Role of Physical

therapy on neck pain

Under supervision of:

Dr. Eman El Sayed El
Fekey
 By:​
 Esraa El-Saied Ibrahim 201902321​
 Fai Sami Ahmed 201902475
 Hadeer Hassan Mahmoud 202004700
 Fedaa Elsaied Mansour 201800765

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 Introduction

Causes
Clinical features:
– History
Objectives – Signs &
symptoms
– Physical
Examination
Differential
diagnosis
Treatment
Introduction
A primary goal of physical therapy for neck pain
is to reduce pain and discomfort so you can do
what you want and need to do each day. Physical
therapists provide guidance on how to perform
therapeutic exercises that are tailored for your
needs and goals. Improve range of motion.
Clinical feature
History

When taking a history, the presence of multiple

red flags should raise suspicion and indicate
the need for further investigation. Although red
flags have not been specifically formulated for
patients with neck pain, low back pain red flags
are commonly applied. Red flags and yellow
flags identified by history or physical findings
indicate the need for further evaluation with
laboratory tests or imaging

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Fever
• Unexplained weight loss
• History of cancer
• History of violent trauma
• History of steroid use
• Osteoporosis
• Aged younger than 20 years or older than 50 years
• Failure to improve with treatment
• History of alcohol or drug abuse
• HIV
• Lower extremity spasticity
• • Loss of bowel or bladder function

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Red flags for lower back pain
(also applicable to neck pain)
Individual factors
1. Age
2. Physical fitness
3. Strength of neck
4. Smoking
• Psychosocial factors
1. Stress
2. Anxiety
3. Mood/emotions
4. Pain behavior
• Occupational factors
1. Manual handling
2. Bending and twisting 8
3. Whole-body vibration
Signs and symptoms
The most common symptoms are:
Pain and stiffness
• In addition to neck pain, pressure on a nerve root or the
spinal cord by a herniated disc or a bone spur may result
in:
• Pain in the arm
• Numbness or weakness in the arm or forearm
• Tingling in the fingers or hand
• Difficulty with balance and walking
• Weakness in the arms or legs

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What Are Cervical Myelopathy and Cervical
Radiculopathy?
Cervical myelopathy and cervical radiculopathy are
nerve-related conditions affecting the neck and/or
spinal cord.

Cervical myelopathy is a condition where the spinal

cord within the neck is injured or compressed.

• In cervical radiculopathy, the nerve roots in the

cervical spine are damaged.

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Causes
• - Trauma
• - Biomechanical injuries
• - Degeneration
• - Inflammation (arthritides)
• - Infection (discitis, meningitis, epidural
abscess)
• - Infiltration (metastases, tumors)
• - Compression (epidural hematoma, abscess)

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Physical
Examination
• Inspection
• From FRONT, BACK & SIDE.
• Look for swelling, deformity, scar,
Examination
muscle wasting

• Palpation
• Stand BEHIND & to the SIDE of the
patient.
• Palpate from Occipital cervical to
thoracic vertebra – from midline
laterally
• Anterior neck & Supraclavicular fossae
palpation

• Movements
• Forward flexion 13
 To check Spinal Cord
Compression
 Hoffman’s Test

-Elicits a pathological reflex present

in spinal cord compression.
-Hold the middle finger at the
middle phalanx between the index
and middle finger of the examiner’s
hand. Flick the distal phalanx at the
pulp with the examiner’s free
thumb.
-The test is positive if the patient’s
index finger and thumb flex.
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 To check Spinal Cord
Compression
 Lhermitte’s Test
-Barber’s chair phenomenon
-Flexion / extension of the neck
produces electric shock like
sensation in the legs.
-This sign is mostly associated
with multiple sclerosis.

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 Signs of Meningism
 Kernig’s Test
-Performed with the patient supine or in a
chair.
-The hip and knee are flexed to 90° and
attempt is made to extend the knee.
-The test is positive if the manoeuvre
causes pain in the neck or back.

 Brudzinski’s Test
-Flexion of the neck causes flexion of the
hips and knees.
 Signs of Thoracic Outlet
 Adson’s Test
Obstruction

- Palpate the radial pulse and, while

keeping the elbow extended, abduct (to
30°), externally rotate and extend the
shoulder. Then ask the patient to take a
deep breath and hold in inspiration and
turn the head to the ipsilateral side. ٧
-The test is positive if there is a loss of
the radial pulse.
- Always compare with the other side.
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 Neurovascular examination
REFLEXES

o BICEPS : C5-6
o BRACHIORADIALIS : C6-
7
o TRICEPS : C7-8

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 Neurovascular examination
Movement Muscle Root Nerve
Shoulder Abduction Deltoid C5 Axillary
Musculocutan
Elbow Flexion Biceps C5-6
eous
Elbow Extension Triceps C7 Radial
Flexor carpi radialis Median &
Wrist Flexion C8
and ulnaris Ulnar
Extensor carpi radialis
Wrist Extension C7 Radial
and ulnaris

Finger Abduction Dorsal interossei T1 Ulnar

Abductor pollicis
Thumb Abduction C8 Median
brevis
Upper Limb Myotomes 19
 Imaging
 X Ray:
-Anteroposterior (AP)
-Lateral
-Open-mouth
-Both oblique views
 CT:
-Traumatic c-spine injuries
 MRI
-In patients with chronic neurologic signs or symptoms, regardless
of radiographic findings
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 Differential diagnosis

Mechanical neck Cervical Disc Herniation

disorders - Nucleus pulposus protrudes through

the posterior annulus fibrosis,
producing an acute radiculopathy or,
ccasionally, a myelopathy.
- Motor vehicle collisions
- Most common level :
- Falls C5-6 (C6 nerve root)
- Sports injuries C6-7 (C7 nerve root)
- Work-related injuries
- Strain injury, caused by an awkward
position during sleep or prolonged
abnormal head-neck positions during
work or
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recreation.
Cervical Cervical spine Cancer
spondylosis/
Stenosis
- Metastases to consider for
- Progressive, chronic neck pain
degenerative disease
(osteoarthrities)
- Ca Lung, breast, prostate
and multiple myeloma,
- Loss of cervical
flexibility, neck pain. lymphoma forms most
neuralgia, radicular pain.
common 1°pathology.
- occasionally
progressive
myelopathy. - MRI

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Cervical Myofascial Pain Syndrome

- A cause of chronic neck pain, often confused with radiculopathy.

- May exacerbate acutely after trauma.

- Psychological stress and specific personality traits are known

risk factors.

- Typically, pain in the neck, scapula, and shoulder ‡ non

dermatomal radiation into the upper limb.

- Tender spots, "trigger points" may be evident on palpation of the

head, neck, shoulder, and scapular region. Neurologic examination
is normal.

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Treatment
Uncomplicated neck pain
-nsiads
-muscle relaxant
-short course opioids
-soft collar
Treatment
cervical radiculopathy
-Advice: activity modification
-oral nsaids
-steroids : short course prednisone
Treatment
conservative treatment
-physiotherapy
-traction
-acupuncture
-electrotherapy
-thermotherapy
Reference(s)
Murray CJ, Atkinson C, Bhalla K, et al.;
U.S. Burden of Disease Collaborators. The
state of US health, 1990–2010: burden of
diseases, injuries, and risk factors. JAMA.
2013;310(6):591-608.
thank you!