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Clinical Kit 5-3-2013 Managing Complex Necks Part 1

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This is the first of two eZines, that focus on assisting clients presenting with complex neck complaints, by using a system of integrated solutions recommended

by our guest presenter Dr.Shaun O'Leary. Here is the first part of Shaun's, 10 Handy Hints when Managing Chronic Mechanical Neck Pain

    1. When your patient complains of a 'heavy head', it is important to remember that without muscles, the cervical spine can buckle, under a mass of less than 1/5 the weight of their head.
      Bearing this in mind it is important to understand the anatomy of the cervical spine. During our training we are introduced to a wide variety of muscles and yet with the cervical spine, it seems there is always another muscle someone can mention which you haven’t heard of. A challenge here is to revisit your cervical anatomy, so you can assess and train muscle function with purpose.
      Music to my ears ..... and that is why we offer Anatomy Workshops Doug
    2. Remember when observing general neck motion, the craniocervical and other typical cervical regions, often are moving in different directions to each other.
      Although motion of the craniocervical and other cervical regions, are complimentary during normal movement, they can function independently of one another. The craniocervical region alone accounts for 1/3 of the total cervical spine motion in the sagittal plane (flexion and extension) and ½ of motion in the transverse plane (rotation). Pretty impressive for just 2 joints! Of additional importance for rehabilitation is the orientation of the craniocervical region. This has a big impact on the pattern of muscle usage, when performing neck exercises.
    3. Impairments in neck muscle function are multifactorial. The emphasis of rehabilitation will depend on the individual patient's needs.
      We are all taught this at university, it’s obvious when you think of it. However the measure of what to address in which patient is a skill. As science adds more and more to our understanding, it may seem that clinical practice is becoming more difficult. However, never under estimate the power of simple reasoning and take in the big picture. Where is the patient now and where do they need to be? This powerful question may give you a large hook on how to start your treatment.
    4. The combination of exercise and manual therapy has the strongest evidence of all conservative interventions, for the treatment of neck pain.
      A Cochrane report (Gross 2005), and a separate article in the journal of Rheumatology, concluded that this combination of modalities had the strongest effect with respect to pain, function and global perceived effect. The foundation for correct technical application of these modalities, is good handling skills and a sound knowledge of regional functional anatomy. However, the foundation for correct practical application of these modalities, is good clinical reasoning and judicious reassessment. It is important, when treating a patient to keep asking yourself if both these modalities are appropriate for this patient, and what is the best way to combine these modalities for this patient? Always be questioning and reevaluating.

Clinical Reasoning

  1. No single test is conclusive, or all encompassing in the assessment of cervical motor function.
    Any test we perform, if performed well, gives us important information. However, you need multiple pieces of information to build an informed clinical picture. Clinicians rely on a battery of clinical tests, including both quantifiable and observational tests to gain information concerning the patient’s cervical muscle function.
    The Is Bigger Better? workshop, helps clinicians to evaluate and sort through different and relevant screening tools and outcome measures ...Doug. Having an up to date knowledge of tests, through ongoing training, the literature and experimentation within your own practice is vital. Remember that the research, is often conducted on the back of clinical innovation and observation.

I hope you enjoyed the first 5 Great Tips provided by Shaun and can see that it represents the tip of the iceberg, when integrating a client's story with the physical and psychosocial aspects, contributing to their 'pain'. Using his expertise and training, Shaun will demystifies this complex situation when he comes to Perth to present his course Integrated Solutions for Complex Necks. We will be sending out the other 5 Great Tips in two weeks.

Recent Blogs of Interest

All the best,



Doug Cary FACP

Specialist Musculoskeletal Physiotherapist

 

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