reduced range of movement would direct inclusion of mobilizing exercises in a management program, and physiotherapists have several approaches to address symptomatic segmental joint dysfunction, including manual therapy and specific exercises, the efficacy of which has been proven in the management of neck pain. Likewise, possible mechanisms of the effect of manual therapy are beginning to be better understood. However, it must be noted that the evidence suggests that manual therapy alone is insufficient for the management of neck disorders. This should not be unexpected as the evidence suggests that relief of pain does not automatically guarantee a return of muscle function.
To be continued…
Luck LI
Musculoskeletal Physiotherapist
From a clinical management perspective, a reduced range of movement would direct inclusion of mobilizing exercises in a management program, and physiotherapists have several approaches to address symptomatic segmental joint dysfunction, including manual therapy and specific exercises, the efficacy of which has been proven in the management of neck pain. Likewise, possible mechanisms of the effect of manual therapy are beginning to be better understood. However, it must be noted that the evidence suggests that manual therapy alone is insufficient for the management of neck disorders. This should not be unexpected as the evidence suggests that relief of pain does not automatically guarantee a return of muscle function.
To be continued…
Luck LI
Musculoskeletal Physiotherapist