4/14/2014 1 Movement System Impairment Syndromes of the Cervical Spine Shirley Sahrmann, PT, PhD, FAPTA Prof Emerita Physical Therapy Washington University School of Medicine – St. Louis Human Movement System • Physical Therapy Identity • Diagnosis made by PTs are of the movement system • Movement System Impairment (MSI) Syndromes – Subset of Movement System Diagnoses MSI Syndromes • Named for the alignment and/or movement direction that most consistently causes pain and is impaired • When the impaired movement is corrected the symptoms decrease or are eliminated Movement System Impairment Diagnoses of Cervical Spine • Extension • Rotation* • Flexion • Rotation‐extension • Rotation‐flexion • * most common component Manual Skills • Hands on for • Assessing the cervical rotation – Where the motion is occurring – The resistance of shoulders and shoulder musculature • Correction of cervical muscle effects and the effect on mobility • Treatment: – Guide patient in correct motion – Alleviating symptoms with correction of cervical alignment, – Cervical motion – Shoulder girdle muscular effects • Manual assistance for correction in several positions Contributing Factors • The musculature of the shoulder girdle affects – alignment, movement, stress on the cervical spine – alignment of the shoulder girdle is a key to cervical pain • The alignment of the thorax affects the alignment of the cervical spine – Both kyphosis and flat • Alteration of intrinsic cervical muscle performance – usually related to head position in relation to gravity • Compensations between upper and lower cervical spine motion Missing figures because of copyright restrictions Copyright Program in Physical Therapy Washington University School of Medicine - St. Louis
Gen Sahr 1 Friday General Session Sahrmann Ortho Sec Cervical Presentation
Sep 24, 2015
Sahrmann cervical extension notes
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MovementSystemImpairmentSyndromesoftheCervicalSpine
ShirleySahrmann,PT,PhD,FAPTAProfEmeritaPhysicalTherapy
WashingtonUniversitySchoolofMedicine St.Louis
HumanMovementSystem PhysicalTherapyIdentity DiagnosismadebyPTsareofthemovementsystem
MovementSystemImpairment(MSI)Syndromes SubsetofMovementSystemDiagnoses
MSISyndromes Namedforthealignmentand/ormovementdirectionthatmostconsistentlycausespainandisimpaired
Whentheimpairedmovementiscorrectedthesymptomsdecreaseorareeliminated
MovementSystemImpairmentDiagnosesofCervicalSpine
Extension Rotation* Flexion Rotationextension Rotationflexion
*mostcommoncomponent
ManualSkills Handsonfor Assessingthecervical
rotation Wherethemotionis
occurring Theresistanceofshoulders
andshouldermusculature Correctionofcervical
muscleeffectsandtheeffectonmobility
Treatment: Guidepatientincorrect
motion Alleviatingsymptomswith
correctionofcervicalalignment,
Cervicalmotion Shouldergirdlemuscular
effects Manualassistancefor
correctioninseveralpositions
ContributingFactors Themusculatureoftheshouldergirdleaffects
alignment,movement,stressonthecervicalspine alignmentoftheshouldergirdleisakeytocervicalpain
Thealignmentofthethoraxaffectsthealignmentofthecervicalspine Bothkyphosisandflat
Alterationofintrinsiccervicalmuscleperformance usuallyrelatedtoheadpositioninrelationtogravity
Compensationsbetweenupperandlowercervicalspinemotion
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CommonImpairments Intrinsic neckmusclesbecomeweakorlongcompromisefinecontrolofvertebralmotion
Extrinsic musclesbecomedominantaddingtocompressive,rotational,&shearforcesexertedonthecervicalspine
UpperCervicalRangeofMotion
LowerCervicalRangeofMotion HeadandNeckExtensors Intrinsicmuscles semispinaliscapitis semispinaliscervicis puresagittalrotation
DeRosa & Porterfield
Head&NeckRotators/extensors Intrinsicmuscles semispinaliscervicis superioroblique
inferioroblique rectuscapitis
cervicis
AttachedtoC2DeRosa & Porterfield
AttachmentofCervicoscapular MusclesExtensionwithTranslation
Trapezius Levator Scapulae
DeRosa & Porterfield
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CERVICALEXTENSIONSYNDROMESignsandContributingFactors:Alteredupperandlowercervical
participation;overdevelopedextensors,inadequatedeepneckflexors
Cervical extension with shoulder flexion.
MovementsoftheUpperExtremitiesCervicalmotioninducedbyshouldermotion
ShoulderFlexionwhilecontractingdeepneckflexorsDecreasescervicalextensionandpain
CERVICALROTATIONSYNDROMESignsandContributingFactors:Asymmetricalupperandlowercervicalrotation;Impreciserotation;AlteredactionofCervicoscapularmuscles
Upward rotation of scapula stretches levator scapulae musclecervical vertebrae will rotate to same side if hypermobile
Kendall 1993
Upper trapezius rotates head & neck to opposite side
Kendall 1993
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Cervical rotation to the right during left shoulder flexion
Right shoulderflexion
Left shoulderflexion
Spinous processesto left
Tennisinstructor
AsymmetricalRotation Cervical rotation limited by trapezius and levator scapulae musclesMaximum rotation Shoulders passively elevated
Upperandlowershiftedtoleft
Cervical rotation limited byupper trapezius & levator scapulae muscles
Maximum rotation Rotation with shoulders elevated
Uppercervicalrotationnotlower
CervicalRotation:ImpairedAffectedbyCervicoScapularMuscles
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ImpairedFlexion
Forward head with increase upper thoracic flexion Flexion lower spine remains extended
NeckFlexors Intrinsicmuscles Longuscapitis Longuscolli
Puresagittalrotation
DeRosa & Porterfield
DominantExtrinsicNeckFlexors
Sternocleidomastoid Sternal&clavicularhead>Mastoid significantinfluenceoncervicalspinemotionbutdoesnotdirectly
attachtoCspine Function:
bilateral flexion unilateral rotatetoone side&laterallyflexto oppositeside
Mechanical Neck Pain - Porterfield & DeRosa
SternocleidomastoidMultipleActions
Rotation
FlexionlowerCspine
ExtendupperCspine
ForwardtranslationwithanteriorshearParticularly withweak intrinsics
Mechanical Neck Pain - Porterfield & DeRosa
LengthenIntrinsicNeckFlexors
Longuscapitis TPsC36>Occiput
Longuscolli TPsC3C5>C1arch BodiesofT1,2,3>TPsC5,6 BodiesofC57,T13>Bodies ofC2,3,4
Mechanical Neck Pain -Porterfield & DeRosa
DeepNeckFlexorMuscleWeakness
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WeakDeepNeckFlexorMusclesUnabletoMaintainFlexion
ImpairedPositioning CervicalExtensionwithRocking
UpperCervicalExtension
Upper cervical extension greater than Lower cervical -
Limited cervical flexion
Initial visit 2 weeks later
ShoulderElevationandKyphosisContributingtoCervicalExtension
Initial visit 2 weeks later
ImprovedAlignment DecreasedPainPoor sitting alignment Corrected sitting alignment
Contributing factors: long trunk, short arms, large breasts with bras straps adding to downwardpull on neck
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DominantExtrinsicNeckFlexors
Scaleni:Anterior TPsC36>1stribMiddle TPsC27>1stribPosterior TPsC57>1stribFunction:Flexionwithanteriorshear
Depressedchestaffectscervicalalignment
Mechanical Neck Pain - Porterfield & DeRosa
CERVICALFLEXIONSYNDROMESignsandContributingFactors:Flatcervicalandthoracicspine
Kendall 1993
CervicalFlexionandFlatThoracicSpine
Cervical Lordosis with thoracic kyphosis
Kendall 1993ImpairedCorrection
SCALENEMUSCLERESTRICTIONAnotherformofFlexionSyndrome:Swayback
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Without arm support With arm support
Passive elevation of rib cage
Initial Visit Two Months later
ShoulderDepression CervicalCompression
Cervicalsurgerytwicestillinconstantpain
Initial Visit Two Months Later
ShoulderDepression CervicalExtension
Initial Visit Two Months Later
ImprovedShoulderMotionDecreasedCompression
Missing figures because of copyright restrictions
Copyright Program in Physical Therapy Washington University School of Medicine - St. Louis
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