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Describe Neck Pain

Describe forward head carriage.

Diagnose from the side. Increase the upper lordodic curve. Flattens the lower cervical. Example Whip lash. loss of cervical lordosis. The patient looks hump back.

Name some Red Flag Risk factors

Yellow slide-->
Vessel disease
Radiculopathy or other neurological problems stemming from the cervical spine (myelopathy)
Spinal stenosis/stroke

Describe the neurological exam

Important: A neurologic screen is needed initially in any person needing a neck exam, especially when examining neck pain

Describe the relative contraindications to OMM.

What are some examples of contraindications.

13. Joint Instability
--->Rheumatoid Arthritis, Down's Syndrome
14. Severe spinal stenosis (less than 11 mm of cervical central canal diameter)
15. Spinal cord injury
16. Syringomyelia
17. Paget's disease
18. Spondylolisthesis of the lumbar spine of grade 2 or greater

What are some side effects to cervical manipulation

What are some complications to OMM?

Complication examples:
Aggravation of a herniated intervertebral disk
Neck pain, radiculopathy, myelopathy
Stroke: Thromboembolic infarction in the vertebrobasilar distribution of the posterior circulation
Ligamentous disruption causing: neck pain, painful stiffness, painful "popping", neurologic signs/symptoms (anywhere from mild to severe)
Worsening of an existing fracture
Spinal cord injury and Paralysis

How do you go about avoiding complications

Are the treatments are SAFE?

The therapeutic role of OMM in the cervical spine is very significant even in the presence of bony or joint disease. Avoiding complications will help give OMM safely to the patients that need it.
Written in 2004 because of concerns in the literature regarding cervical spine manipulation dangers
The literature was extensively researched.
It was found that OMM of the Cervical Spine, including HV/LA, is effective for neck pain and head ache, and is relatively safe, when in comparison with other common treatments...even safer than taking NSAIDs
Vertebrobasilar accident (VBA) leads to ischemic stroke and vertebral artery dissection.
Risk of VBA occurring spontaneously is nearly twice as high as the risk of a VBA resulting from or related to cervical spine manipulation

Compare the risks of NSAIDS vs OMM

VBA: risk of occurring spontaneously is twice the risk of it resulting from cervical spine manipulation
Epidural steroid injection is a popular treatment for neck pain.
Subdural injection occurs in ~ 1% of procedures.
Intrathecal (or subarachnoid) injection occurs in ~ 0.6-10.9% of procedures.
Intravascular injection is the most significant risk and occurs in ~ 2% of procedures and ~ 8% of procedures in pregnant patients.
Cervical epidural abscess is rare, but has been reported in the literature.

What is the bottom line of the AOA position Paper about the risk of OMM?

How do you diangose the Lower Cervicals? C2-C7?

Sidebending is assessed via the posterior articular pillars using TRANSLATION
Rotation is assumed to be to the same side as sidebending due to the coupled motion
Must test each vertebra in Flexion and Extension

what is the treatment of the lower cervical using HV/LA?

Describe HV/LA for the Lower Cervicals

How do you go about diagnosing upper cerivcals? C1 (AA) or C2? C2 on C3

What are the treatment options of the upper cervicals if the side of roation of AA is opposite of the side of Rotation of C2?

What are the treatment options of the upper cervical if the side of rotation of the AA is the same side of rotation of C2

How do you treat UC with HVLA?

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