Cervical (Neck) Joint Manipulation/Mobilization Techniques

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In this article we are using manipulation to mean graded oscilation techniques, and high-velocity thrust (HVT) to mean high-velocity ,small-amplitude motion performed at the end of the pathological limit of the joint.

Spinal manipulation is indicated for pain modulation and to improve range of motion.Although the application of HVT technique is appropriate for the thoracic ,lumber,and sacral spinal areas.Common cervical joint manipulation techniques,with the exception of craniocervical region,are described in this article.For the craniocervical region,muscle energy technique are described to improve mobility at the occipito-atlantal and atlanto-axial joints.

Clinical Tip:-

Spinal manipulation can be graded I-V and can be used to modulate pain or improve joint motion.All spinal and rib manipulation,with the exception of high-velocity thrust techniques,are performed for 1 to 2 minutes and then reassessed for increases motion or decreased pain.Intervention is terminated once the desired result is achieved or to patient tolerance.

  • Grade I—small-amplitude oscillations are used for pain modulation,typical during the acute stage following injury.
  • Grade II—large-amplitude oscillations are also used for pain modulation.Dosage and indications are similar to grade I manipulations.
  • Grade III—large-amplitude oscillations that go up to the resreictive joint barrier are designed to improve joint range of motion and can be used during the subacute or chronic stages of healing.
  • Grade IV—small-amplitude oscillations that go through the restrictive joint barrier.These manipulations are designed to improve joint range of motion and should be used only during the chronic stages of healing.
  • Grade V (HVT)—high-velocity and low-amplitude thrust applied at the physiologic limit of joint motion.These manipulations are performed only one time and designed solely to improve range of motion.

PRECAUTIONS:

  • If a manipulation procedure causes a change in sensation or an increased pain to radiate down an extremity,or if a patient reports a felling of dizziness or light-headedness,do not perform additional manipulations.
  • Use extreme caution if the patient reports either a current history of corticosteroid use or excessive pain.

 

CONTRAINDICATION:

  • Unhealed fracture
  • History of joint or ligamentous laxity caused by trauma or systemix diseases,such as rheumatoid arthritis
  • Vertebral artery disease occlusion
  • Acute joint inflammation/irritation
  • Cauda equina symptoms

 

MANIPULATION TECHNIQUES:-

 

Manipulation to Increase Cervical Flexion

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Patient position: Prone with arms resting comfortably at patient`s side.Place a pillow under the clavicular region for patient comfort and to promote a neutral cervical-thoracic curve.

Therapist position and hand placement : Stand on one side of the patient with your body facing toward his or her head.Use a two-thumb contact on the spinous process of the superior restricted segment of the three-joint complex.

Manipulation force : using force through the thumb,slide the superior vertebra in a cephalad-anterior direction.

Manipulation to Increase cervical Extension

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Patient position : Prone with arms resting comfortably at patient`s side,use a pillow for patient comfort and to promote a neutral cervical-thoracic cruve.

Therapist position and hand placement : Stand at the head of the patient with your body facing toward his feet.Use a two-thumb contact on the spinous process of the superior restricted segment of the restricted three-joint complex.

Manipulation force : using force through the thumb,slide the superior vertebra in a caudal-posterior direction.

Manipulation to Increase Cervical Rotation and Side Bending

This technique increase the diameter of the ipsilateral foramen,as seen with contralateral rotation and side bending.

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Patient position : Supine

Therapist position and hand placement : Stand at the head of the patient with one hand (the hand opposite the side of restriction) supporting the head and the other hand in contact with the lateral aspect of the verterbra to be manipulated.The medial side of the second MCP joint should be in contact with the edge of the facet and pillar to be manipulated and the rest of your hand relaxed on the postero-lateral portion of the patient`s neck.Passively place the patient`s head and neck into flexion,contralateral rotation,and side bending to take up the slack untill the segment to be treated is identified.

Manipulation force : Using force through the metacarpal joint of the second digit,slide ( or upglide) the cervical facet in an anteior-superior-medial direction at a 45 degree angle.

 

Manipulation to Increase Cervical Rotation

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Patient position : Prone with arms resting comfortably at patient`s side,use a pillow for patient comfort and to promote a neutral cervical-thoracic curve.

Therapist position and hand placement : Stand on one side of the patient with your body facing toward their head. Use a two-thumb contact on the three-joint complex to cause rotation toward the direction of restriction.

Manipulation force : Using force through the thumb,slide the superior vertebra in a cephalad-anteromedial direction.

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